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Deciding on cosmetic surgery versus fillers depends on short- and long-term views

Key iconKey Points

  • When considering long-term cost and post-treatment morbidity, differences between noninvasive and invasive procedures for facial rejuvenation usually favor the latter
  • There are misperceptions that fillers involve no downtime, surgeon says
  • Decisions in today's economic climate may be driven by financial issues

Most aesthetic surgeons would agree that injectable fillers have a role for rejuvenation of the aging face. However, consideration of patients with poor cosmetic results or frank complications after repeated filler injections and the cumulative costs and downtime associated with this practice reinforces the need for thoroughly reviewing the pros and cons of all options and remembering to be a doctor first.

Dr. Baker
These concepts were discussed in a panel discussion focused on the benefits and negative long-term sequelae of repetitive fillers during The Cutting Edge 2011 31st Aesthetic Surgery Symposium. Daniel C. Baker, M.D., proposed there may be an ongoing "filler frenzy," considering cases of patients from around the world who present with anatomic distortions, nodules, granulomas and other complications after repeated filler injections.

"There are benefits of fillers, especially to provide temporary improvement for patients who might like to postpone surgery or as a technique to enhance or prolong surgical results. However, there are patients undergoing repetitive procedures, sometimes using multiple different products over time, and it is important to consider the negative aspects of that," says Dr. Baker, professor of plastic surgery, New York University School of Medicine.

Numbers game
Dr. Baker and Foad Nahai, M.D., point out that when it comes to long-term cost and post-treatment morbidity, the differences between noninvasive and invasive procedures for facial rejuvenation usually favor the latter. Dr. Nahai has done the math to support this view (see sidebar titled "Numbers game").

"A patient who has undergone repeated filler injections over a period of five to 10 years could have paid for more than one facelift procedure. And when you add up the amount of downtime after repeated filler injections spent recovering from swelling and bruising, it probably is far more than from a single facelift," says Dr. Nahai, clinical professor of plastic surgery, Emory University School of Medicine, Atlanta.

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