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What soft tissue filler would you recommend?

Q:

I have used Perlane and Radiesse fillers.  Neither one have worked for me.  What other soft tissue filler would you recommend?

A:

Fillers are not all created equally.  Some are designed to fill grooves, while others are designed to add volume to hollowed-out areas of the face.  Radiesse is in the former category, as are the hyaluronic acid fillers (Restylane/Perlane, and Juvederm).  If the problem to be corrected requires overall volume enhancement, these may not be the ideal treatment choices.  A more effective option may be treatment with Sculptra Aesthetic.  Sculptra is a product which stimulates your own collagen production to provide a long lasting soft youthful contour.  Most patients require 3 treatment sessions during which the skin is numbed, and multiple injections are administered.  Treatments are spaced four to six weeks apart.  Results from Sculptra can last up to two years.  

Alternatively, a great choice for filler is your own fat.  Fat grafts can give a more permanent correction and are very versatile in terms of contour, placement, and volume in the face.  The fat grafting  procedure may cause more bruising and swelling than the synthetic injectables, but the results are longer lasting.  

Pamela B. Rosen, M.D., FACS
Pompano Beach, FL

A:

There are many variables in filling the face.  First, what are you trying to fill?  Perlane and Radiesse can both fill lines (though not fine ones), creases and contour problems.  For fine lines, a thinner Hyaluroonic Acid filler is better.  For large areas of contour problem, fat may be the ideal.  Secondly, how much filler did you use?  Frequently, even for just the folds between the lips and nose, two or more syringes are required.  It is, therefore, possible that you just did not use enough.  Thirdly, what was the experience of the person who did your injections?  Correct use of fillers requires significant experience and finesse.  And, finally, were you trying to accomplish something that fillers will not do?  Sometimes, the only answer is a Laser procedure, peel or surgery.  I would suggest seeing someone different for another opinion.  Make sure they have significant experience using multiple types of fillers, Laser, peels and surgery.

A:

I'm not sure if "not worked" meant didn't last or what the problem was.  Fat grafting can be a permanent solution to fill hollows and wrinkles in the face.  A consultation with a plastic surgeon experienced with fat grafting would be helpful

A:

Fillers fill defects or contour deficiencies.  If yours did not, I would question the technique used by whomever you chose to do the procedure for you.  Of they simply did not use enough. 

Assuming they used correct techniques and you simply need more filler, fat is an excellent option as most people have extra somewhere on their body.  The only caution with fat is that is it theoretically will act as the fat from where it was harvested and weight gains in your future could result in increases in volume where your fat was injected.

Sculptra is certainly an option if you do not have any fat to harvest or you do not want to go through the harvesting procedure (but it can help diminish contours in other areas such as your neck).

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