Volume loss to the face is a natural part of the aging process or can happen when an individual experiences significant weight loss. The two options for treating volume loss are injectable fillers and fat transfer. Filler can be done in the office as a “walk-in, walk-out” treatment with no downtime and immediate results. Fat transfer is a surgical procedure that involves removing fat from one are of the body, usually the abdomen, hips or thighs, and placing it in the face where volume is needed. There is a recovery period of a few days to one week. Fat transfer is a permanent long term solution, where fillers are temporary.
Three Ways the Face Ages –
Loss of elasticity and gravity over time
Volume redistribution – loss of volume in some areas, fat pockets in other areas
Surface characteristics – sun exposure, acne, etc.
All three of these issues are evaluated by Dr. Nichter during the consultation and recommendations are made as to which procedure or combination of procedures will provide the best outcome. Treatment may include any one or more of the following: facelift, neck lift, fat transfer or fillers, liposuction, laser resurfacing, laser tightening, chemical peel, skin care regimen.
As the characteristics of the face and skin change throughout the aging process, there becomes the desire to restore ones appearance to a more youthful look. In areas of the face such as the temples, eyes, and cheeks there can be noticeable volume loss resulting in a hollow skeletal appearance. Using fat from your own body or injectable fillers is the optimal solution for addressing this issue.
Dr. Nichter discusses the Top 5 characteristics of the neck that he evaluates for potential improvement.
- Amount of fat beneath your chin – younger patients may just need liposuction.
- Platysma bands – Located in the front of the neck. Muscles that separate and present themselves as 2 bands (a.k.a Number 11 bands).
- Amount of redundant skin – The amount of loose skin will determine if a surgical or non-surgical procedure is needed.
- Skin quality – Skin texture, acne, age spots or sun spots, broken capillaries, volume or lack of volume, fine lines and wrinkles are all taken into consideration when assessing what treatment or procedure is necessary.
- Misc. features – A prominent mandibular gland or recessed chin
Dr. Nichter talks about the people who may be a candidate for a neck lift in the video above. He states that candidates can range in age from their 20’s or 30’s up to their 80’s. Younger patients seeking neck improvement often times complain of fullness beneath their chin, which is an excess of fat, which can be removed with liposuction. If the skin doesn’t tighten from the liposuction procedure, Dr. Nichter may recommend using the Sciton® SkinTyte laser for additional neck contouring improvement. Patients who are older who are seeing the effects of aging in their neck, will often times require a combination of procedures to achieve optimal results. The procedures could be any one or more of the following: liposuction, platysmaplasty, neck lift,facelift, or laser tightening.
Patients experiencing volume loss in their face are typically good candidates for injectable fillers. In some cases, a patient may have such significant hollowing that fat transfer may be a better option due to the amount of volume needed. Voluma® by Allergan is the first FDA-approved filler for volume replacement, while other fillers such as Radiesse, Restylane, etc. are used to minimize fine lines and wrinkles. Injectable fillers are not permanent, so an ongoing commitment is needed to maintain optimal results.
Injectable fillers will typically only last 6 months to 2 years depending on the type used, however fat harvested from the body and transplanted into the face is essentially permanent. Not all of the fat cells will survive the procedure, however the ones that do survive are programmed to think they are still located in their previous location. When fat is taken from the abdomen or flanks, these cells are prone to resisting shrinkage, which means that will remain the case when transferred to the face. Unlike facial fat, which is susceptible to depletion.
In the above video Dr. Nichter discusses the various types of neck lifts he offers at his Orange County practice, Pacific Center for Plastic Surgery. He also talks about the recovery following neck lift surgery and the long term expectations with scarring.
Dr. Nichter explains how fat transfer to the face is performed. Fat transfer is a great option for those seeking a more permanent option for restoring lost volume to their face. While facial fillers are also an option, they are not long lasting like fat transfer, and they can be quite expensive if someone needs a lot of volume replacement.
Facial fillers such as Juvederm and Voluma are very popular options for improving lost volume and fine lines and wrinkles, however in some very rare cases a patient may not be pleased with the result from their treatment. Some fillers are reversible should a patient request to have the product removed. In the above video, Dr. Nichter explains this in further detail.