shutterstock 1189798375-min

Before I reached a certain age (let’s just say, it rhymes with “sporty”), I’d only ever cared about what I considered to be an excess of body fat. I had, admittedly, never given much thought to the fat in my face — until it started to disappear. It hardly seemed fair: Did I really have to choose between a slim physique and a smooth face?

To see if I could bring back a bit of my baby face, I met with board certified UCLA plastic surgeon [Jason Roostaeian, MD](https://aedit.com/provider/jason-roostaeian-md-449). He explained to me that [facial aging](https://aedit.com/aedition/how-your-phone-might-be-aging-you) isn’t just caused by gravity, but also by the redistribution and loss of fat throughout the face. The result: wrinkling and irregularities. 

[Fillers](https://aedit.com/procedure/temporary-lip-fillers), he explained, can restore some of that lost facial volume and refresh the youthful contour temporarily. After discussing all of the risks, I decided to give it a try — peppering Dr. Jason with questions as he thoughtfully examined my face, injecting hyaluronic acid filler into my tear troughs and cheeks.

I tried not to wince as I wondered aloud: How often am I going to have to do this? “It varies from patient to patient,” Dr. Jason told me. “But plan on dermal fillers lasting about six months to a year.” 

While I’d never been stellar at mental math, it seemed obvious that, as a sporty-something-year-old, this was going to get pretty pricey by my golden years. “Once you get older, you’re better off getting a facelift with fat grafting,” explained Dr. Jason, “which will take care of the skin laxity and the volume loss at the same time.”

He had me at “[fat grafting](https://aedit.com/aedition/why-everyone-is-talking-about-fat-grafting).”

## **The Technique Used In Facial Fat Grafting** 

Sure, I’d heard about the [Brazillian Butt Lift](https://aedit.com/procedure/brazilian-butt-lift) (during which plastic surgeons transfer [liposuctioned](https://aedit.com/procedure/power-assisted-liposuction) fat from the belly and flanks to bulk up the booty), but I had no idea that similar fat injection techniques were being used to permanently plump up cheeks, lips, under eyes — basically, anywhere that [facial fillers](https://aedit.com/aedition/everything-you-need-to-know-about-dermal-fillers) were gaining fame. 

I needed to know: Why isn’t everyone doing this? “First off, it’s a surgical procedure that includes all of the associated risks and recovery time,” Dr. Jason explained. “Secondly, because fat is a living tissue, it’s less predictable — though, at the end of the day, using your body’s own fat as filler is always going to be the gold standard.”

When pressed for more details, Dr. Jason told me that although some doctors perform facial fat transfer procedures under local anesthesia, he prefers to use general to ensure patient safety and comfort. “We have to be very careful with our technique,” Dr. Jason told me. “Imagine we’re taking tiny seeds of purified fat and dispersing them throughout the area to give them the best chance to grow and survive, while providing a smooth, even result over time.” He said that plastic surgeons generally overfill areas of the face during a fat grafting procedure because it is not unusual to lose about 30 (or even as much as 50) percent of the transferred fat cells over time.

When I asked about possible complications associated with facial fat grafting, Dr. Jason pointed out that because a patient’s fat is their own tissue (known as “autologous fat”), there’s no risk of adverse reaction — though swelling and bruising are typical and may be quite pronounced. “Because we’re distributing the fat throughout a given area through a very small incision, we end up affecting a lot of tiny blood vessels, which is bound to cause bruising,” he shared.

## **The Facial Fat Grafting Procedure**   

Full disclosure: I don’t think I was totally listening at this point. Instead, I was already fantasizing about the fate of my face and whether it was possible to tack on this fat transfer treatment to an unrelated procedure I had coming up. Since I was going under anesthesia anyway, why not wake up looking younger? Dr. Jason told me that the facial fat grafting would add about 45 minutes to my existing surgery and that the recovery typically takes about two weeks. I decided to give it a go.

Right before my fat grafting surgery, I came face-to-face with Dr. Jason and his purple surgical marker. He sat in front of me, considering the peaks and valleys of my face before tracing a pattern along my contours. We then discussed possible donor sites during an informal body fat analysis (which I can only liken to swimsuit shopping with a stranger) to determine exactly where Dr. Jason would be harvesting the filler for my face. 

