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Fat Grafting or Fillers

Fat Grafting or Fillers

Patient I: Dr Sin Yong, I want to look younger. My friends suggested that I go ahead for fat grafting to improve me facial volume.

Is that the best option for me?

Fat Grafting has been around since the 1900s and has progressed to allow for improvement of volume in multiple regions apart from just the face. Think about buttock augmentation, breast augmentation, etc etc

Dermal Fillers used to be bovine collagen in the 1970s and has went on to include hyaluronic acid fillers since the 2000s, a natural progression of technology and research. 

Here, let’s examine the potential advantages of each!


Fillers

  • Exact “take”.One ml = one ml
  • Possibility of dissolving if dislike results
  • Collagen stimulating agents for rejuvenation effect 
  • Variable hardness to give strong or soft contour depending on region intending to improve
  • No fat embolism complications
  • Ready to use in sterile syringes – Lunch Time Procedure
  • Longevity according to filler, ranges 1-3 years

Fat Grafting

  • Variable “take” according to region and individual
  • Unlikely to dissolve if overfilled 
  • Stimulates collagen depending on level of placement
  • One hardness and will grant less definition to areas that require strong lifting
  • Possibility of fat embolism complications 
  • Need for liposuction procedure with associated downtime to harvest the fat
  • Longevity is permanent

What does this mean for patients?

As a patient, you would need to consider the following factors

  1. Down Time– Fat grafting will always involve a surgical procedure to harvest the fat, whereby post procedure, there will always be some swelling and bruising over the donor site. Fillers are pre manufactured and ready to use in sterile syringes.
  2. Fall Back Plan – The question to ask here is whether you are certain of the end result. If you have tried fillers before and like the resultant look, you might be a good candidate for fat grafting if you seek permanent long term results. Conversely, if you have not seen a possible end result before, jumping straight to fat grafting might be a huge risk as you will have to bear the end result as longevity is relatively permanent.
  3. Region to be treated – Certain areas such as the chin, jawline and nose will require a filling with increased hardness and stronger lifting effect. In such regions, fillers with strong lift are superior to fat grafting to provide the ideal result.
  4. Are you ready? – Ask yourself this over and over again before going for fat grafting, as this is something that is minimally reversible. It can dramatically improve your looks permanently, but also carries a possibility of permanently changing your facial contour in a way you might not like. 

Can Fillers Be Dissolved and Reversed?

Yes, it can! And it is accomplished through the use of Goal Directed Hyalase!

Goal directed hyalase targets hyaluronic acid fillers that requires dissolving.

Common regions for goal directed hyalase include:

  • Irregular contours
  • Too superficial placement of fillers
  • Unsightly bumps
  • Grossly assymetrical facial features due to fillers

By only dissolving small amounts of fillers using appropriate amounts of hyalase, we will be able to restore the facial contour and shape without removing all the fillers that are on the face. 

Steps To Goal Directed Hyalase

1) Clinical History Assessment 
Evaluates what type of filler, the amount placed, the technique employed.

2) Physical Facial Assessment
Evaluates the depth of placement and amount of filler present. Also evaluates what is the ideal treatment forward – whether to dissolve all fillers (Clean Slate Technique) VS partial dissolution (Goal Directed). 

3) Allergy Testing 
Hyalase treatment carries a small chance of allergy and requires a testing on the skin if you have not used hyalase prior. 

4) Commencement of Hyalase Treatment
Results should be ideal and visible immediately after treatment and can persist to improve over the next 48 hours. 

* Dr Sin Yong is a regular user of Goal Directed Hyalase to treat over filled areas or areas that require even the most minute correction to achieve overall facial symmetry and proportion. Always consult your doctor before commencing such a treatment. 

Dr Sin Yong Recommendations

Depending on the area treated, the solution might not always be to fill the area with fillers. Take dark eye circles for example, we are always looking at a possibility of increased pigmentation, increased vascularity, or lack of volume. Using fat grafting or fillers as one size fit all treatment will not produce the superior results compared with using multiple modalities to target the root cause of the problem, which might be increased blood vessels or pigments. 

Dr Sin Yong trains other doctors in dermal fillers and is an advocate of advanced fillers such as Radiesse and Ellanse.
Based on region treated, he would recommend the use of advanced fillers like Ellanse / Radiesse if permissible, giving especially good results on the nose as compared to using HAs. HAs will have to be selected in other regions like lips / tear trough, where it would not be permissible to use advanced fillers. 

Dermal filler treatment or fat grafting is a minimally invasive procedure and cases of complication have been reported. It is hence important to select an adequately trained physician to perform the procedure for you. Do consider all the above factors before proceeding with such a procedure. 

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