Dr. Seiler's Notes: "Fillers versus Fat"

 

From “Fillers versus Fat” by an editor in Cosmetic Surgery Times: Sept 2011.  In my practice, I have had very good results in using dermal filler (Juvederm) for facial revolumizing (see my article in PSP!).  Fat injections in the face, especially after liposuction somewhere else, have become popular.  However, I believe that it is the less common patient who might really need more than what Juvederm can do.  Although fat injections into the face have a place in a very particular patient if performed by a very skilled surgeon, I have simply seen too many complications with the procedure to be a huge if any fan at all.  This article discusses these concerns.  I will hit the highlights and report some quoted sections from the article. 

Says Val Lambros, MD:  “Fat has advantages, and so do off-the-shelf fillers [like Juvederm].  Unfortunately, outlandish claims are being made about fat grafting’s efficacy with no evidence to support those claims.  Consequently, the use of fat is garnering a fair amount of enthusiasm without users fully understanding some issues surrounding it.  For instance, injected fat can grow. [!!]  This will be the greatest long-term problem with fat.  I have seen increasing numbers of people who have gained weight after their fat injections:  Their faces are growing and it doesn’t look good.  [Dr. Seiler adds this will not happen with Juvederm].  What’s more, fat is difficult to remove.  I think that, in the future, we are going to  see a wave of people who can be identified as those who have had overzealous facial fat grafts. . . that continued to grow because their faces will look like balloons.  Another issue with the fat is that it’s not reliable.  In older people it tends not to work very well; in younger people it works better.  It’s a perfect example of the catch-22 of facial plastic surgery—the more you need it, the less well it works.  Also, the grafts don’t always ‘take,’ so you can do one side of the face and get a beautiful result, while the other side gets nothing.  If you are going to rely on injected fat, you have to be fond of ambiguity or at least be able to tolerate it.  With fat, touch-up procedures are often necessary.” 

He goes on to explain how much finesse and skill the surgeon has to have, and I have seen far too many patients who have come to my office very disappointed in their “fat injected” face from another office and I honestly tell them that they didn’t even need it in the first place and I could have given them a great result with Juvederm (and now they are . . . well you fill in the blank).  He also reminds the reader that a filler like Juvederm is easy to remove if the patient is just not happy with it (which does not happen in my practice).  “That’s not the case with fat, especially with respect to lips, where it is particularly difficult to remove it.”  He continues:  “Telling patients that fat grafting will give them a young-looking face that is smooth, round, full and wrinkle-free is only partially true, because if your ‘tool’ gives them a smooth, round and wrinkle-free look by ballooning the face up, you have removed the definition and delicacy of the face and can’t go back.  Unfortunately, many newbies are beginning to do more and more fat grafting in the face, and complications can occur.  The most common complications of fat grafting happen when it is used in the lower lids.”  And I say that I can almost always get a good result in the lower lids or “tear trough” with Juvederm. 

One reason for using fat instead of a filler like Juvederm is because of fat’s suggested longevity (it lasts longer).  On the one hand that is possibly true, but on the other, you may not want it to last forever!  Features of the face change and you may need revolumization in a slightly or majorly different area years later.  Also, with the complication risk, in my book, its just not worth the risk.  Trust me, if I recommend Juvederm for you, it’s the best thing for you.  My patients know that I have no problem telling them that something or some procedure that I do not perform/offer is better for them if it is.  Dr. Lambros says, “I don’t tell the face what to do, the face tells me.”  As this makes me smile, and should you, it makes the point that you have to go to someone who knows what they are doing and also knows what they are not doing that might be better. 

Take home:  do your research, ask questions, trust your injector, be educated.  You as a patient have every right to interview your doctor as much as he or she interviews you.  Ask how many procedures they have done, how many problems they have had, what’s their training, show me pictures of real patients, do they have patients that will let you call them to discuss their success.  Ask the doc why they are the one you should let treat you!