He planned to make a total of four small incisions: one in each thigh to collect the fat and then one in each cheek about halfway between my mouth and nose. It’s through the latter that he’d inject the fat after purifying it in the operating room.

## **Recovery After Facial Fat Grafting**

The next thing I knew I was lying in recovery with a surgical glove filled with ice water splayed across my face. I was too groggy to even wonder about my results. After about an hour, the nurse cleared me to leave, sending me and my husband home with instructions to apply cold packs consisting of gauze soaked in ice water for the first 48 hours and to sleep as upright as possible to prevent swelling.

Standing before my bathroom mirror, I looked like I’d passed out after a fraternity hazing: bloated, a little bruised, and covered in Sharpie babble. But my skin was so smooth, plump, wrinkle-free, and refreshed. Though Dr. Jason had told me that the initial swelling from the procedure would obscure the final result, I was already pleased.

For the first 48 hours, I was totally unproductive. The cold packs made reading or even watching TV too challenging, but, after a couple of days, I was able to be up and about around the house — albeit with soreness in my cheeks and at the donor site. I’d also developed moon-shaped magenta bruises across each tear trough that seemed to be growing larger and darker daily. 

I realized that not being equipped with the proper concealer was going to be problematic. I threw on a baseball cap, pulled the brim down extra low, and ran to CVS to grab a tube of a color corrector. I dabbed the makeup over the bruises, took a step back, and saw a woman with purplish-green shiners staring back at me. But, man, she looked so young.

## **The Results After Facial Fat Grafting**

Over the subsequent weeks, I became pretty adept at camouflaging my ever-changing bruises as they morphed and shrank unevenly from red to purple to blue, green, and yellow before finally fading away. If anyone noticed my technicolor transformations, they didn’t let on (with the exception of my mother-in-law, who deadpanned, “You look like you’ve got two black eyes”). 

When I asked Dr. Jason whether or not it was typical for patients to have lingering bruising, he said it generally “clears up completely within 10 days or so. But every patient is different.” For me, caking on the concealer for a few weeks seemed a small price to pay in exchange for a positive, permanent result.

Dr. Jason also told me that it would take about three months for the swelling to subside completely and the surviving fat to become established. With the passing weeks, every sign that appeared from my “old” face made me wonder: Would I end up looking happily refreshed or disappointingly unchanged? 

I felt strangely conflicted. On the one hand, I was incredibly satisfied with my initial appearance, but on the other, I was equally reluctant to invest too much in the outcome. Notes from my journal about one-month post-op capture the conundrum: “Woke up this a.m. and the left smile wrinkle was back. Ugh. Yesterday went shopping without any concealer — felt amazing.”

By the time I saw Dr. Jason for my three-month follow-up, the soreness in my cheeks and thighs (initially akin to a pulled muscle), and small red scars from the incision sites had completely resolved. Much of the fullness in my cheeks and the evenness under my eyes remained. As Dr. Jason evaluated the outcome, I held the hand mirror and saw no apparent signs of plastic surgery other than a slightly younger selfstaring back at me, smiling.

AEDITION expert perspective-min

Patient Perspective Collection | The AEDITION

Patient Perspective

After growing weary of the price and upkeep associated with dermal fillers, one writer decided it was time to try something a bit more permanent.

What It's Really Like To Get Facial Fat Grafting 

shutterstock 1097196746-min

Minimally invasive procedures including dermal fillers are becoming increasingly popular and accessible, but it can be hard to figure out exactly how they work, what all of the different products do, and which option is best to achieve the results you want. This guide will give you all of the information you need to understand the differences between hyaluronic acid fillers and collagen-based fillers, how long you can expect the results to last, and how each product achieves optimal results. 

## **What Are Dermal Fillers and How Do They Work?**
Dermal fillers work to restore lost volume in certain areas of the body and enhance areas, such as the lips or [cheeks](https://aedit.com/procedure/cheek-augmentation-with-fillers), by adding volume in a controlled way. A decrease in collagen is one of the biggest causes of fine lines and wrinkles and experts believe the breakdown begins when people are around 25 years old. 

