Filling in a face that looks drawn

08/14/2012 12:00 AM

08/13/2012 2:26 PM

Q. I am getting concerned with my looks. I am in my early 30s and in great shape. The problem is that as my body looks better, my face is looking worse. I look drawn and older. My friend, who doesn’t work out, and recently lost lots of weight, has that same look. What can I do and do you suggest the same thing for my friend?

Fortunately for you, we have many avenues to help you and your friend. I will first tell you about non-surgical options. There are many non-permanent fillers that will work for you. These include Restylane, Perlane, Juviderm, Radiesse and Sculptra. I am going to assume you are not planning to suspend your (probably) insane workout, nor do you have unlimited resources to spend on fillers.

Given those assumptions, I am going to recommend that you start with Sculptra, which is what I call a bio-active filler. It kicks your immune system into high gear and gets your cells to produce collagen. This collagen fills in your volume loss so that you will no longer look like you’ve had a facial weight loss.

In essence , when you use Sculptra , you are building a scaffold to fill in and support your tissue. This support, once established, may last up to one year or more. Other fillers would work well, but the amount of money and the longevity of the products might not be as long.

You have to let your physician know you want Sculptra in advance, as it needs to be mixed a day or two before use. Your physician will inject you, usually with two vials, to maximize your results.

Initially, you will look great, but over the next few days you will likely think your doctor ripped you off (he didn’t). Approximately three weeks after you have been injected, your face will start “growing,’’ filling in the volume loss.

This “growth’’ is your body’s collagen filling in. You will be asked to return to your doctor’s office about four to six weeks after your injections to be evaluated and to see if you need more Sculptra. If you do not, you should plan on a refresher course of injections about once a year. I would give your friend the same advice.

A surgical option for you is fat transfer, assuming you have any fat to give.

I like to do temporary fillers to make sure you like the new potential look. If you do, then you can go ahead with grafting. If you don’t, no harm done.

Fat grafting may be done using local or general anesthesia. Fat is removed using low pressure so as not to injure the fat stem cells. Your fat is “prepared’’ the way your surgeon feels is best. Then the fat is transferred into syringes and injected under low pressure and in small quantities to improve the chances of survival.. Fat transfers are very satisfying to the surgeon and the patient because the results are long lasting (permanent once it takes) and the supply is usually endless.

About Dr. Carlos Wolf

Dr. Carlos Wolf

@carloswolfmd

Dr. Carlos Wolf has been working in the field of plastic surgery for more than 20 years. He answers your questions about plastic surgery.

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