The Real Skinny: Pumping Up the Volume (In Your Face)

It’s just how Mother Nature works: our face loses volume as we age, resulting in hollow cheeks and skin that begins to sag. Your youthful face is gradually replaced with an older, more tired looking version of you. Surgery can correct loose, saggy skin, but it cannot add volume. Fillers and injectables provide a solution for adding volume back to the face and restoring a more youthful look.

There are many different types of fillers, each with different characteristics, which allow an experienced injector to tailor the filler (or combination of different fillers) to the problem/problems in a patient?s face. It’s all about understanding how to use the right filler in the right areas of the face on the right patients.

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Selecting the right filler for the right facial area is an art form, and has a lot to do with understanding the way the product flows through the syringe and into the area.  Thicker filler materials last longer and are good for elevating the cheeks or filling deep hollows, but will feel lumpy if used to treat fine superficial lines. Fine lines and lips are areas where thinner filler will produce a better result.

The Quick Fix: Fillers and Injectables

Hyaluronic Acid Fillers
If you’re a first-timer, I always recommend starting with a hyaluronic acid (HA) fillers. These produce great results that can last between six months and a year. The great thing about HA fillers is that the results can be easily tweaked, they can be easily dissolved with an injection if you don?t like the way you look, and the filler will eventually reabsorb over time. If you like the results, you can use longer acting filler at your next treatment.

The first HA fillers on the marketand most widely used are Juvederm, Restylane, and Perlane.  Over the last few years there have been several new or relatively new fillers introduced that are great for addressing specific problem areas.  Voluma XC, brand new to the market, is an HA filler thicker than the first generation of HA fillers, that is great for adding volume to the cheeks.  It lasts longer than other HA fillers ? approximately 2 years.  And Belotero, another HA filler that is thinner than the first generation HA fillers, and is great for fine lines around the mouth.   Belotero does not last as long as the traditional HA fillers.

Non-HA Fillers
Next are the more permanent non-HA fillers like Radiesse and Sculptra.  Radiesse contains a different type of tissue substance that is not dissolvable.  It does break down, usually over 6 ? 12 months, but unlike HA fillers that can be dissolved quickly if you don?t like the results, you have to wait for the breakdown to occur.  Sculptra, a collagen stimulating filler which acts as a scaffold for your own tissue to grow into as it breaks down. In Europe, there are many more fillers available which are starting to make their way to our market.

A word of caution: always make sure that any filler you receive has been FDA approved. Believe it or not, there are counterfeit fillers out there that have similar names, but are not FDA approved.
When fillers are done right, your results should look natural and you will seem visibly younger, without looking over-inflated.  The key is finding an experienced injector that you like and stay with them.  Over time, they will know the best filler(s) to use in different areas to give you a great result.

How Long Do They Last?
You can expect around 6-12 months for most hyaluronic acid fillers and for Radiesse.  Because Voluma XC is thicker, it can last up to 2 years. Sculptra requires 2 or 3 injections to achieve the final results, but it can also last up to 2 years.

Fat Transfers: a Longer-Term Solution

Long term, a fat transfer can be a more cost-effective solution for treating some areas of volume loss.?Your own fat tissue, transferred to the face, incorporates into your facial tissue as a living substance.  It gives very natural results that add volume, smoothness and vibrancy to the skin.  ?To obtain the fat, your surgeon will perform a microliposuction procedure (you may be a little swollen for a few days after) and reinject the purified fat into the face.  Unlike fillers, a fat transfer requires some downtime, ranging from a few days to two weeks if large amounts are placed in multiple areas. It should be noted that the Fat transfer procedure sometimes needs repeating to achieve optimal results.

Tip: if you are having a liposuction procedure, fat transfer is an easy add-on procedure for those patients who also need to add volume back to the face. Instead of discarding the fat, why not make use of it?

How Long do Fat Transfers Last?
Fat transfers produce a longer term result,  but may not be a permanent solution for everyone.

Permanent Fillers and Facial Implants
Most plastic surgeons avoid using permanent fillers in the face, other than fat, because of the potential for long-term problems and complications.

Facial Implants are sometimes used to augment the cheeks, chin or jawline. Personally, the only area that I like to use these implants is the chin. In other areas, the implants have a tendency to look different as your face ages. While the rest of the face changes as you age, the implants stay in the same place and don?t change in volume. If this creates an unnatural look, the implants must be removed surgically. In addition, some of these implants can cause some bone loss in the face over time.

Bottom Line
In my opinion, fillers allow more flexibility in shaping the face as you age than implants.   If you’d like to restore youthful fullness to your face, enjoy plump lips, enhance shallow contours or soften those facial creases and wrinkles, fillers may be the perfect solution.

-Dr. G