Dermal Fillers


Dermal fillers cheek enhancement is primarily used to achieve a more pleasant and youthful appearance. Hence, it requires precise injection and deep understanding of “universal” beauty and proportion to achieve results that look natural and pleasing, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley in his recent Snapchat videos.

 

To demonstrate the effects of dermal fillers cheek enhancement, he showed a young female patient who wanted slight elevation and fullness on her upper cheek. She also requested for a conservative lip augmentation (involving only the lower lip) and a minimal skin lift and tightening along her jawline to reduce some of its fullness.

 

Dr. Smiley uses laser light to perform facial analysis. The idea is to identify the level of symmetry between the two sides to achieve results that look proportionate and natural.

In the video, Dr. Smiley said that “symmetry is important in facial dermal fillers” and so he uses laser light to ensure that the volume, shape, and height on both sides of the face are almost the same.

 

“While no one has a 100 percent symmetry, we can at least improve the proportion with meticulous analysis of the face prior to injection,” he said.

 

Because the patient’s right cheek had a little bit of more height than the left side, Dr. Smiley adjusted the amount of dermal fillers.

 

Dr. Smiley also used a laser light to help him determine the best placement of dermal filler injection. The light drew an oblique line between the tragus (small bump in front of the ear) and the corner of the lips; anything below it was not injected to ensure a nice contouring.

This oblique line helps Dr. Smiley determine where dermal filler injection should go to achieve some lifting effect. The area below the laser light does not receive any filler; the idea is to create a nice contouring or a slight depression.

 

 

“This line and the area beneath it are excluded. We only focus on the upper aspect of the cheek to create this nice contouring and definition, or a slight depression,” he said.

And by focusing on the upper cheek, Dr. Smiley said dermal fillers cheek enhancement will also have some lifting effect, further contributing to the pleasant and youthful appearance of the face.

 

To further achieve a more pleasant facial contour, the patient received a new modality (non-surgical) to lift and tighten the skin with the use of focused ultrasound energy.

 

“The Ulthera device can lift and tighten the skin along her mandibular area (jawline) to reduce some of its fullness, he explained.

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While fat injections or dermal fillers can serve as an alternative to lower eyelid surgery, not all patients with under eye-bags can benefit from them.

 

The appearance of under eye-bag or “shadowing” is caused by different or even a combination of factors. Excess skin, herniated deep fat, loss or “shrinkage” of superficial fat (beneath the skin), or a combination of these variables may contribute to this aesthetic issue.

alternative to lower eyelid surgery

Before and after photos of a patient who have had fat transfer in her lower eyelid.

 

Basically, a “true” or standard lower eyelid surgery uses incision positioned very close to the lash line so the eyelashes can conceal the resulting scar. Referred to as an external incision technique, this allows the surgeon to remove excess skin and fat and possibly reshape the muscle.

 

However, not everyone with under eye-bags has excess skin. If the extra fat primarily causes this appearance instead, dermal filler injection (e.g., Restylane and Juvederm) can conceal the unsightly bulge.

 

The main purpose of dermal filler (as an alternative to lower eyelid surgery) is to make the lower lid bulge the same level as the upper cheek. This is a rather straightforward approach and does entail no or very little downtime; hence, it appeals in patients with busy schedule and cannot afford surgery and its ensuing “social recovery.”

 

But there is one caveat when dermal fillers are used to conceal the under eye-bag caused by excess fat: Touch-ups are generally needed at 6-12 months interval.

 

Meanwhile, fat injection or fat grafting is a method that provides longer-lasting effects than dermal fillers, with studies suggesting that its results last an average of 12-15 years. The procedure starts off with the collection of superficial fat (beneath the skin) usually in the tummy; only a few teaspoons are needed since the lower eyelid is just a small area.

 

The collected fat volume is then put in tubes and processed through centrifugation; the idea is to discard the oil, red blood cells, and other biomaterials except the fat cells. Afterwards, the purest form of fat is injected to conceal the bags.

 

It is important to note that fat injection and dermal fillers are basically volumizers (they add volume) and so they can also address the deep tear trough and the abrupt lid-cheek junction that come with aging.

 

It is not uncommon to combine volumizers with excision-based lower eyelid surgery to achieve the best results possible. This is particularly true for patients with excess skin, herniated deep fat, and abrupt lid-cheek transition, as suggested by leading Orange County plastic surgery expert Dr. Tarick Smiley.

 

Due to the laxity of skin and other supportive structures, the deep fat along the lower lid becomes prominent (i.e., it bulges out) with aging. In contrast, the superficial fat “shrinks” and thus gives the appearance of deep tear trough or abrupt transition between the lid and cheek.