Dermal fillers are versatile, minimally invasive, and relatively low risk, which makes them a popular option for people who are looking to get the upper hand on signs of aging. They are not the same as neurotoxins like [Botox®](https://aedit.com/aedition/comparing-neurotoxin-botulinum-type-a-injections-botox-dysport-jeuveau-xeomin) and work in a completely different way, but they do treat similar skin complaints. Fillers are FDA approved to address the following concerns:

- Brow Furrows
- Crow’s Feet
- Frown Lines
- [Under Eye](https://aedit.com/procedure/under-eye-filler) fine lines
- [Acne Scarring](https://aedit.com/procedure/acne-scar-treatment-dermal-fillers) 
- Pronounced Nasolabial Folds
- Fine Lips
- [Aging Hands](https://aedit.com/procedure/hand-rejuvenation-with-dermal-fillers)
- Vertical Lip Lines
- Cheek Enhancement

## **Types of Dermal Fillers**
Dermal fillers come in various forms and can be made from different ingredients to serve a variety of purposes. These are the most common types.

### **Calcium Hydroxylapatite (CaHA)**
Calcium Hydroxylapatite is  similar to a mineral and is naturally found in human bones. The most common brand of CaHA filler is Radiesse® and is used for enhancing volume in the cheeks (and other areas of the face) and plumping frown lines and nasolabial folds (deep lines from the nose to mouth).

The product is potentially suitable for vegans since it is made using biosynthetic processes and no animals or animal products are used in its production. Not only is this preferable for some people on an ethical basis, it can also reduce the chances of an allergic reaction. CaHA fillers are renowned for being safe, producing a natural-looking result, and were initially used in reconstructive surgery. Though they have a long history of safety, patients must still ensure that the person administering the product is properly trained and that the procedure takes place in a sterile medical setting. 

Depending on how fast your body metabolizes the product, CaHA fillers like Radiesse® should provide visible results for 12 to 24 months. It is common for results from your first filler procedure to last a little less time than subsequent procedures, but your practitioner will be able to give you an accurate estimate based on the condition of your skin, your lifestyle, and other factors.

### **Hyaluronic Acid (HA)**
Hyaluronic acid is the most common type of filler used in the U.S. and is made from another substance that can be found naturally in the body in areas such as the joints, skin, and even eyeballs. Hyaluronic Acid fillers are produced under a number of brand names, including: 

- Captique®
- Esthelis®
- Elevess®
- Hylaform®
- Juvederm®
- Perlane®
- Prevelle®
- Puragen®
- Restylane®

HA fillers are extremely versatile. They can be used on fine lines and wrinkles on most areas of the face (including crow's feet, smile lines, and worry lines) and can also be used to treat a wide variety of skin complaints including some types of scarring and redefining lips.

The substance is widely used in the medical profession and is the same product injected in the joints of those suffering from arthritis. The body produces HA naturally, but the formulations injected as fillers are extracted and processed before being used for cosmetic purposes. Most HA fillers are also infused with the numbing agent lidocaine which helps minimize the discomfort caused by the injection procedure as well as reducing pain afterward. Results from HA fillers are temporary and generally last between six and 12 months. That can be great if you’re unsure of whether or not you’ll like the results, but it also means you need to be aware of the potential financial commitment of keeping up the results.  

### **Poly-L-lactic Acid (PLLA)**
Poly-L-lactic Acid is a biodegradable synthetic substance that is safe for use in the body. It is used to make a range of medical devices including dissolvable stitches. It is classified as a collagen stimulator because the main role of the substance is to help your skin rebuild collagen on its own. The filler itself dissolves after a few days, but the results generated by the increased collagen production can last over two years. The treatment is usually carried out in several sessions because a single treatment may be insufficient to stimulate enough collagen to achieve the desired result. It is generally used for lips and deeper wrinkles like laughter lines and nasolabial folds.

The most common brand of PLLA filler is Sculptra® and its ability to stimulate collagen production makes it unique. Also unlike other fillers, results take longer to show. The course of treatment is usually once a month for three months and, after the full treatment period, it can take up to six weeks for the full effects to be visible. It is, however, considered a semi-permanent solution, so unlike other forms of fillers that will definitely need topping up on a relatively regular basis, those receiving PLLA fillers can expect longer-term results.

### **Polymethylmethacrylate (PMMA)**
Polymethylmethacrylate fillers are a semi-permanent solution used to treat medium-to-deep lines, wrinkles, and furrows. The most commonly used PMMA brand is Bellafill® and is used to treat nasolabial folds, pitted scars from acne, and lips.

