Total Facial Volume Replacement – Sculptra and Autologous Fat vs Gel Fillers
Misconceptions, Questions, and Expections
Is my face going to look too full or round?
Short answer: No. I am replacing lost volume that has occurred.
Long answer: The face has lost about 25% of bone volume by age 60. That causes increased size of the orbits, decreased projection of the midface, and shortening of the mandible. Fat volume decreases (especially in temples, cheeks, and perioral areas) and the fat pads separate and descend down the cheek. Providing replacement of this loss in the proper locations, allows restoration of youthful shape and contour.
What is total volume loss? 
I use this term to refer to the changes described above. This differs from localized areas of volume loss that we routinely enhance such as the lips and cheeks. Total volume restoration allows more general replacement of the loss of subcutaneous fat.
What is the best filler to use for total volume replacement?
There are currently two fillers that I feel address the total soft tissue loss that occurs in the face. 
Autologous fat (harvested from the patient) and Sculptra. Both allow soft improvement in the areas of volume loss without creating heaviness in highly mobile areas such as the lower cheeks.
I use these fillers to complement the typical gel fillers (Juvederm Voluma, Juvederm Ultra, Restylane, Belotero). I continue to use gel fillers for bone-volume replacement (deep injections to provide structure) and for superficial, small-diameter wrinkles.
How long does Sculptra last?
Sculptra results last up to two years. It works by promoting the patient’s own collagen production. This collagen formation is appealing to many patients with its soft and natural feel. These results do take some time which is different than the immediate gratification of many of the other fillers I use.
Here is an example of a Sculptra injection schedule:
Day 1: Injection of 2 vials of sculptra
Day 3: Back to normal without evidence of swelling.
Day 3-60: increasing collagen formation and volume replacement
Day 45-60: Injection of 2 vials of sculptra:
Day 60-120: further collagen formation
This can repeated for another cycle if needed.
Every year: Touch up with 1-2 vials of sculptra.
If you are interested in a consultation to see what the best options are for you, please get in touch with us! jordan@rihanimd.com
Have a great week!
JR
