Dermatology World

Better together

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Restoring volume with fillers, combining procedures enhances results

By Jan Bowers, contributing writer, September 2, 2013

Call it the global approach to facial rejuvenation. After years of attacking the individual lines and wrinkles that many patients loathe, leading cosmetic dermatologists have learned to address their underlying causes with multiple agents and procedures. “Years ago, we just injected the fine lines and wrinkles. We didn’t realize that restoring a youthful look was more about restoring lost volume in other areas of the face,” said Bruce E. Katz, MD, clinical professor of dermatology at the Mount Sinai School of Medicine and director of the Cosmetic Surgery and Laser Clinic at Mount Sinai Medical Center. “That depletion of volume — which results from gradual loss of fat, muscle, and bone — leads to deepening nasolabial folds, marionette lines, and laxity of the jowls. Everything droops because the support structure’s not there anymore. So now we use fillers to restructure the face, to counteract the gravitational changes.” 

Fillers approved by the U.S. Food and Drug Administration include hyaluronic acid (Restylane, Perlane, Juvederm, and Belatero, the most recently approved), poly-L-lactic acid (Sculptra), and calcium hydroxyl apatite (Radiesse). Voluma, a hyaluronic acid widely used in Europe, is expected to reach the U.S. market within the next year or two. In addition, a handful of autologous agents provide other options. Dr. Katz said he uses platelet-rich plasma (PRP), already FDA-approved in wound healing, to restore volume and stimulate stem cell growth. “We’ve used it in the tear troughs, and it’s done very well,” he said. “Not only volume, but texture, luminosity, and pigment are all improved.” Kimberly J. Butterwick, MD, a private practitioner in San Diego who co-authored an in-depth look at autologous fat transfer techniques in Facial Plastic Surgery Clinics of North America (15(2007):99-111), said she can “recycle” as much as 30 to 50 cc’s of fat from a liposuction procedure into a patient’s face. “It’s way too expensive to use synthetic filler in that quantity, but we can use as much fat as we want,” she said. “The longevity isn’t entirely predictable, but I’ve seen some patients for whom the fat has stayed in their cheeks for many years.” (One study cited in Dr. Butterwick’s paper reported 55 percent fat loss within six months followed by negligible loss at nine and 12 months.)