Where and When to Use Fillers or Fat

Fillers and fat seem to be on a level playing field in plastic surgery but Dr. Joe Shvidler talks about his algorithm that he uses to determine which patients and what areas of the face will benefit from either fillers or fat for the best result.

by Joseph Shvidler, M.D.

I think there’s utility for both, and I’ve developed an algorithm in determining which areas I use fillers. I break down the volume loss in the mid-face in three different stages: minimal loss, medium loss, and large volume loss, and I treat those differently.

So somebody in their 20’s and 30’s may have minimal loss or early signs of aging in the mid-facial area and I’ll treat each appropriately.

For somebody in their 40’s and 50’s I may recommend a filler such as hydroxyapatite or hyaluronic acid. Sometimes I’ll use polylactic acid filler for someone who’s very active, like a marathon runner, and just has global facial volume loss.

For someone in their 60’s who has significant volumetric change due to aging, I think that’s where the fillers no longer achieve the desired result and I usually go to fat at that point. And again, I break that down into a smaller volume fat augmentation and a large volume fat augmentation. And you have to be very judicious with fat. I’ve heard about not-so-nice outcomes in the younger patients with fat so I’m very judicious with it. I tend to use fat augmentation in older patients who have had very stable weight throughout their life and just have significant volumetric loss in their mid-face. For this patient I could inject the nasolabial folds or do a rejuvenation around the eyes.