Dermal Fillers


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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Can Sculptra buttock augmentation provide the same results as the Brazilian butt lift? This is arguably the most common question of patients who want to reshape their backside but have very low body fat percentage to make butt augmentation via fat transfer a viable option.

 

While Sculptra and other lab-made fillers can add volume to almost any part of the body, leading Beverly Hills plastic surgeon Dr. Tarick Smiley says that Brazilian butt lift remains the gold standard because it gives the surgeon more control over the projection, shape, and size of the buttocks.

 

sculptra buttock augmentation

In essence, Brazilian butt lift is a buttock augmentation via fat grafting in which excess fats are removed from various donor sites (usually the lower back, hip-flank region, back rolls, and frontal abdomen) and later re-injected into the patient’s backside.

 

The celebrity plastic surgeon regularly posts Snapchat videos showing how the Brazilian butt lift is accomplished and thus may help viewers (or would-be patients) form “reasonable” expectations and goals.

 

The problem with Sculptra, he says, is one will need multiple procedures performed several weeks apart just to achieve a “conservative” amount of augmentation; hence, patients seeking for more drastic results will have to adjust their expectations. Furthermore, it may cost as high as $30,000 on top of the fact that the results can only last an average of five years, says Dr. Smiley.

 

The average cost of Brazilian butt lift, meanwhile, is between $5,000 and $9,000; its highly variable pricing is due to factors such as liposuction or donor sites, clinic location, doctor’s fee, and operating room fee.

 

With blood supply ingrowth within and around the fat grafts, the results of Brazilian butt lift are near permanent, Dr. Smiley further explains.

 

Sculptra and other traditional fillers are best reserved for treating small areas such as the laugh lines, deep tear trough, flat or gaunt cheeks, and thinning lips, says Dr. Smiley.

 

Should the patient elect to have Sculptra buttock augmentation, Dr. Smiley says that while the filler is FDA-approved for facial volume loss, injecting it into the backside is an off-label procedure.

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Dermal fillers or fat transfer: Which one provides better results?

 

These two treatments (both are injected into the soft tissue) are also referred to as volumizers as they replace facial volume loss that results in nasolabial folds (laugh lines), flat cheeks, deep tear trough, and thinning lips.

 

dermal fillers or fat transfer

Photo Credit: Ambro at FreeDigitalPhotos.net

In order to answer which one provides better results, dermal fillers or fat transfer, several factors are taken into account such as the treatment site, cosmetic goals, and use of ancillary procedures such as facelift, if there is any.

 

Leading Los Angeles plastic surgeon Dr. Tarick Smiley says that despite of the more natural effects of fat transfer, under certain circumstances the use of dermal fillers might be a better option.

 

For instance, the thinning lips are best treated by dermal fillers, particularly hyaluronic acid-based products like Restylane. Because the “site” constantly moves (while eating, speaking, yawning, etc.), the fat grafts may not settle properly or gain their new blood supply to become a permanent fixture.

 

And since the effects of dermal fillers are just temporary, usually 4-6 months, they are ideal for patients who want to see first the effects of volumizers before resorting to more permanent treatments like fat transfer or even facial implants.

 

Nonetheless, most patients with facial volume loss are good candidates for fat transfer in which a small amount of fats, not more than a few teaspoons, is collected from the donor sites, usually the tummy and hips, says Dr. Smiley.

 

The celebrity plastic surgeon even treats fat transfer as an integral part of facelift surgery. With a multifaceted approach in which the sagging skin and gaunt appearance are treated simultaneously, he believes that the results look more natural and are more “stable.”

 

“Stable” results mean that the face is less susceptible to the effects of continuous aging. Dr. Smiley warns that failure to address the loss of volume in the lower eyelid could lead to an abrupt transition between the lid and upper cheek, which can present itself right after surgery or years down the road.

 

Fat transfer and facelift are best performed simultaneously so the patient will only experience recovery once, he explains.

 

Because the results of fat transfer are near permanent (studies have suggested that on average they can last 8-10 years), in the long run they are cheaper than having regular dermal fillers injections.

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