Are permanent and semi-permanent fillers good options for facial volume
people often ask for permanent solutions for issues like facial volume deficit
related to genetics or facial volume loss due to aging it's natural to want
something that will last and not require periodic maintenance it is important to
know the potential adverse effects of semi-permanent and permanent fillers and
the higher risk involved with using them in comparison to hyaluronic acid fillers
which I use routinely in my practice I'm Dr. Amiya Prasad 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 in my practice I've performed comprehensive treatments for facial
aging which include facelift surgery eyelid surgery and facial implants two
specialized techniques for injectable filler placement and the use of lasers
and radiofrequency technology my approach is characterized by a natural
aesthetic style I select procedures for my patients based on meaning of specific
criteria including safety predictability and minimal to no recovery time when it
comes to permanent procedures I often say that most patients want something
permanent until they deal with the problems from so-called permanent
solutions procedures such as facial implants are considered to be permanent
however it's important to remember that your face is not permanent when you're
younger facial dimensions can fluctuate with changes in weight as you age facial
volume changes from diminishing bone muscle fat and soft tissue changes in
bone volume may the most significant impact as the bone
structure provides the foundation for the whole face so even if a facial
implant itself is permanent as bone volume changes with aging a facial
implant will be affected by the changes in bone structure while facial implants
can be surgically removed and replaced as the face changes semi-permanent and
permanent fillers are not in any way comparable in terms of the ease of
removal if surgery is required to remove semi-permanent or permanent fillers it's
typically not possible to remove all of the material these materials can move in
deeper areas so that many fragments of material it becomes too risky to try to
remove these fragments because of the risk to nerves which can cause facial
paralysis unlike hyaluronic acid which exists
naturally in the body and is therefore safely metabolized by the body
semi-permanent and permanent fillers are designed to be resistant to any of the
body's natural metabolic processes it is possible to get what's called a foreign
body reaction to semi-permanent and permanent fillers the result can be a
formation of disfiguring nodules which require surgical removal this is
typically associated with the additional loss of normal skin and additional soft
tissue infections are a possibility with any filler treatment or implant bacteria
from the skin surface can enter the skin when the filler is placed resulting in a
type of infection called biofilm when any infection occurs with an implant in
almost every case the implant is removed in the case of a hyaluronic acid filler
the filler can be dissolved with an enzyme called hyaluronidase which
eliminates the site where the bacteria takes hold with semi-permanent or
permanent fillers dissolving is not an option and surgical removal becomes the
only option unfortunately when bacteria create a
biofilm type of infection even after extensive surgery with maximal removal
of material recurrent infections can continue to occur in the spirit of
providing my patients with safety predictability and if needed
reversibility I recommend hyaluronic acid fillers for
volume correction hyaluronic acid fillers come in various thicknesses and
viscosities which are suitable for different areas of the face for the
cheeks jawline and chin I routinely use hyaluronic acid fillers like Juvederm
Ultra Plus and Juvederm Voluma these thicker fillers can last one to two
years and are safely metabolized by the body they are also completely reversible
and can be dissolved without surgery using the enzyme hyaluronidase I place
these fillers in the cheeks using a special technique called Structural
Volumizing which I'm able to place fillers deeper at the bone level under
the muscles so the fillers don't spread and look soft and doughy this deeper
placement gives the face a much more solid defined and contoured structure as
compared to traditional filler placement in the soft tissue layer of the cheeks
which can look puffy as the filler spreads out for the lips upper and lower
eyelids are used softer fillers like Restylane-L Restylane Silk Juvederm
Juvederm Voluma I use specialized techniques for
placement such as the use of blunt cannulas through limited entry points
for the lips this makes the procedure more
comfortable with a low risk for bruising and minimal swelling as an eyelid
surgery specialist I routinely use cannulas and soft hyaluronic acid
fillers to treat areas such as the tear trough and camouflage minimal puffy
under eye bags these softer fillers can last six months to a year since all of
these fillers are made of hyaluronic acid a naturally occurring substance in
the body they are all safely metabolize was time there are other facial fillers
that are not permanent but have some disadvantages in my opinion for example
poly-l-lactic acid which is used in the material called Sculptra is a material
that triggers a metabolic response to create volume I previously used Sculptra
before the introduction of the newer hyaluronic acid fillers each patient
responded to polylactic acid differently making outcomes less predictable
another material i used to use is Radiesse Radiesse is made up of a material called
calcium hydroxyapatite which is similar to bone the calcium hydroxyapatite is
in the form of tiny spheres which are suspended in a gel medium the drawback
to Radiesse is that the material is not reversible or fully removable despite
having a substance similar to bone the effects of radius typically does not
last as long as a thicker hyaluronic acid filler like Juvederm Voluma in
consultation I find that once people understand that the natural anatomic
features of the face are not permanent and that the facial foundation changes
with time then semi-permanent or permanent fillers are not optimal safety
and predictability are extremely important when it comes to any filler
treatment while hyaluronic acid fillers are not permanent that can be placed
predictably and they can last a long time they're safe to use and they are
easily reversible I hope you found this information helpful thank you for your
question