Question:

I'm a 38-year-old woman with very hollow cheeks looking to have either fillers or cheek implants.  In making my decision about a treatment and a doctor, I would like to know how long lasting these types of treatments usually are. 

Answer:

This is a very good question.  The answer to your question, however, depends upon the treatment that is agreed upon.  There are multiple fillers that can be used to enhance the cheek region or what we call the malar eminence, if this is in fact what you are talking about. 

When discussing fillers the first category that we look at is permanent versus non-permanent fillers.  The permanent fillers of which silicone is the most commonly mentioned are in my estimation not the first line of choice.  

Permanent fillers have a potential of having more important or long lasting complications.  Although it is attractive to consider a treatment to be permanent, it also can be a negative if there is a complication associated with the permanent implant.  I have seen in my practice several complications from permanent silicone-based implants placed not only in the lips but around the eyes and in the cheeks as well.  For this reason it is my preference to begin any treatment with fillers with an absorbable or non-permanent filler.  

The types of fillers available today are collagen, hyaluronic acids, poly-l-lactic acid which is Sculptra, and calcium hydroxylapatite which is Radiesse.  All of these fillers have different qualities and characteristics which are unique to that particular filler.  

It is important to discuss the type of filler that you are using with your physician so that you understand the limitations, the benefits and the potential complications from each filler.  

Having said that, most absorbable fillers are very safe.  The most common complications are very minimal and are related to the injection sites.  The most common side effects from injections are bruising, redness and later the development of nodules or lumpiness.  When a filler is permanent, the chances for a more serious complication such as a foreign body granuloma, which is a type of reaction to a foreign body, is even greater. 

The good thing about using non-permanent fillers is if you do not like the result or if you are unfortunate enough to have a complication, these almost always go away.  

In addition there is a subset of absorbable or non-permanent fillers which can be treated with an antidote to dissolve that filler.  Hyaluronic acid fillers such as Juvederm, Restylane or Prevel have an antidote that can be injected which disintegrates the filler almost immediately.  This is another advantage of these types of fillers.  

It is very important to talk to your doctor who is going to be filling your face with these substances to make sure that he explains all of the benefits and potential risks with ways of treating these.  

Lastly, I would mention that fat injections which consist of taking your own fat, preparing that fat, putting it into syringes and then injecting the fat into the areas where you need it is a very safe procedure, although it is an operative procedure which must be performed in the office or in an operating room.  

Once again, I stress and emphasize the need to have a detailed conversation with your certified plastic surgeon regarding the risks, benefits and potential complications of any filler that you use.  There is the possibility that your own fat, when injected into your face or other areas where it is needed, could possibly last permanently. 

Posted by:  Dr. Siporin