SAN DIEGO—A panel of experts on facial plastic and reconstructive surgery offered words of wisdom and cautionary tales about treating the aging face in a session at the 2017 Annual Meeting of the Triological Society, held in conjunction with the Combined Otolaryngology Spring Meetings.
Explore this issue:June 2017
The panel touched on the uses of autologous fat grafting, the do’s and don’ts involved in aging face cases, the risks of overzealous and inappropriate filler use, and the challenge in surgery of overcoming a bad result from filler use that has gone awry.
Autologous Fat Transfer
Travis Tollefson, MD, MPH, associate professor and director of facial plastic and reconstructive surgery at the University of California, Davis, said that use of autologous fat transfer is expanding. This approach can be helpful in areas of the aging face that become a bit smaller due to the loss of natural fat.
“Autologous fat grafting … is something that we’ve transferred from the aging face or the cosmetic world into the reconstructive world at a high pace,” he said. “You’ll find a lot of reconstructive cases, as well as aging face cases now, where autologous fat plays a big role in the restoration of volume of soft tissue…. It’s very clear that we can fill in areas and combine autologous fat grafting or fillers with more traditional aging face surgeries.”
Compared with fillers, autologous fat can produce a permanent result. The advantage of synthetic fillers, however, is that they can be injected in the office with little down time after the injection, he added. “The other benefit of the fillers… is that you can place them in the different layers more accurately because they are smooth, and there are different visco-elastic characteristics that allow you to choose the filler that you want to use for the layer.”
Also, in the case of hyaluronic acid, the effects can be reversed if the outcome isn’t acceptable, he said. “With fat transfer, we don’t have a reversible technique, so if you have excess fat in an area,” surgery is required to fix it, he said.
While the risks associated with the use of fillers are low, they can involve a risk of blindness when used around the eye, as well as skin necrosis from vascular infarcts in certain situations, said Dr. Tollefson. “These are too high-risk for me to use in most danger areas, so I do choose autologous fat in most of those cases,” he added.