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Will fat injections last longer and therefore be less pricey than Botox and fillers for forehead lines and deep laugh lines?

Q:

I'm 31 years old with strong forehead lines and starting to see deeper laugh lines.  I've had Botox in the past, but stopped due to the price of keeping it up.  I have been looking at getting fillers in my laugh lines, but they too only last a few months longer than Botox.  I would like something more permanent than Botox or fillers.  Should I go with fat injections?  I'm curious to the cost of this procedure.  I know the Botox and fillers are pricey alone, especially having to keep them maintained.  Please advise.

A:

To answer your questions, an examination would be required. Yes, fillers are cheap and an easy correction to your issues. Fat grafting on the other hand, although permanent, will be a bit expensive ($3,000 to $5,000). Consider a consult with a member of the ASAPS in your area to answer your questions.

Gary R. Culbertson, MD, FACS

A:

Botox and Fillers do different things, and different fillers can accomplish different things. You can fill the lines on the forehead with a Hyaluronic Acid (HA) filler. Fat will do nothing for these lines. Juvederm, a HA filler, can last up to a year. However, these lines are caused by the muscle and the best treatment, short of surgery, is to combine Botox and a filler as well as use of a skin care regime using Retin-A. Frequently the most cost effective treatment of these lines is a brow lift so the muscles no longer have to work to hold the brows up. Fat can reduce the "laugh lines." They can also be reduced with Radiesse, a filler that lasts about 18 months. Though fat is more expensive initially, it is relatively permanent, except that aging will continue and you may need more as further cheek sag occurs. See a Plastic Surgeon who has all these alternatives available.

A:

Fat Grafting for permanent elimination of lines and wrinkles.

 

A number of 'soft tissue fillers' are available for temporarily improving facial areas that have lost volume, are naturally thin or hollow, or have developed noticeable and bothersome lines and creases. The most popular fillers currently are hyaluronic acid products like Juvederm® and Restylane® which can be used to, among other things, plump up thin lips and to fill out nasolabial folds (lines that run from beside the nostrils to the area beside the corners of the mouth) and marionette lines (lines that run from the corners of the mouth towards the jawline). In this practice we have performed thousands of injections with these safe and reliable hyaluronic acid fillers. They are well-tolerated by almost all patients and they produce very few post-injection problems. The improvement generally lasts from four to eight months, the average being about five to six months. Of the available hyaluronic acid soft tissue fillers, I have been most pleased with the performance of Juvederm®.

Other injectable fillers are currently available which attempt to produce a longer-lasting soft tissue augmentation by incorporating substances that are more slowly metabolized or that cannot be metabolized by the body. These are sometimes referred to as 'semi-permanent' fillers. Some incorporate non-degradable biologic materials (e.g. Radiesse®, which contains calcium hydroxyapatite, the mineral component of bone) or non-biologic (synthetic) materials (e.g. ArteFill®, which contains polymethyl methacrylate, also known as Lucite) that are designed to persist in the body permanently. Another is Sculptra®, which consists of a synthetic polymer called poly-L-lactic acid, which is also used as an absorbable suture material.

Unfortunately, the body treats these materials as foreign objects, and as a result the placement of non-degradable and synthetic materials may lead to inflammation, infection, migration and granuloma (an inflammatory cyst) formation - none of which are problems that you want to experience near the skin surface in your face. In general, the 'semi-permanent' injectables containing these materials are less likely to produce a result that looks and feels natural, and because of the potential complications I feel that they should never ever be injected anywhere close to the skin surface. We do not use any of these injectables in my practice.

If you are looking for a longer-lasting result than you are getting with Juvederm® or Restylane®, we have a much better solution for you: you own fat, currently residing somewhere that you don't need it. The improvement is designed to be permanent, and your body will not treat it as a foreign object. Your immune system won't attack it. The cost is about the same as several syringes of a 'semi-permanent' filler. And the quality of your facial skin may, in fact, actually improve in the areas where fat is grafted.

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