It is used for patients who are seeking a more permanent solution to their skin complaints, but it does take a fair number of injections to achieve the desired results. Your practitioner will likely use a method called threading in the dermal subcutaneous junction which should prevent any visible signs of the injections. However, the most significant drawback of PMMA over other filler products is the risk of the filler itself being visible under the skin. To avoid this, your practitioner will most likely use less product on your first treatment, which means you will not see the full results you are expecting immediately, but more product can be added at a later date. It is a good option for those who are looking for a permanent solution to signs of aging, but the process is somewhat more lengthy than other more temporary dermal fillers.

## **What is Getting Dermal Fillers Like?**
An injection procedure is generally carried out after a consultation with a board certified dermatologist or plastic surgeon. During the consultation, the practitioner will not only discuss your skin concerns, but they will also look at how your face moves and your natural facial expressions to assess which treatment options are right for you. 

During the procedure, the practitioner may apply a topical anesthetic (numbing cream) to the areas that will be injected. Some practitioners may also inject a local anesthetic. If you are concerned about pain during the procedure, discuss this option with your provider during your consultation. They will then inject the filler below the skin with a needle or a catheter depending on the area and results desired. The procedure is quick and downtime is minimal. Some patients experience some bruising or swelling straight after the procedure, but it typically subsides after a couple of days.

Results are generally seen immediately, but full results can be seen a few days after the procedure. The length of time that results will stay visible depends on a few factors including where the filler is injected, which product is used, and your own metabolism.

## **Recovery and Side Effects**
Recovery from dermal filler injections generally takes up to a week with swelling and potential bruising being the two most common side effects. Your practitioner will explain any potential side effects specific to the injection site, but in general, dermal fillers are safe and effective. According to the American Society of Plastic Surgeons, there are some more severe, but rare, side effects including allergic reactions and infection at the injection site which should be considered. There is also the potential for fillers to leave an asymmetrical result, but if they are injected by an experienced, board certified plastic surgeon or dermatologist, these risks are minimal. On the whole, fillers are a popular and effective way to preserve a youthful appearance.

AEDITION rejuvenators-min

Medical Aesthetics Collection | The AEDITION

Aesthetics

Minimally invasive procedures including dermal fillers are becoming increasingly popular but it can be hard to figure out how exactly they work, what the different products do, and which option is best for you. Here's everything you need to know. 

Everything You Need To Know About Dermal Fillers

PG46053-5252BD49-EEA6-41A0-9A6E-7749001C38D2

It is easier than ever to make your outer appearance a better reflection of your inner self. Facial feminization procedures have been gaining popularity among men hoping to look more approachable or transition to female, as well as among women hoping to have a more feminine appearance. 

Fortunately, altering facial features to create a softer, feminine look does not have to require facial feminization surgery (also known as FFS). Below are the most common non-surgical procedures to achieve facial feminization without plastic surgery. 

### **1. Re-Defining the Jaw**
“Men have square and lower jaws, strong mid faces, and a more hallowed face,” West Hollywood-based board certified dermatological surgeon [Jason Emer, MD](https://aedit.com/provider/jason-emer-md-722), explains, “women need to be more full, lifted, with a heart-shaped look.” While many people jump to jaw reduction plastic surgery to re-contour and re-shape the mandible bone, there are less invasive and non-permanent options as well. [Botox®](https://aedit.com/procedure/jawline-slimming-with-botox) of the masseter muscle is an injectable that can also narrow the jawline. The masseter muscle wraps around the jaw and can be temporarily contracted with Botox® injections, leaving patients with a more narrow jawline. While Botox® will take a few sessions to achieve your desired look, and requires continued injections, compared to jaw reduction surgery it is significantly less risky. When consulting with a board certified plastic surgeon, make sure to discuss the risks of jaw reduction surgery, like the potential of a damaged the mental nerve (the sensory nerve which provides sensation to the front of the chin, lower lip, and teeth).

Another minimally invasive technique is a [PDO thread lift](https://aedit.com/procedure/pdo-thread-lift), which uses threads to lift any sagging tissues in the neck or face, such as the cheek, chin, and jaw bone. By lifting the loose tissues, you can re-define the appearance of the desired area. Like Botox®, a PDO thread lift is temporary, lasting about six months.

