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In the modern art of facial plastic surgery, doctors have a growing array of tools to help them achieve the natural-looking, youthful face that patients desire. Dermal fillers, fat grafts and implants help surgeons create a custom look to meet the needs of each patient, and part of the surgeon’s skill is knowing when to use each option for the best results.

“One of the trends in plastic surgery today is that people want fuller cheeks,” notes Sam Rizk, MD, director of Manhattan Facial Plastic Surgery and Park Avenue Facial Surgery in New York City. “Part of the aging process is losing facial volume in the cheeks and the temple area. Loss of volume in the upper face causes people to look older, and this is something that cannot be corrected with a facelift.”

Injectable fillers, autologous fat transfer, and cheek and chin implants can restore lost volume and reshape a patient’s face when used alone or in conjunction with a facelift. Each method has its pros and cons, and each of the doctors interviewed for this article has used all three methods.

Injectables Offer Immediate Results

Hyaluronic acid-based dermal fillers sold under the brand names Juvederm (juvederm.com), Restylane (restylaneusa.com), Elevess (elevess.com) and others are the most widely used type of fillers. Other options include calcium hydroxylapatite (Radiesse, radiesse.com) and injectable poly-L-lactic acid (Sculptra Aesthetic, sculptraaesthetic.com). With the exception of poly-L-lactic acid, dermal fillers are fast-acting with little to no downtime, and the results last from a few months to two years. In 2011, dermal fillers were one of the most popular minimally invasive cosmetic procedures, second only to Botox Cosmetic, according to the American Society of Plastic Surgeons (ASPS, plasticsurgery.org).

“With injectables, the disadvantage is that they’re temporary, and the advantage is that they’re temporary,” says Jeffrey Spiegel, MD, chief of facial, plastic and reconstructive surgery at Boston University School of Medicine in Boston. “They are expensive to maintain, but they are an inexpensive way to try out facial contouring.”

Younger patients and patients who are new to plastic surgery like fillers because they can see results right away in most cases; if they don’t like the results, they know the effect will not be permanent. Doctors can even reverse the effects of hyaluronic acid fillers by injecting hyaluronidase. The primary side effects of hyaluronic acid injections include minor swelling and bruising.

Hyaluronic acid is a substance that occurs naturally in the body, so it has a low risk of allergic reaction, but it is also reabsorbed by the body, so the effects last—on average—three to five months. Patients who tire of repeating injections several times a year may eventually graduate to more permanent facial contouring solutions.
Fillers can be used in small amounts, giving doctors great control over the results. Conversely, it is difficult to apply enough volume of fillers alone to sculpt areas in need of greater contouring, such as the chin or hollow cheeks.

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