As we age, we lose facial volume. There is loss of bone and fat in and around the eyes, mouth, chin and temples. This volume loss results in brow and cheek drooping, and wrinkles around the mouth.

The main injectible fillers used today are Juvederm, Restylane, and Radiesse. Juvederm and Restylane are used mainly in the lips and lower eyelid/cheek areas where small volumes (2-3 ccs) are used. They are hyaluronic acid (HA) gels and best used for superficial wrinkles, volumizing the lips, and filling in the depression under the eyes. Injected through very small needles with anesthesia mixed in them, both products are easily reversible using an enzyme that (almost immediately) dissolves them. There is no excuse for a “bad job”. These products usually last 6-10 months and are injected during a routine office visit.

Radiesse is used as a deeper filler. This can be used in the cheeks, chin and jawline, to fill in lost volume. It requires a slightly larger needle and can cause bruising. It lasts longer than the HA products, typically 10-14 months, and is also injected during a routine office visit. It is not reversible but may be massaged and spread out if there is a bump or nodule.

Fat transfer is performed in all areas of the face. It is harvested via liposuction and injected back into the face. Fat transfer is used for volume replacement not to treat fine lines. Much larger volumes (20-60 ccs) are used because the entire face can be injected. The brows, forehead, temples cheeks, chin and entire peri-oral area may be treated. Fat transfer is commonly performed with a facelift to achieve a natural result without a pulled look. It also improves the skin tone and texture.

A fat transfer is a surgical procedure and has a recovery period with bruising and swelling. A fat transfer is longer lasting (2+ years) and often semi permanent after the initial swelling goes down. The results are much more dependent on the surgical skill of the surgeon than injectibles, and it takes longer to see the final result. A fat transfer is often what a person needs if they have already had a facelift and want an improvement with their look.

So which is best for you? It all depends on your goals. If you want to alleviate fine lines around the mouth and eyes, then a filler such as Juvederm combined with BOTOX works very well. If you want an overall more youthful look and have a significant amount of facial volume loss, a fat transfer with or without other procedures may be the best treatment. Your surgeon will discuss treatment options, and together you can plan your rejuvenation process.

Rex Yannis, M.D. specializes in Ophthalmic Plastic & Facial Cosmetic Surgery, as well as, skin rejuvenation of the face, neck, chest, arms and hands. He practices in Palm Desert at Evans Eye Care and can be reached at (760) 674-8806.