In the 21st century, patients seeking permanent facial soft tissue enhancement have the luxury of choosing a naturally occurring, non-toxic, safe, effective, and extremely well-tolerated filler: their own fat. Structural fat grafting is the process of harvesting fat from the trunk and/or thighs and transferring it to facial sites that require volume enhancement. It has no limitations anatomically - one can beautifully, naturally and permanently fill the temples, peri-orbital (eye) area, cheeks, lips, nasolabial folds, marionette lines, jawline, etc. It does not incite an inflammatory response or immune response, and it will never be rejected by the body. Fat also contains stem cells, which are dynamic cells that have a remarkable capacity to repair human tissues. Many facial fat grafting patients tell me that the quality of their skin improves dramatically in the months following fat grafting, and many plastic surgeons who perform a great deal offat grafting procedures believe that stem cells are responsible for this effect (myself included).So if fatty soft tissue volume is what is missing (which is the primary process of facial aging), it makes perfect sense to replace it withfat. It doesn't make much sense to me to replace it with a material used as an industrial lubricant.Fat grafting is also a reasonable option cost-wise compared to non-fat soft tissue fillers, but cost is not the primary issue here. Your face is priceless, and you should treat it that way when considering the risks and potential complications of any injectable filler. Particularly ones that are not FDA-approved for injection into the subcutaneous tissue of the face.
Although fat is far better than a foreign body like those fillers you describe, do you have enough elsewhere. If you do, then fat is best because you are replacing like with like.
Sculptra is a substance that creates inflammation to achieve its fill - sort of like getting punched in the face. Not desirable for facial atrophy - even if it FDA approved.
Radiesse is a great filler but the anount needed is expensive to resolve the typical lipoatrophy patient. The best technique for fat transfer is Viafill.
Fat grafting for lipoatrophy
Fat grafting is an extremely effective and powerful technique to recontour the face and body. Fat grafting can effectively be used in areas of lipoatrophy. When considering this procedure, it is very important to work with a board-certified plastic surgeon who is very experienced and fat grafting techniques out as well as contouring techniques of the area by your interested. The reason for this is that the way to produce the best results for you may be a combination of fat grafting with other procedures. This is especially true in the face.
Lipostructure (fat injection) and lipoatrophy
This has not been my experience and I believe that structural fat grafting is a reasonable option for lipoatrophy.
Since I am discouraged from providing outside links, I would recommend that you search lipostructure and lipoatrophy.
Dr. Sydney Coleman in New York is considered the expert on this subject and you may want to email him.
Fat transfer is not a good option for lipoatrophy
Fat grafting is a common procedure in our practice to complement facial enhancement and rejuvenation.
For HIV associated lipoatrophy, it does not appear useful because it tends to melt away within 2 months. Although it is poorly understood why, this condition prevents the facial tissues from "holding on" to the transferred fat.
Therefore, I usually recommend Sculptra, Radiesse or appropriate cheek implant (i.e. submalar implant, malar implant etc.) for a reliable improvement. Sometimes, the combination of both options is necessary for best results.