Exploring Silicone Part III, Silicone Versus Fat as a Permanent Filler
October 7, 2008 by dr. lam
The patient on the left is shown AFTER a facelift by another dallas plastic surgeon. On the right the patient is shown one year after a single session of fat transfer to the face and 3 serial injections of silicone into her lips and facial folds.
To conclude this 3 part series on understanding silicone, we should explore how I envision silicone versus fat use in my practice. If I am to perform a permanent filler in someone I would love to know the long-term safety of that product as well as its efficacy. As mentioned before, medical-grade silicone injections have been used for cosmetic enhancement since the 1960s. The first fat transfer was performed in 1898, and the first fat transfer using micro-injections done since the 1970s. Most of the new permanent injectable fillers have only been around a year to 15 years with many of the ones which have been around for 15 years undergoing constant purification, refinement, and other changes due to long-term problems. That does not sound safe to me, and I have no interest in using any other product other than silicone and fat transfer as permanent fillers.
In answering my forum questions, I realize truly how difficult it is to understand when I use one product or the other and why. I will first describe how I use each product and why then offer a short table to have the reader better understand these principles in a synopsis format. First, fat transfer is NOT a bio-inert substance. It is in fact a live “graft”. It survives based on blood supply and can fluctuate due to weight and blood supply take. Therefore, fat transfer should be used in this fashion with respect. I use fat grafting solely for volume contouring of the aging face but not to fix a little scar here or there. By putting fat in entirely asymmetrically you risk that the fat will grow disproportionately. You should not have to worry about that with silicone. Second, fat is very soft and fails in my opinion to make much change in the folds and lines of the face, whereas silicone works much better for that. I think fat transfer also leads to significant prolonged distortion of the lips with high resorption. Therefore, I always have the simple mnemonic “fat is not good for lips and lines” to help my prospective patient understand where fat fails. Interestingly, these are the two areas where most surgeons use fat. I use silicone to fix scars, to augment lips, and to correct folds of the face. Another way to look at it is that I use fat over large areas of the face and silicone over tiny areas of the face.
Over the long-term, subtle changes (typically positive) can occur with each product but for different reasons. With the micro-droplet silicone technique, collagen builds with each treatment so you will see changes after a few months particularly with acne scarring that can help you see positive changes. With fat transfer, remarkable stem cell changes have been witnessed (I have seen it) that shows skin texture improvements, scar reductions, etc.
These two permanent fillers have very distinct qualities, properties, limitations and must be used skillfully, as they are both permanent. Here is a quick summary:
Liquid Silicone Versus Fat Grafting
Comments
Feel free to leave a comment...
and oh, if you want a pic to show with your comment, go get a gravatar!