Injectable Fillers and Fat Grafting

Injectable filler materials can be used to fill contour depressions and fine lines as well as modifying facial shape.  Typical contour depressions include the nasolabial folds and marionette lines.  Lipstick bleed lines and crow’s feet are examples of fine lines.  Lip and cheek augmentation are typical shape changes, which can be produced with injectable fillers.  Some injectable fillers are useful for one of the above categories and not others.  The average durability varies with different injectables.  All injectables carry risks of tissue reaction, infection, asymmetry, nodularity, and others.  Fortunately, with currently approved injectables these risks are uncommon.    A consultation can help determine the most appropriate modality to treat your concerns.  Alternatives to injectables include various surgical treatments such as autogenous fat transplantation (fat injection), as well as solid cheek and chin implants. 

Various injectable materials are on the market in the United States including Restylane, Juvederm, Perlane, Radiesse and Sculptra.  Fat injection is now performed using FDA cleared systems for processing the fat such as the Cytori PureGraft system.  Use of these options to restore age related volume loss in the face have undergone explosive growth over the past few years providing a substantial improvement in facial rejuvenation over skin lifting alone. 

In addition, many fillers that are not approved for treatment in the United States are in widespread use.  Some materials are being used for an application different from that for which they are approved -which is a widespread and legal part of the practice of medicine.

Dr. Bass cautions that the effects of these materials in cosmetic applications are unknown.  Patients should be extremely concerned about placing unapproved materials in their faces, especially materials that are permanent or non-biological.

Restylane is a safe and natural cosmetic dermal filler that restores volume and fullness to the skin to correct facial wrinkles and folds, such as nasolabial folds. Restylane is FDA cleared for use as a cosmetic filler.  This material is made from hyaluronate which is the predominate matrix material in our skin and connective tissues.  This is a very biocompatible material with little tissue reaction.  Restylane has recently been released with a new formulation that includes anesthesia medicine mixed directly in the injectable material (Restylane L).  This material is commonly used for lipstick bleed lines, crow’s feet, lip augmentation and fill of nasolabial folds and marionette lines.

Radiesse is a long lasting injectable contouring agent which is FDA cleared for cosmetic correction of facial contours such as nasolabial folds.  This provides 1-1.5 year durability for correction of depressions like nasolabial folds and marionette lines but is not used for fine lines like lipstick bleed lines or crow’s feet.  Other areas of preferred application include cheek and chin contouring, nasal contouring, as well as correction of early aging changes in the pre-jowl sulcus before facialplasty is necessary.  The material is made of hydroxylapatite which is the mineral matrix occurring naturally in the body, although the Radiesse material is made synthetically and is therefore sterile and not from an animal source.

Juvederm is an FDA cleared cosmetic hyaluronate filler like Restylane but slightly different in chemical formulation.  Applications are similar to those for other hyaluronate fillers –dermal lines and subdermal fill.  There do not seem to be significant differences in the degree or durability of correction in comparison with Restylane.

Fat Injection, which is medically known as autogenous fat transplantation, utilizes your own fat, which is harvested with a needle and syringe to provide contour correction on the face and body.  This is a minor procedure which requires recovery.  Advantages include the use of your body’s own cells rather than a foreign material as well as the long duration (1-3 years or more) of the cells which survive in the new location.  Disadvantages include the recovery associated with the treatment and the variability in the amount of injected fat which does survive, often necessitating re-treatment one or more times over a year or two.  FDA cleared systems for fat preparation such as the Cytori PureGraft system are used.