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Facial voluminization can be done by three specific treatment methods. Non-surgical synthetic injectable fillers, autologous fat injections or implants of various material compositions are the different approaches, each with their own advantages and disadvantages. While some tout that one facial volume method is better than the others, the reality is that each one has specific indications and no method is best for all patients. Thus I prefer to think of facial volume methods as part of a circle where patients enter and leave various points in the circle based on their outcomes. (e.g., a patient may ‘graduate’ from injectable fillers and now want a permanent implant)

One facial skeletal area where injections probably have the highest rate of aesthetic success is that of the cheeks. Because the cheeks cover a broad midfacial area and patients usually desire a softer contour, non-hard materials like injectable fillers and fat can have successful results. But lack of permanency and/or failure to achieve a distinct shape make it necessary to turn to implants and go to a different point in the facial volume circle.

The differences between fillers and implants in the cheek area is best seen on a 3D CT scan. A 3D CT scan of patient who had 11ccs of Radiesse injectable filler in the cheeks had decided to get a permanent result with custom cheek implants. Since he liked the overall volume of the fillers the custom implants were designed to have a similar volume but with a distinct shape higher up along the infraorbital rim and then out onto the cheek and zygomatic arch. The scan also shows that fillers are out in the soft tissue while implants are down on the bone. These implanted location areas combined with differences in the material stiffnesses account for their different aesthetic effects even though their volumes are similar.

Dr. Barry Eppley

Indianapolis, Indiana

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