 

To address the aforementioned problems, a small linear incision is made within the lower lid that allows the surgeon to remove the excess skin and reduce the deep fat pad. For additional fine-tuning, fat injection is used to create a smoother lid-cheek junction.

 

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Facelift for laugh lines, or medically referred to as nasolabial folds, requires going deeper than the skin to achieve natural results that can last for many years. It is important to note that relying on skin alone will lead to a short-lived outcome due to the relative weakness of this layer.

 

Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says that a youthful face has its malar fat pad attached to the cheekbone high, giving it a relatively plump look.

 

facelift for laugh lines

The high cheekbone appearance gives younger faces an inverted triangle shape, which aging gradually reverses, he adds.

 

Aging causes the facial skin and supportive structures to lose their strength, which in turn also causes the malar fat pad to descent. Dr. Smiley says this contributes to the nasolabial folds, which run from the corner of the nostril down to the mouth.

 

Facial volume loss can further aggravate the appearance of nasolabial folds, making the patient appear perennially tired or even angry. On top of that, repeated smiling (and other facial expressions) deepens this fold throughout life, he adds.

 

Facelift for laugh lines warrants elevating the SMAS, a layer overlying the muscle. With this facelift technique, the celebrity plastic surgeon says the skin, malar fat pad, and tissue are raised all at the same time, leading to more natural, longer-lasting results.

 

Moreover, the SMAS facelift technique allows the surgeon to eliminate most of the tension on the skin, further contributing to favorable scars and better wound healing.

 

The sagging cheek fat pad that contributes to the laugh lines is pulled upward so it will lie over the cheekbone. To further smooth out these “folds,” Dr. Smiley says that some patients require a simultaneous fat injection in which the goal is to replace lost facial volume.

 

Fat injection for the correction of laugh lines can serve as a stand-alone procedure in patients whose mid face has not yet sagged to a significant degree. Another option is dermal fillers (e.g., Perlane, Radiesse, Restylane, and Juvederm) whose effects last an average of 4-6 months and so they require regular touch-ups.

 

The results of fat injection, meanwhile, can last 12-15 years, says Dr. Smiley.

 

While the upfront cost of fat injection is higher than most dermal fillers, in the long run it is less expensive because it does not require touch-ups.

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Dermal fillers such as Radiesse, Juvederm, and Restylane are sometimes referred to as volumizers as they work by plumping the skin. They are different from Botox injection. Although both procedures involve injection, Botox relaxes the muscle and so it will no longer contract, eventually smoothing out the appearance of wrinkles.

 

With proper examination of the anatomy and meticulous injection, dermal fillers results are supposed to look natural, according to California Surgical Institute website.

 

The list below explains how natural results are achieved from dermal fillers.

 

  • Physical exam

 

The ideal filler will depend on several factors such as the treated site and the patient’s expectation.   It is important to note that some materials can last for 4-6 months (hyaluronic acid-based products), while others can persist for about two years (Poly-L-lactic acid fillers).

 

Thicker fillers, i.e., they have thicker consistency, generally suit patients with markedly deep facial wrinkles or significant depression. Thinner fillers, meanwhile, favor areas with thin skin such as the lower eyelid to prevent visible bumps and other surface irregularities.

 

  • Going the conservative route

 

Over-correction or over-injection can lead to unnatural look, which the media has referred to as the pillow face or chipmunk cheek. Hence, some doctors will start with only one syringe and then ask their patients to wait 2-3 weeks (or until their swelling has subsided) so they can decide for themselves if additional treatment is needed.

 

  • Eye for detail

 

Dermal filler injection must only be performed by a qualified doctor. It is important to note that some states are somewhat lenient that they allow nurses and aestheticians to perform the procedure.

 

A good rule of thumb is to have the procedure done by a board-certified plastic surgeon or dermatologist who performs it on a regular basis.

 

The right injector can prevent asymmetry, “done” look, and other dead give-away of dermal fillers.

 

The success of dermal fillers results boils down to precision. For instance, it is critical to inject the medial aspect of the nasolabial folds or laugh lines to prevent cheek ptosis/sagging.

 

  • Post-injection care

 

Patient cooperation will also determine the final results. A good rule of thumb is to avoid extreme heat or cold, massage or pressure on the treated area, and strenuous physical activities for at least two days.

 

The postop-injection management mentioned above prevents inadvertent shifting of the fillers, asymmetry, and excessive bruising and swelling.

