Thank you for your question.
You're 35-years-old.
You've submitted with your question several photos that are very helpful and you state
that you've had Radiesse injection in the cheeks and chin and you mentioned the volumes.
And you state that you really like the results and 2 years later, things have deflated.
And you want to ask about other options whether a surgical fat grafting or whether to stick
with fillers.
Well, I can certainly give you my perspective on a question like this for people like yourself
who come into my practice.
A little bit of background, I'm a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I've been in practice in Manhattan and Long Island for over 20 years and the evolution
of solutions for what you describe has been something I've been very actively involved
with over the 20 years in my practice.
Now understand, when you ask this question, every doctor comes to the table with their
own personal experience and bias and certainly I can share with you the basis for what I
would recommend and see if this makes sense with you and then you now decide whether that's
the approach that you want to take.
So prior to the injectable fillers, there were facial implants and fat grafting.
Now the advantage of facial implants like a cheek implant is that it was being placed
on the bone structure directly on the structure where there is a relative volume deficit which
I believe may be part of what your situation is.
And so, that made a lot of sense because it was really augmenting the bone.
The challenge sometimes is with relative thin skin and the shape of those implants.
Sometimes people felt that they were too large, not the look they wanted and that is one potential
drawback.
Now when it comes to the area like the chin, it is fairly straightforward because chin
augmentation with a facial implant is a very good approach for long-term benefit in this
area.
So it's something that is probably worthwhile considering.
Now when it comes to the other options such as fat grafting, fat grafting has improved
as a method and with better understanding of the physiology of fat.
What unfortunately still remains a constant is the predictability, the challenge is the
predictability.
No matter who does this type of procedure, there is always going to be a certain amount
of fat that makes it and a certain amount that does not.
I personally feel also that for the type of look that you're trying to achieve, you're
probably better with something that is closer to the deeper structures, closer to the bones.
So with fillers like Radiesse which was placed probably just under the skin, you were happy
with that result.
I think that with fillers like Radiesse and as I prefer such as newer hyaluronic acid
fillers that are thicker and last for longer periods of time like Juvederm, Voluma, we
use a method called structural volumizing.
This is kind of a balanced and a hybrid approach where you get the benefit of the principle
of cheek or I should say implant or breast augmentation where you place something on
the bone but you get the reliability and the customization that you can do with the filler.
So I think that in your situation, I would go with structural volumizing with a filler
like Juvederm Ultra Plus or Juvederm Voluma.
You can get similar longevity of approximately 2 years and let's say you wanted a little
bit more, you can come to the office and in a few minutes, a little bit more can be placed.
That type of customization is really great.
You've eliminated the unpredictability of fat, you've eliminated the surgical element
of surgical implant placement which is a very big deal and again it depends.
These procedures for implants can still be within a short period when it comes to recovery.
But when it comes to thinking of predictability and customization, it is really wonderful
being able to do structural volumizing.
This is different from placing the filler under the skin where there is some benefit
for you as well because there is obviously or apparently a relative layer of skin between
the skin and the underlying bone structure.
You are very lean.
So it can be at the bone level between the bone and the muscle and then just below the
skin level between the muscle and the fat.
So there is a lot of opportunity there and an important element to your physiology is
that it is continuously changing.
And so in terms of facial structure, you might lose a little bit of weight, gain a little
bit of weight and in that respect, the fillers can be really adjusted to compensate or to
be adjusted to not place as much.
So, I think that you were probably starting with a good thing and I would say injectables
is the way to go.
But understand that there are different methods to doing these injectables and so that is
where, I think structural volumizing is something maybe worth exploring for you.
So I hope that was helpful, I wish you the best of luck and thank you for your question.
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