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The Perfect Facial Filler
by Dr. Paul Howard
There are dozens of foreign body facial fillers in development at this time. The sheer number of fillers indicates that the perfect material, composition, thickness, and longevity are under evolution and each practitioner must use his or her judgment regarding which is best for an individual patient. The longevity of the material has increased from several weeks to 3 or more months but in all circumstances the foreign material fillers (Restylane, Juvederm, Radiesse) are temporary. There will always be a place for the temporary injectable filler as a touch-up procedure with minimal or no down-time. The multiple injections of foreign material in the lips or for deep wrinkles will eventually cause subcutaneous scars which manifest themselves as “thickness.” The overall “take” of the material changes over time so that the result is less predictable. One of the best uses of Juvederm, or its equivalent, is to obtain a temporary lip enhancement that allows the patient and surgeon to determine how much fullness is desired.
In the instance that the lips are too full or too pouty the material will resorb over a period of time so that over-estimating volume is not permanent and some idea of the desired enhancement is visually determined. Photos of the lips at the desired fullness can then be used as a template for the more elegant and permanent autologous fat injections. Temporary fillers are always a good choice for the patients who are undecided about lip enhancement and need visual clues, if only temporary, to make an informed decision regarding a permanent procedure. The treatment of deep wrinkles usually involves either temporary or permanent filler injection in conjunction with Botox for facial muscle relaxation. The overuse of Botox as a temporary wrinkle treatment has created what is called a “mask face,” paralyzing or weakening the facial muscles causing an unnaturally smooth visage with little or no facial expression. The expressionless, or static, face photographs well but facial expressions are necessary to show emotion, a nice trait to have when communicating with other humans.
What are the characteristics of the “perfect” facial filler? Permanency, reproducibility, naturalness, affordability, and minimal down-time are a few of the most desirable traits for a facial filler. In principle, which filler addresses the cause of volume loss in the aging face? The applicable Plastic Surgery principle tells us to replace lost tissue with tissue in kind: bone for bone, cartilage for cartilage, skin for skin, and fat for fat. These are Plastic Surgery principles which apply equally to Reconstructive and Cosmetic Surgery and should be headed if at all possible, moreover a lack of surgical skill is no excuse for lack of principle. Fillers that are not the best choice for the patient but are simply the most expedient for the surgeon are a poor choice and indefensible.
Stem Cell, or Permanent Fat Transfer, has been around for over two decades and is my prefered method for addressing the loss of volume in the aging face as well as other corrective deformities such as acne scars. The "take" of stem cell fat transfer is above 85%. It is natural appearing, natural feeling, and is permanent.
The Above photos show an actual patient of Dr. Paul Howard. Photos demonstrate elegant results for Fat transfer for acne scarring.
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