### **2. Volumizing the Cheeks**
Usually, women have fuller, more forward projected cheeks compared to men. [Cheek augmentation](https://aedit.com/procedure/cheek-augmentation-with-implant) can be done surgically with permanent cheek implants, where patients can choose from varying sizes and shapes to achieve the right degree of fullness and forward projection they desire. Non-surgically, [dermal fillers](https://aedit.com/procedure/cheek-augmentation-with-fillers) like Voluma® or Radiesse® are also a good option. Dermal fillers work with the cheek’s native tissue to give a natural appearance. While dermal filler requires more maintenance than cheek implants, there is a lower risk of infection, migration, and asymmetry. 

### **3. Chin Augmentation**
Because of men’s square jawlines, their chins are usually not as pointed as women’s and do not create a triangle with the two cheekbones. The options for [chin augmentation](https://aedit.com/procedure/chin-augmentation) are very similar to those for the jaw and cheeks. There is reconstructive plastic surgery available to resculpt the chin bone as well as Botox® and dermal filler to provide a non-surgical and non-permanent option. Botox® works with the mentalis muscle to turn the chin down and [dermal filler](https://aedit.com/procedure/chin-augmentation-with-soft-tissue-fillers) adds fullness to make a more pointed chin. Since jaw redefinition, cheek volumization, and chin augmentation all require Botox® and/or dermal filler, often patients will choose to do all three together for a more symmetrical and feminized face.

### **4. Reshaping the Nose**
Believe it or not, a [rhinoplasty](https://aedit.com/procedure/liquid-rhinoplasty) (a.k.a. nose job) is not the only way to restructure the nose. Small amounts of dermal filler, including long-lasting Bellafill®, can help feminize the nose too. While dermal filler isn't able to reconstruct the nose (e.g. make the nose smaller or narrower), it can enhance feminization by lifting the tip of the nose and reducing the appearance of dorsal humps. 

### **5. Lip Augmentation**
Lip fillers like Juvéderm® Volbella, or Restylane® Silk, are another non-invasive way to instantly feminize the face. It takes about 15 to 20 minutes for a dermatologist to inject the dermal filler, the results are immediate, and it can last around four to six months. Due to recent celebrity trends, [lip augmentation](https://aedit.com/procedure/lip-implants) has been overwhelmingly popular, especially for women. Different types of filler will give different results — from volume to smooth vertical lines around the mouth. 

### **6. Facial Hair Removal** 
[Removing facial hair](https://aedit.com/procedure/laser-hair-removal) is a good first step for those transitioning, particularly for transgender women who are not undergoing hormone therapy. When transitioning to female, hormone therapy includes lowering testosterone levels and increasing estrogen into a typical female range. Lowered testosterone is responsible for the thickening of facial hair and, if lowered, can result in lessened hair growth. However, trans women not undergoing hormone therapy can eliminate facial hair through laser hair removal. While it can take anywhere from six to 12 sessions to see a significant reduction in facial hair growth, the results are long-lasting and only require occasional maintenance. The procedure is non-invasive and produces stronger results than waxing or shaving. Be sure to speak with a dermatologist to determine which type of laser is best suited for your hair type.

### **7. Eyebrow Shaping**
Another noticeable difference between the male and female face is the eyebrow shape. Women tend to have higher set eyebrows that sit above the brow ridge (also known as the supraorbital ridge), the brow bone located above the eye sockets, as well as a more arched shape. While there are surgical facial feminization surgeries, such as an [endoscopic brow lift](https://aedit.com/procedure/endoscopic-brow-lift), Botox® is a good non-surgical option to create a more feminine arch. Additionally, patients can opt for an ultrasound to tighten the skin around the eye, thread lifts to give a cat-eye look, or filler under the eye to lift the brow.

## **The Takeaway**
While most features can be feminized through Botox® and filler, there are some features that would require surgery. A lip lift, for example, requires a plastic surgeon to remove a section of skin in between the tip of the nose and upper lip. Additionally, an Adam’s apple reduction would include a surgical tracheal shave (also known as a thyroid cartilage reduction or TCR). 

As always, it is crucial that patients carefully vet providers and, in this case, choose a surgeon or doctor who specializes in FFS. Achieving the softer, feminine face you have always dreamed of is an empowering and life-changing moment. Experimenting with dermal fillers, Botox®, and PDO threads is a great non-permanent start. 

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