"I think fillers have been used to fill in what perceives to be a hollowed area. In fact, the entire face is slowly deflating as we age and the reason you see different defects on the face is because of this large volume loss of fat," says Mark Berman, M.D., a cosmetic surgeon in private practice in Beverly Hills, Calif.
The volume that is lost as the patient ages occurs over the entire head, Dr. Berman says. It is not concentrated to individual lines or wrinkles. Physicians need to take a global approach to rejuvenation instead of a focal one, he says, adding that an ideal approach to total facial rejuvenation would be to address the whole face, an endeavor for which synthetic fillers may fall short."You often need a lot more volume than what you get with fillers. It's one thing to take a younger patient who has lost just a bit of volume and replace that with filler temporarily. However, older patients often exhibit much more significant volume loss, and in these patients, fat grafting is often the ideal treatment approach," Dr. Berman says.
The adipocytes live for approximately seven to 10 years, Dr. Berman says, and as they die and deplete over time, so do the stem cells they produce. Facial deflation results, and according to Dr. Berman, the logical replacement of this volume loss is fat cells and not synthetic fillers.
Even though fat grafts last far longer and can offer significantly more volume compared to synthetic fillers, fat grafting techniques are not used as often, Dr. Berman says.
"I think the reason why so many physicians spanning many different specialties use synthetic fillers is because it is an easy procedure to learn and an easy one to perform. In contrast, fat grafting requires a little bit of surgical skill and time. You are sculpting the patient from the inside out and physiologically restoring the volume loss," he says.