Archive for February, 2013

Fat May be the Right Filler for You

February 28, 2013

In an age where the predominant health topic seems to revolve around trying to rid ourselves of excess fat, why would anyone want to discuss why adding fat to certain areas may be something to consider?

This discussion is suited to anyone who has ever had fillers injected into their face or considered having such injections.  I would like to introduce considerations for when and why someone might consider using their body’s own tissue rather than a pharmaceutical product that comes in a syringe.  The takeaway from this article should be for a patient to have a better understanding of fat grafting and to generate awareness of this modality so that patients may ask more informed questions.

Non-surgical treatment to treat wrinkles and signs of aging have rapidly increased over the past five years.  In a fast-paced world with shrinking expendable income, people often turn to what are perceived to be less costly alternatives to surgery to address concerns about visible signs of aging.   Often, personnel delivering these treatments don’t have the experience and training to offer alternatives which a well informed patient should know about when making important decisions about their care.

Usually, people first turn to fillers and botulinum toxin to treat wrinkles.  Botox and similar compounds are used to treat wrinkles that appear when facial muscles contract.    These are called “dynamic” wrinkles.  However, Botox does not treat wrinkles that are present when you face is relaxed.  These wrinkles are called “static” wrinkles. Treatment of “static” wrinkles is why most people first come to use pharmaceutical fillers.

Modest improvement of “static” wrinkles is usually accomplished with fillers, however, that is not where the story ends.  As we age, there is more going on than the wrinkles that we see on our face.  As we age, there is a general deflation of the deeper layers of fat that defines a youthful face.  Take a look at a picture of your yourself 20 years ago.  Assuming you are about the same weight, one cannot help but notice that some modest deflation has occurred.

The loss usually first becomes apparent in our mid 40’s and continues throughout our lives.  It happens in our temples first, then in our cheeks, our lips, and other places.  At the same time we tend to accumulate excessive amounts of fat under our chins, and we see descent of the more superficial layers of fat.  It is this progressive shifting of facial fat that leads to very important signs of aging that should be addressed as part of a comprehensive plan to restore youthful features.

Borrowing fat from areas where we have excess accumulation of fat is one way to restore the contour of a youthful face.  But why would someone choose to have this “surgical” procedure versus a filler from a pharmaceutical company that can easily be performed in under an hour by a dermatologist or in some offices a nurse?

There are many advantages to using your own fat for restoring volume in the face, however, what if I told you that in some situations it might even be cheaper then all of these “easy” fillers.  In an era of people looking for cost effective treatments that is a very important consideration.

The most common fillers are only temporary solutions.  Depending on the filler used, they typically last for a period of 6-12 months.  These injections need to be periodically repeated to maintain their effect.  Fat on the other hand, when injected, tends to shrink a little at first but what remains is with you indefinitely.  That is one of the large advantages to using your own fat for this purpose.

When the goal of treatment is to comprehensively treat loss of fullness and volume in the face, the amount of volume needed is often anywhere between 10-30cc.  At these volumes the cost benefit of using pharmaceutical filler products tends to disappear and the cost advantage lies with using your own fat.  This is especially true when considering the need for periodic repeat treatment with these fillers.

Fat tends to move and feel more natural when injected into areas such as the lip when compared to some of the fillers.  For instance, some of the fillers can feel firm when placed into areas such as the lips which should be supple in a youthful individual.

There are other less obvious considerations. Fat is one of the bodies most plentiful sources of “mesenchymal” stem cells.  These are the cells that are able to replicate and turn into cells that contribute to improvement in circulation and elasticity in the skin.  Though much has been written about these cells, most surgeons who perform fat grafting will tell you that an improvement in skin quality is often seen after performing fat grafting.

Please keep in mind that no matter what filler you choose, trying to fill a face that has lost its elasticity can result in an overly inflated appearance and should be avoided unless also addressing the excess skin and descent of tissues.

So, I hope I have made a strong case for why you as a patient should consider speaking to someone who has experience with fat grafting.  However, to be fair, I would like to take a moment and describe when a pharmaceutical filler might be the right choice for you.   Pharmaceutical fillers are good for patients who don’t need a lot of volume to accomplish the intended treatment goals.  Fillers are also ideal for someone who needs to be ready for an important event or meeting as fast as possible as fat transfers tends to cause relatively more swelling and recovery time.

To make an appointment with Dr. Deschamps-Braly, please contact our San Francisco office +1.415.624.3922.

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