Facial Implants

Dear Sir/Madam,

I'd like to ask you about facial implants and fat injections. Which is the better surgery for facial augmentation, the facial implants or the fat injection?

There is a difference between when to use a facial implant such as silicone or other materials or fat injection. I prefer to use a facial implant if there are features of the underlying bony framework that needs to be augmented. That is to say an implant adjusts the framework and the foundation, that is the bone. I use fat injection when I need to add volume, create pleasing contours, or fill in wrinkles and furrows. The fat injection allows me to be more artistic and distributes the fat and the volume over a wider area and to blend in and feather the edges. Even with carving implants, this is not as possible. There are occasions when both will work such as augmenting the cheek or sometimes the jawline. Ask your surgeon to distinguish between the above two indications and suggest what is best.

James J. Romano MD, FACS
James J. Romano MD, FACS
1650 Jackson StSFCA94109US

James J. Romano MD, FACS

1650 Jackson Street, Suite 101,
San Francisco, CA, 94109, US

Facial Implants vs Fat Grafting

Facial implants and fat grafting are not really the same thing and are not necessarily interchangeable. Facial implants are permanent devices that are implanted surgically onto the bones of the face to alter the apparent structure/shape of the facial bones. Chin implants, cheek implants and jaw implants are common examples of places that facial implants are placed to change the apparent dimensions of the facial bones. The implants once placed are permanent, fixed, firm and immobile – just like bone would be.

Fat grafting in contrast uses fat harvested from elsewhere in your body and then injected under the skin. This is done to augment the soft tissues (of the face). The grafts are soft and mobile similar to the surrounding soft tissues. Fat grafting can be used to fill out certain areas of the face where some fullness has been lost due to aging or it can be used to fill out certain areas to improve the aesthetic contours. The location and amount of fat that is injected is customizable to each individual to achieve the desired results. The locations are also not necessarily confined to bony areas of the face. Fat grafting may also at times be performed under local anesthesia.

Depending upon the specific results you want, one procedure or the other or even a combination may be the way to get the best results. Seek the consultation of a plastic surgeon certified by the American Board of Plastic Surgery. They have a website listing all the certified plastic surgeons. Members of the American Society of Aesthetic Plastic Surgery will all be board certified in plastic surgery and have demonstrated an interest and competence in cosmetic plastic surgery as well.

Alexander G. Nein MS, MD
Alexander G. Nein MS, MD
2400 Patterson StNashvilleTN37203US

Alexander G. Nein MS, MD

2400 Patterson Street, Suite 202, Nashville,
TN, 37203, US

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There is no single correct answer to your question. Without pictures and more medical history and information that would come from a face to face consultation with a ASAPS member, any advice would be speculative. Both pathways you have offered will work for the "right" person. In general, facial implants are more lasting in terms of the "volume fill." There is always a regression of volume fill with fat injection over time. So, the best answer for you is to find a ASAPS member in your area and go over these options.

Michael I. Kulick MD
Michael I. Kulick MD
450 Sutter StSFCA94108US

Michael I. Kulick MD

450 Sutter Street, Suite 2620,
San Francisco, CA, 94108, US

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