Answer: Injectable fillers would be good for you. Yours is a great indication for non-surgical options such as fillers. For augmenting the cheeks, we do use surgical and non-surgical procedures somewhat more often to correct aging changes; however for those who naturally have poor cheek projection and shape these techniques can provide equal or even greater improvement. In my practice, the surgical options would include fat transfer, cheek implants or a mid-face lift. Among the injectable fillers, I prefer either Radiesse or Sculptra for cheek augmentation.

Answer: When comparing fat transfer with injectable fillers for facial rejuvenation, the benefits of fat transfer are: it is autologous tissue and not a synthesized product; it can provide large volumes at a more reasonable cost; the results should be longer lasting and even permanent. The downsides of fat transfer are: there is a risk of visible or palpable nodules or lumps if injected too superficially or in certain areas like the lips; it may be most comfortably performed under IV sedation for anesthesia. Fat transfer is best indicated for correction of deep facial wrinkles or folds and for restoring volume to the cheeks and other areas of the face, which has been lost as a result of aging and or weight loss.

Answer: There is no one single filler that is the best for treating facial lines in all circumstances. There are a variety of fillers available and they have different properties and different indications. Hyaluronic acid fillers (Juvederm, Restylane) are best for filling superficial and intermediate facial lines. Radiesse is best for intermediate to deep facial lines and folds. Radiesse and Sculptra are used to restore lost volume from atrophy. These fillers can all be effective at temporarily correcting more minor changes of facial aging at limited expense and with no down time. When these changes become more advanced, surgical procedures will likely be more effective and even more affordable than repeated treatments with temporary fillers.

Answer: Radiessse provides temporary relief of facial wrinkles and folds. It is one of the longer lasting of the dermal/soft tissue fillers. Its effects will last up to 9 months or more. Radiesse is meant to be injected into the deep layers of skin or beneath the skin in the subcutaneous fat layers. It is best used for correcting deep wrinkles and folds and for restoring volume in areas of the face where there has been atrophy and loss of soft tissue and even bone. Radiesse is often used in combination with other fillers such as hyaluronic acid (HA) products where layering is performed, injecting Radiesse in a deeper plane to elevate a deep fold and injecting the HA filler in amore superficial layer to correct the overlying skin crease.

Answer: Injectables such as Botox and fillers are excellent products that have revolutionized aesthetic medicine. They are safe and effective and can be performed during a brief office visit, with little or no anesthesia and with little or no down time. They should not however be mistaken for the non-surgical equivalent of surgical procedures. In general, injectable procedures give much more temporary and less dramatic results when compared with surgical procedures. They are wonderful for correction of earlier, more minor changes of facial aging, and for patients who desire more subtle improvements or who cannot take time off for recovery from surgery. There is no amount or technique of filler injection that can accomplish what a facelift, eyelid lift, or nose job can. When practitioners who are not surgeons attempt to do so, the procedures may be equally or more costly compared with surgery, and sometimes give unnatural or even grotesque results.

Answer: Botox and injectable fillers are similar only in that they are both indicated for correction of facial wrinkles caused by aging and or muscle activity. They differ in the parts of the face for their intended use and in their mechanism of action. Botulinum toxins like Botox and Dysport are primarily used in the upper one third of the face. Their only FDA approved indication is for correction of the frown lines between the eyebrows. All other uses are “off label”. Botulinum toxins are neuro-muscular blockers that paralyze facial muscles. They temporarily correct facial wrinkles by reducing or eliminating the muscle activity that causes them. Their effects last about 3 to 4 months. Injectable fillers such as Restylane, Juvederm and Radiesse are primarily used in the lower two thirds of the face. They temporarily correct facial wrinkles and folds by directly filling them in and restoring lost volume. Their effects last from 6 to 12 months.

Answer: Wrinkles in the forehead are animation lines that result from contraction of the frontalis muscle that elevates the eyebrows. For that reason, they are primarily treated with botulinum toxins to paralyze the muscle. When forehead wrinkles are present without animation, then they may be corrected with injectable fillers. These wrinkles are relatively superficial and therefore are best treated with hyaluronic acid type fillers that are the safest to inject into the intermediate layers of the skin. These fillers include Juvederm Ultra and Ultra Plus, Restylane and Perlane. Their effects should last between 6 and 9 months. Complications include bruising, visible or palpable lumpiness or skin discoloration from visible, superficially injected product. Other more rare complications include temporary redness or inflammation, and skin necrosis. Longer lasting fillers such as Radiesse and Sculptra are meant to be injected into deeper layers and would be inferior for correction of forehead wrikles in most patients.