Facial Fat Transfer vs. Fillers: Which is Better for You? [Shannon O'Brien, MD, Portland]

Eva Sheie (00:00):
You're listening to Where Before Meets After. Have you heard of filler fatigue and have you seen it with your own eyes?

Dr. O'Brien (00:07):
Yeah. Filler fatigue in general is when patients just get tired of coming in and having injections and requiring injections, which even if it's only once a year, it's another time to have to come in and kind of be messed with. And so people have turned to things that may be a little more regenerative in stimulating tissue growth, in growth, stimulating collagens. And then sometimes I'll use fat instead of filler. So it's the patient's own tissues, which has some benefits as well.

Eva Sheie (00:45):
If you're suffering from filler fatigue and you have currently an HA filler in your face, can you get it reversed?

Dr. O'Brien (00:55):
HA fillers can be reversed if it's a result you're not happy with or if you want to do something different, try something different. There's an enzyme that we naturally make in our body that has been reproduced pharmacologically, that can be injected in and dissolves this sugar, which is the hyaluronic acid is a sugar. And so that enzyme sort of breaks it down and things kind of settle back to where they were before typically.

Eva Sheie (01:27):
Are you seeing any other consequences of filler fatigue like people coming in for facelifts or asking for surgical consults earlier than they may have in the past?

Dr. O'Brien (01:40):
I think that in general, people talk about and are a little more open with the fact that surgery is sometimes what's necessary to correct their problems rather than just sort of sneaking and trying to get a needle to correct things that maybe surgery needs to. I think there's a little more recognition with that. And that has probably come out of filler fatigue, patients who have been trying with filler and kind of get tired of it. But I also think people are just a bit more open and with social media, I think that people understand what filler can and can't do. Whereas I think people were dumping milliliter after milliliter of filler into people's faces when in reality that was maybe making them look a little odd, not necessarily more youthful.

Eva Sheie (02:26):
Yeah. So many TV shows to use as examples, bad examples. How young is too young to get a facelift?

Dr. O'Brien (02:36):
Facelifts can be done on the earlier side, but it's more common in ladies or men who have lost some weight. If their skin has been stretched at some point, such that then after they lose weight, they may become candidates earlier than what we would traditionally have thought of as facelift candidates. Sometimes it's just in the neck and the face is still preserved in some of the younger years after weight loss, but there's not really specifically a too young to have a facelift depending on the circumstances of your life. But in general, most people start moving into that realm in their 40s, 50s, sometimes 60s.

Eva Sheie (03:19):
What are the advantages of using fat over fillers? Because we started with fat and then we didn't close that.

Dr. O'Brien (03:25):
I think that fat is a nice alternative to fillers because it is your own tissue and the cells that survive the move, and by move, I mean I borrow the fat from the belly or a thigh or something like that and sort of clear out any fluids or oils. And then I inject just the fat cells back into a spot on the face whether it's cheeks or lips or temples. It can be used in all the same places as filler can be used. And some of those fat cells will set up their blood supply and will stick around for a really long time. We do tend to continue to lose fat in our faces. And so as we age, some of that fat may disappear again, but it's your own. Sometimes with fillers, people have a little bit of a puffy aspect to the appearance of the skin or the body part in particular underneath the eyelids.

(04:22):
Ladies and gentlemen who've had filler under their eyes can definitely see a little bit of a almost water balloonish look and sometimes a little bluish look to the area. And that's never what you want to see. And so using your own fat does not create that same response. And most people don't mind repurposing their fat from a place that maybe they don't feel like they want or need it to a place where they do. So it's kind of a win-win.

Eva Sheie (04:54):
Recycling is good.

Dr. O'Brien (04:56):
Yes.

Eva Sheie (04:58):
Okay. Is there anything else that we should cover today?

Dr. O'Brien (05:01):
I often do fat grafting at the time of other facial procedures or even other procedures. It can be something that's added on while you're asleep already.

Eva Sheie (05:12):
Could you do it with a LUX peel at the same time?

Dr. O'Brien (05:15):
Usually do it separately from the LUX peel because with fat grafting and with the LUX peel, you definitely get some swelling and you just don't want too much inflammation sort of get one in place and then take care of the ... If you do the fat grafting first or you do the LUX peel first and then you do the other, you're probably going to get better take of the fat graft.

Eva Sheie (05:39):
Thanks for listening. I'm your host, Eva Shie. Follow the show and submit questions for our experts at wearbeforemeetsafter.com. Where Before Meets After is a production of The Axis.