Thank you for your question.
You submitted a question without a photo and so I’m going to still I’m going to try
to give you some conceptual ideas of what you’re asking but you’re specifically
stating that you get injectable fillers in your lips above and below your mouth as well
as in the cheeks and you like the results and love the results actually, and you are
a little bit frustrated by the longevity that they only last 3-4 months.
And so you’re asking about other options.
Well I can certainly give you some guidance as to how I can counsel my patients in my
practice about situations like yours.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I’ve been in practice in Manhattan and Long Island for over 20 years and injectable fillers
is a very significant part of my practice and I can help you understand the thought
process that a lot of doctors use, myself included, and I think also I can also offer
you an option that still involves fillers as a strategy that might benefit in terms
of long-term results.
So In terms of the frustration with 3-4 month longevity most likely when you’re talking
about that type of longevity you’re talking about the placement of a soft tissue filler
such as Restylane or Juvederm Ultra and placing it at the more superficial levels of the tissue.
When you place these types of fillers you want a correction, an improvement and you
want to avoid lumpiness and that’s why these fillers are designed in a way so that they
minimize lumpiness and they can be placed relatively superficially.
When people say I want a longer lasting filler, very often that longer lasting filler tends
to be a filler that’s thicker.
The problem with putting a thicker filler in a superficial area is that it has the tendency
to look more lumpy and be problematic.
Now when it comes to the lips In terms of volume correction, I think that you are potentially
committed to a certain level of filler before it becomes problematic in terms of irregularities
or lumpiness.
So may want to try an alternative option from a different company and discuss this with
your doctor, but see which one maybe lasts for a little bit longer.
When it comes to the area of the cheeks as well as the area of the jawline I think there’s
something worth considering when you describe below the mouth and there is a concept that
we apply to our patients when it comes to filler placement it’s called structural
volumizing.
You see people want volume in their cheek area, and their jawline, their chin, the challenge
is getting the correction to look good and to give you really good youthful appearance.
And so there’s a distinction that I always make.
If you put a soft tissue filler more superficial or into the fatty layer of the skin, you can
only place so much and it doesn’t necessarily give you angularity it gives you a little
of volume, but if you go above a certain amount it tends to become too rounded or it tends
to kind of softly flatten out in a way that doesn’t give you definition.
Structural volumizing is a concept where we’re placing the filler at the bone structure level.
That is something that most doctors don’t do.
And there is a very specific method to doing this.
And when we place this at the bone level the cheekbones looks really really nice and really
well defined.
And when it comes to longevity the results can actually last a lot longer.
So when you use for example a Juvederm Ultra Plus or a Juvederm Voluma we can actually
have a longevity in the cheek area that can go 1 to 2 years as opposed to 3 to 4 months
that you might be experiencing now.
So the placement at that level may be a way to kind a balance out what you’re looking
for.
So when I talk to my patients about this type of procedure, the same applies so when I improve
the jawline, the chin area I’m placing it in a deeper level and typically that tends
to last longer.
The more superficial, then you just have to accept the certain amount of maintenance as
part of the process . It’s really a combination of factors and also understand that when you
place these soft tissue fillers sometimes or often the body does create some degree
of collagen and responds to that placement and you may get some correction that’s a
little bit longer term.
And sometimes my patients have actually said that it’s starting to last a little bit
longer and it actually does occur.
But everyone is an individual we have to always customize to their needs.
So the other option that you could also like to consider is of course facial implants.
But a lot of times people are used to having fillers they are not always crazy of the idea
of having facial implant placed.
Since the fillers have improved so much over the course of time.
Then facial implants do still have a very important role as a surgeon I can certainly,
I certainly use a lot of facial implants but I can say just on the day-to-day desires of
most people who want minimal downtime and quick correction fillers have become very
very versatile and it’s the placement of those fillers and the levels and the artistry
of placement that really makes a big difference.
So I think the take home message here is learn more about structural volumizing for areas
where the fillers can last longer and maybe even give you a better result than maybe what
you’re currently getting.
Maybe explore some alternative fillers in the same category to see if one type of filler
lasts longer than another.
Relatively speaking and hopefully you understand the direct relationship between the thickness
of the filler the level that it can be placed and the longevity of that filler.
So I hope that was helpful, I wish you the best of luck and thank you for your question.