What we use depends on what area of the face needs improvement.

Each filler that I use in my practice has its own set of characteristics that make it the right choice. “I tell my patients that what we use depends on what area of the face needs improvement, how long they want the results to last, and how much downtime they can endure,” says Dr. Susan Stevens Tanne, medical director of Cosmetic Laser MD.

For my patients that have never tried any type of fillers or injectables, I usually recommend that they begin with fillers made of hyaluronic acid, such as Restylane, Belotero or Perlane, since they can be reversed if you don’t like the way you look, and they fade over time.

Some of my patients need more significant lifting and/or filling of the cheeks, and filling of the chin area. I see this in patients as they age, with shrinking of the fat pads that normally act as scaffolding for the skin. This is also common in those who are very thin, or are hard-core exercisers. This type of hollowing results in a gaunt, tired look. I use Radiesse or Perlane for a more significant filling effect in these patients. Filling these larger areas require that the filler be placed deeper, which is why Radiesse works well in these patients. “Done properly, my patients achieve very natural looking youthful results, which lasts from six months to one year and sometimes longer,” says Dr. Tanne.

“One of the biggest improvements in the placement of injectable fillers has been the introduction of microcannulas, which I have been using almost exclusively for the past couple of years. Rather than using sharp needles that can result in significant bruising, a small pilot needle is used to just puncture the skin, which has been numbed, and then the needle is removed and replaced with a blunt tipped cannula. This method required much less numbing and is more comfortable for the patient. A microcannulas has a rounded, closed end, rather than a sharp cutting end, typical of traditional needles, and a small side opening to allow the filler to flow out. Patients have responded very favorably to this method, and love the almost total absence of bruising”, says Dr. Tanne.

For some patients, fat transfer is the preferred treatment rather than using synthetic filler in their face.  To obtain the fat, a microliposuction procedure is done, removing only a very small amount of fat after you have been carefully numbed with an anesthetic solution.  You may be a little swollen for a few days after this part of the procedure. The fat is then spun in a centrifuge to remove any oils and debris, before being re-injected into the face. Unlike fillers, fat transfer requires some downtime, ranging from a few days to one week, if the fat is placed in multiple areas of the face. Fat can be a more cost-effective option for patients that are using many syringes of filler every year, and can be a long-term solution. However, since this can produce a long-term to permanent result, I usually only recommend this option for patients that have tried synthetic fillers several times previously. One added bonus is that fat contains your stem cells, which gives a youthful smoothness and vibrancy to the skin.

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