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Advice on facial fillers for lipoatrophy

Aug 13, 2012

Hi Dr Pierone,

I have read many of your responses regarding this question, and have recently consulted a Doctor and discussed filler options with him. He basically told me to run a mile from synthetic fillers like artefill, artecoll and recommended that for large volume filling of my face I should go for fat graft injections in operating theatre. I do have worries about whether the fat will be long lasting and permanent, and also whether it will look even and not striated if areas of the fat dies off. But funny enough, he mentioned these same reasons for avoiding sythetic fillers. The problem of uneven texture and lumps. Is he correct? Is this the best course of action, and if not, where else would you reccommend I go? Because I am wanting to fill cheeks, temples, eyelids, and chin. I would really appreciate your advice.

Thank you Kay

Response from Dr. Pierone

Hello, and thanks for posting.

Fat grafting can restore facial volume if there is subcutaneous fat to harvest. The immediate concern is that many people with lipodystrophy have visceral fat, but not enough subcutaneous fat available.

But if there is fat available, the next concern is that the survival of transplanted fat varies quite a bit. Most surgeons will overfill the fat grafted areas because they realize that some of the grafted fat will not develop a blood supply and die within days or weeks. How to predict how much fat will survive is very difficult. Another related challenge is that grafted fat may take in some areas, but not others. This produces contour irregularities and a lumpy appearance, especially with facial animation.

Actually, one of the ways that facial fillers may be helpful is to rebalance fat grafting contour irregularities. I have used Artefill to treat several patients who had lumpy bumpy results after fat grafting. I was able to position this filler into the depressions of the fat implant to smooth out the feel and appearance. So in a sense, facial fillers may be considered a means to remediate suboptimal results from fat grafting.

The advice to run away from synthetic fillers simply indicates that this doctor is misinformed. All commercially available facial fillers are synthetic in nature, and represent technological advancements to provide treatment options for aesthetic or reconstructive purposes. There are a wide range of facial fillers and they have different performance characteristics. Some like Juvederm or Restylane last about 6-12 months. Radiesse lasts about a year, sometimes longer. Sculptra lasts about 2-3 years, but takes a few months to produce its effect after it is injected. Artefill is the only FDA approved permanent filler, but is really a hybrid product consisting of the combination of temporary bovine collagen and permanent PMMA microspheres.

There is no simple answer as to which facial filler is best. I have used Radiesse, Sculptra and Artefill for treatment of facial lipoatrophy and they all can produce transformative results. There is also a learning curve for the application of this technology and not all injectors have the expertise to produce the best results. These products are also very expensive, so the patient assistance programs (in the United States) often dictate which ones we use.

I hope this information helps and best of luck!

Lipoatrophy and Truvada
What progress has been made with lipodystrophy?

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