 

  • Simultaneous Botox (only if warranted)

 

Some patients need Botox to further achieve natural results from fillers. In such cases, the consensus is to inject Botox first, then proceed to fillers after about a week.

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A lower eyelid fat transfer is a powerful tool in facial rejuvenation procedure that can provide natural-looking results in the hands of a skilled surgeon, as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smiley.

 

While dermal fillers can also correct the hollowed lower lid or deep tear trough, which is the transition between the thin-skinned eyelid and the thick-skinned cheek, fat transfer is perceived to be superior particularly if the goal is to achieve near permanent results.

 

The fat graft that persists about a year postop is expected to last a lifetime (or at least 10 years). Most surgeons aim to achieve a survival rate of 50-70 percent; it is important to note that some of the grafts will “perish” in the first few months of injection and so it might be necessary to slightly over-correct.

 

Dermal fillers, meanwhile, typically require 2-3 touch-ups every year because they are made of biodegradable material that the surrounding tissue gradually absorbs.

 

Dr. Smiley has recently performed lower eyelid fat transfer in a female patient with deep tear trough caused by soft tissue atrophy or “shrinkage” caused by the aging process. The procedure entails proper handling and injection of fat to achieve smooth, near permanent results.

 

lower eyelid fat transfer

 

The patient described has been considered as a good candidate for lower eyelid fat transfer “as a stand-alone” procedure (without simultaneous skin excision) because she only had very mild tissue laxity.

 

However, some patients can benefit more if their fat transfer is combined with the “standard” eyelid surgery (blepharoplasty) particularly if there is noticeable loose skin; this is achieved by placing the incisions at the natural upper lid crease or very close to the lower lash margin so the resulting scars are inconspicuous.

 

The celebrity plastic surgeon says one of the challenges or caveats of lower eyelid fat transfer is the risk of lumpiness because it deals with an area whose skin is markedly thin. To achieve smooth result, he highlights the importance of meticulous injection in which very small amounts of grafts (less than 0.1 cc) are introduced, as opposed to dumping them all at once.

 

The aforementioned technique, which is called structural fat grafting, also ensures spaces between each graft and thus allows blood vessels ingrowth needed for its long-term survival. Without this vascularization process, the body will eventually absorb the fat.

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Liposuction and fat transfer cost is highly variable due to factors such as the donor and recipient site, amount of transferred fat, clinic location, professional/surgeon fee, among others.

 

While liposuction and fat transfer has many uses in cosmetic and reconstructive plastic surgery, its application is widely popular in Brazilian butt lift (i.e., buttock augmentation via fat injection) and facial rejuvenation surgery.

 

liposuction and fat transfer cost

According to Realself.com, an online forum dedicated to popular plastic surgery procedures, the average cost of Brazilian butt lift is $6,550. Nonetheless, some patients may have to pay for a hefty price tag (as high as $14,000) if their surgeons cater to high-profile people or their clinic is located at a posh district.

 

But the truth is, the average cost of Brazilian butt lift may greatly vary even among patients treated by the same doctor because others may require just two liposuction areas, while some entail up to six “donor” sites.

 

To further shed light on the issue, one Brazilian butt lift patient treated by leading Beverly Hills plastic surgeon Dr. Tarick Smiley paid about $6,000 for liposuction and fat transfer that involved collecting donor fats from the lower back, flanks, inner thighs, and bra rolls.

 

The vast majority of patients will need at least two liposuction sites to collect an adequate amount that will be injected into their backside. However, women on the thinner side may need more donor sites to harvest enough volume to deliver the desired results.

 

But in facial rejuvenation via fat transfer, the volume of fat required is no more than a few teaspoons; hence, the viable donor sites are almost always not an issue.

 

A fat transfer involving the face—i.e., flat cheeks, laugh lines, and deep tear trough—can run as low as $3,500, or as high as $11,000. The hefty price tag almost always comes with simultaneous procedures such as facelift, neck lift, eyelid lift, or brow lift.

 

The upfront cost when fat transfer for facial rejuvenation is used instead of dermal fillers (Restylane and Juvederm) is higher, although in the long run the patient may actually save more because fat grafts that “survive” in the first 3-6 months are expected to be near permanent.

 

Traditional fillers, on the other hand, typically require 2-3 touch-ups every year.

 

Meanwhile, some doctors have also started offering fat transfer to replace breast implants; however, the amount of augmentation is rather limited, i.e., not more than a cup size.

 

Because of the rather marginal results from breast augmentation via fat transfer, many surgeons view it as just an ancillary procedure of breast implant or breast reconstructive surgery. Its primary use is to add more soft tissue coverage to hide implant rippling and minimize palpability.

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