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Q:

What are pros/cons of these 3 methods of enhancing the upper cheek/temple of the face: fat transfer, Bellafill, and Sculptra?

Wondering if it is just the individual preference of the doctor (as to what he or she is most accustomed to using), or is there a big cost difference and/or variation in the lasting effect? Do all the methods have equally predictable results?

A:

Hello and thanks for posting.

The forehead is one of the best regions for fillers. Botox can help with dynamic lines, but does not address the volume loss. Like many aspects of facial rejuvenation, combination therapy often yields the best results.

The individual preference of the doctor does mean a lot. Practitioners develop experience and comfort with certain approaches and tend to recommend treatments that they know well. I have seen new patients who report that they had previous consultations in which they received very different treatment plan suggestions from different clinicians. This reflects the fact that in many situations there are multiple ways to achieve a positive aesthetic outcome.

Your question is a case in point. Volume augmentation of the upper cheek/temple may be effectively performed Bellafill, Sculptra, or fat grafting. Other approaches include HA fillers like Voluma or Restylane Lyft. Radiesse is also a filler that may be used in these regions. So there is no one “best” strategy and certainly no controlled trials that demonstrate superiority of one filler vs another.
That said, there are significant differences between these fillers.

I have never performed fat grafting, mainly because the results are so unpredictable. I can’t tell you how many patients have told me that they had fat grafting and it was all gone within a few months. But some surgeons love injecting fat and believe that in many cases the transplanted fat survives and produces long-term benefit. I have seen some good results in patients who had fat grafting, but I have also seen really bad results as well.

Bellafill is the only FDA approved permanent filler. It is also the most expensive. It is composed of 80% bovine collagen and 20% PMMA. The PMMA is the permanent component of this filler. Because only a portion of the injected filler is permanent, a series of injections is needed to achieve long-term durable results. There is also a chance of late development of granulomas, inflammatory nodules that may result from an overly robust immunologic reaction directed at the PMMA. The risk of granulomas was 1.7% over 5 years. Because of the permanent nature of this filler and risk of granulomas, many practitioners want nothing to do with this product. However, I really like using this filler because of the durable and generally predictable results. The unpredictability of this product really pertains to the risk of granuloma. If it does occur, this complication can be effectively managed by injecting the granulomas with corticosteroids and 5FU.

Sculptra – PLLA – is a filler that has a very gradual onset of action, it takes a full 2-3 months after injection to know exactly how much volume enhancement will develop. So the unpredictability is related to the variable amount of collagen that different individuals produce in response to the PLLA. This product is typically injected at 2 month intervals in a series of injections and the results typically last about 2 years. It has remained a niche type filler because of this slow onset of action in arena where most people are looking for faster results. The immediate costs are lower than Bellafill, but in the long-term follow up treatments will be necessary.

I hope that this information helps and best of luck to you!

Regards,
Dr. Pierone

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