Dr. Joseph Shvidler: I think there's utility for both, and I've developed an algorithm in determining which areas I use fillers. I break down the volume loss in the mid face in three different stages. minimal loss, medium loss, and large volume loss, and I treat those differently. So with somebody in their 20's and 30's may have minimal loss or early signs of aging in the mid-facial area, I may us hyaluronic acid or hydroxyapatite filler. For somebody in their 40's and 50's I may recommend a filler such as hydroxyapatite or hyaluronic acid. Sometimes I'll use polylactic acid filler in somebody who's very active like a marathon runner, a female who is very active and just has global facial volume loss. Somebody in their 60's who has significant volumetric change due to aging, I think that's where the fillers no longer achieve the desired result and I usually go to fat at that point. And again, I break that down into a smaller volume fat augmentation and a large volume fat augmentation. And you have to be very judicious with fat. In this meeting we hear a lot of lectures about not so nice outcomes in the younger patients with fat so I'm very judicious with fat. So I tend to use it in older patients who have had very stable weight throughout their life and just has significant volumetric loss in their mid-face and I could just inject the nasolabial folds or do a rejuvenation around the eyes.
Where to Use Fillers or Fat: There's an Algorithm For That!
Fillers and fat seem to be on a level playing field in plastic surgery but Dr. Joe Shvidler says he has an algorithm that he uses to determine what areas of the face will benefit from either fillers or fat.