People ask me all the time, “What are the different options to add volume to my face?” I believe the real question should be, “Do I need volume added to my face, where should I place it, and what should I use?” As we age, we seem to gain more fat on the areas of the body where we do not want it, such as on the abdomen, butt, and thighs, and we lose it where we want it, on the face. As the founder of Carolina Facial Plastic Surgery Center in Charlotte and Columbia, I believe in adding volume to correct facial topography. Topography is defined as recording the three-dimensional quality of a surface, and is most commonly used to describe the surface of the earth (elevations, depressions, hills, and valleys). A face that has smooth topography or smooth transitions from one area of the face to another will reflect light, which creates a bright, attractive appearance. A face that is depleted of volume will have an irregular facial topography, or many “hills and valleys”. These irregularities cast shadows on the face that create an aged appearance.
I use injectable fillers of the face in two ways. They can either be used to fill in specific lines and camouflage a deep crease, or be used to correct the underlying cause of aging and loss of facial fat. The ability to fill in a deep wrinkle such as the smile lines or fine lines is a straight-forward, easy, and satisfactory use of injectable fillers such as Perlane, Restylane, or Juvéderm.
Facial topography of a youthful face is best described as smooth. A youthful face has a smooth transition from the cheek that gently flows into a small valley, underneath the eye or the smile line. As we age, the smoothness is lost and the facial topography becomes more irregular. The aging face accumulates hills and valleys in the facial contour that add shadows to the face. I believe this shadowing effect is a great contributor to facial aging. This type of aging is corrected in a more sophisticated manner using injectable fillers and autologous fat transfer. The face is composed of interconnecting web fat compartments. Different people lose fat at different rates in each compartment, and filling these compartments with either injectable fillers or autologous fat transferred to the face can greatly improve facial topography. This form of facial rejuvenation requires an artistic eye and requires the detailed anatomic knowledge of the face that a facial cosmetic surgeon possesses.
Autologous means that the injectable material is from your own body. This makes the product more natural and safer to inject than a product that is not made by your body. Fat transfer is known to create great results, but it can be unpredictable. Injectable fillers are natural products but they are not alive, and thus we know how they will behave and how long they will last. Autologous fat taken from the abdomen or legs is alive tissue, and as in all living tissue, it may change with time. Patients who often have significant changes in their weight may not be the best candidates for autologous fat transfer, as the transferred fat to the face has the potential to grow if the patient gains a large amount of weight. Generally, transferred fat will look good immediately after the procedure but some of the transferred fat will not survive and the volume will go down. In many patients, the fat will slowly come back to give a smoother facial appearance over time. It is still unknown how long autologous fat will last, as the fat is living tissue. I know that autologous grafted fat will last longer than the injectable facial filler. In the medical community, many believe that the effect of fat transfer to the face can last 3-10 years. This is a wide range, but again, we are dealing with live tissues.
At the Carolina Facial Plastic Surgery Center, we strongly believe loss of facial volume in specific areas changes the facial topography. If we can improve facial topography and smooth the facial transitions, we believe we can get faces with fantastically youthful appearances. Autologous fat transfer and injectable facial fillers are two options that are available to selectively add volume back to the aged face.
Dr. Jonathan Kulbersh is a board certified head and neck surgeon who completed his fellowship in Beverly Hills in facial plastic and reconstructive surgery. He has two offices in the Carolinas. One office is in the Southpark area of Charlotte serving the Eastover, Meyers Park, Ballentyne, Lake Norman, and Huntersville areas. The other office is in Irmo, South Carolina, serving Columbia, Lexington, and the Lake Murray regions.