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Filler vs. Sculptra vs. Fat Grafting
As indiviuals age, facial volume diminishes uniformly across the face. Lines, such as the nasolabial folds all deepen. 30 years ago the only option to treat these issues was injectable collagen. Believe it or not that collagen consisted of ground up cows’ skin that was harvested from cows raised on an island to avoid transmission of deadly Mad Cow Disease, which is caused by a virus known as Creutzfeldt-Jakob disease.
Wow, have we come along way. The first breakthrough came along about 20 years ago when science learned to synthesize hyaluronic acid. Hyaluronic acid is a clear gel which occurs in nature in humans and animals as well. It absorbs water. Restylane was the first synthesized hyaluronic acid available for facial injection. Then came Juvederm. Now there are too many different hyaluronics to count. They all are variations on the theme, and have different half-lives, densities, durability, pliability, etc. Hyaluronics are an important tool in the armamentarium of plastic surgery. They have a remarkable safety record in the right hands and essentially obviate the need for allergy testing that was associated with collagen. Perhaps the biggest drawback to hyaluronic is that they are expensive. They are universally packaged in one cc syringes. One cc is only 1/5 of a teaspoon and 1/15 of a tablespoon. The cost of one cc is $700-$900 per cc. In a simplified sense, they tend to last between six months or a year. So using hyaluronics to restore global facial volume is universally disappointing. Unfortunately when they are injected in very high quantities, they can have lingering effects, such as persistent edema, which is a major drawback.
The next Injectable that came along was Sculptra. Sculptra is small particles of a corn sugar that is injected into the face. The body reabsorbs the Sculptra, but in its place deposits its own collagen. This whole process takes nine months to fully flourish. But the advantage of Sculptra over other fillers is that Sculptra creates four or five times the volume of a single syringe of filler. It is only slightly more expensive per injection. So Sculptra gives more bang for your buck in terms of volume and durability. Because Sculptra is so long lasting it should only be injected by highly skilled and trained injectors. In inexperienced hands, it can cause some dense lumps of collagen. Granted, these are more often more palpable than invisible. Fortunately, they are extremely rare in skilled hands. Make sure your Sculptra injector has good skills and lots of experience.
The latest injectable is fat grafting. Fat can be harvested from a fatty area of the body, isolated and centrifuged, and then injected into the face. Fat has several advantages. Generally, it is available in more than adequate quantities. Many patients are pleased with the idea that no foreign substances are introduced into the body. Our fat cells are the closest thing that most people have to stem cells. Stem cells are proven to be somewhat regenerative in a wide variety of settings. I was hesitant initially to make this claim, but we have seen many cases where skin texture, previous scarring, etc. is improved, presumably due to the stem cell effect of the fat grafting. The total one time cost of fat grafting is generally higher than injectables. However, when you consider the cost per CC and the permanent durability of fat, all of a sudden, fat grafting becomes by far the most economical approach. When performing fat grafting, we analyze the patients face in youth and analyze the contours by printing out your older face pictures in black-and-white. We then try to mimic them so that we create and restore a pattern that actually occurred in nature. There are clearly examples in Hollywood of stars who have had excessive fat grafting. In well over a decade of fat grafting we have never had such an occurrence. Fat grafting is so effective, predictable, and gratifying that we typically perform approximately 40 to 60 cc of fat grafting on almost all of our facelifts.
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