.

Fillers or Facial and Periocular Fat Transfer?

By Dr. José Villamarín.

Today we are going to talk about the most interesting options we have to redefine or rejuvenate the look, as well as other parts of the face or neck and hands: fillers -also called dermal fillers or injectables- and lipofilling, also called autologous fat transfer or fat transfer.

As we all know, one of the most important components of aging of the eyelids and periocular area, as well as in other parts of the body, is the collapse or thinning of the subcutaneous tissues, as well as the appearance of wrinkles and loss of smoothness and elasticity of the skin. the skin. Fillers and grease have an important role in improving or solving these problems.

Who should inject fillers or other substances into the face or neck?

It is a great controversy. But in my practice, I am solely responsible for the injection of this or other substances and other procedures, since I consider that it is a real medical act with its benefits and risks, and I have my opinion based on many concepts, reasoning and experience.

In my opinion, the injection of dermal fillers or other substances or the execution of procedures on the face, and in the periocular area in particular, requires a deep knowledge of human anatomy, specially face and neck anatomy, which I believe can only be achieved after long studies and dissections with cadavers, as well as studies of human pathology and surgery, in the achievement of the degree of doctor of Medicine (M.D.). In addition, the dissection of cadavers for doctors is highly recommended as ongoing training, an activity that many doctors and aesthetic surgeons tend to perform frequently, and among which I include myself, in authorized courses throughout the world.

I also agree with the opinion that it is not only a matter of knowing how to correctly inject (using needles or cannulas) any type of substance, such as anti-wrinkle treatment with neuromodulators, dermal fillers or local anesthetics, but also understanding and knowing how to prevent and treat its complications, which although rare, they can be very serious. The medical doctor, in my opinion, is the only one with deep scientific-technical training and with full legal responsibility in this and other medical acts, as well as the only one prepared to receive their achievements and to manage their derivated or secondary complications.

What are the main differences between dermal fillers and facial and periocular lipofilling or fat transfer?

Dermal fillers, fillers or fillers, are substances that are injected with special needles or safety cannulas and in consultations, by authorized and trained personnel, to give volume and shape to areas that require it, particularly aged areas of the face, neck and hands. One of the areas where they are most frequently injected is the middle third of the face and the periocular region, in particular. There are many dermal fillers that are injected in many countries, and some are banned in Spain. Those authorized in Spain include hyaluronic acid, calcium hydroxyapatite, and polylactic acid, mainly.

On the other hand, autologous fat transfer is a great alternative to dermal filler. It consists of extracting fat from other parts of the body, with special technology, usual specific processing, and injection in the face, neck and hands, mainly. It can have volumizing and also regenerative effects, and each function has its protocol and technology. Usually, the lipofilling procedure with the fat transfer to the face is performed in the operating room with local anesthesia and sedation, for a primarily volumizing effect, and sometimes combined with other procedures. On rare occasions it is performed in consultation, with local anesthesia and for regenerative processes (stromal vascular fraction) rather than volumizers and using a special protocol. However, fillers are generally injected in the office and with topical anesthesia and special creams.

The transfer of your own fat performed on the face, neck, or hands for rejuvenation or redefinition, does not imply a risk that your body will reject it. The fillers can give integration problems or some degree of reaction or rejection.

The final results of fat transfer can take from three to nine months to be fully visible, the time it takes for the fat to integrate structurally and functionally, and they last for many years, which we consider permanent. This is not usually observed with fillers, which tend to have an immediate effect but last a short time, at most 6 to 24 months.

Finally, it is common to see a little more inflammation, bruising and slower recovery with lipofilling in the postoperative period.

Due to the greater complexity, lipofilling is more expensive as a single act, although if we add up the cost of fillers over several years, there are many cases where fillers are more expensive. In any case, lipofilling does not cause filler fatigue, filler overfilling syndrome or rejection, problems that I will talk about in future blogs.

The conclusions…

In essence, both techniques are excellent solutions and their indications depend on the needs and desires of the patient, the doctor’s recommendation, and the situation of each case. In any case, the fillers are more immediate, repeatable due to transients, injection in consultation and cheaper for each application. On the other hand, lipofilling, aka as fat tranfer, is usually used in the operating room, the result is delayed but permanent and usually a single application, and it does not produce rejection reactions. In general, for young people the use of fillers is admissible; In older patients, with other pending surgical procedures or previous treatments with fillers, I recommend fat transfer.

If you want more information, do not hesitate to contact Dr. José Villamarín requesting an appointment in person or through his online consultation. Thank you.