What’s the difference between using fillers versus fat transfer?

The most popular “fillers” in use today are probably hyaluronic acid derivatives, such as Juvederm, Restylane and Perlane. Hyaluronic acid is a naturally occurring molecule found in collagen. When it is synthesized for injectible purposes, it becomes a clear, gel like substance.  
Hyaluronic acid injectible fillers are meant to be injected “intradermally” meaning, within the thickness of the skin itself. Because of this, a little “bumpiness” and “transparency” of the skin can occur. Hyaluronic acid is sold in 1 cc syringes, and is meant for small, isolated areas and the lip. Depending on the manufacturer, hyaluronic acid can last from about 6 to 12 months. Recently, Juvederm Voluma has been approved for use deep under the skin, and claims to last up to two years.

“Autologous” fat transfer,requires a minor surgical procedure to extract fat from your body; separating and washing the fat; and injecting the fat into areas of the face. Generous amounts of fat can be obtained, so that autologous fat transfer is ideal for volumizing the face, where more than one or two cc of filler are required. Fat transfer to the face does not leave a scar. A general rule of thumb is that about 50% of the transplanted fat should survive and be permanent. Sometimes, a second or third fat transfer may be indicated for optimal results. The transplanted fat is also sensitive to weight gain or loss, just like fat everywhere else on the body. It is important NOT to overdo a fat transfer procedure, as the result can look very artificial.

So it depends on the type of “correction” the individual is seeking or requiring. If small superficial lines like the nasolabial fold or lips is all that is needed, then a hyaluronic acid filler is more suitable, and would be temporary. If restoring volume to an aging face; and more volume and lift is needed, then autologous fat transfer is more economical, and mostly permanent.

Best Wishes

Dr. Oyama April 9,2014

​What's the big deal with the new "teardrop" or anatomic implants?  Are they better?

What goes around comes around....just like hemlines.  Actually, anatomically shaped implants are not new at all, as they've been around since the beginning of breast augmentation nearly 50 years ago.  While the contemporary anatomic shaped implants have improved cohesive gel and shell technology, certainly the concept is not new.

The rational for using a shaped implant would be to obtain a more natural result, as if the shortcoming is because of the implant, not the surgeon or technique.  This has not turned out to be the case, because historically, the anatomic implants wax and wane in popularity, while the round implants have endured consistently.  

However, if you are a 25 to 35 year old woman, who hears about "teardrop" implants for the first time, then you would be thinking it's the latest and the greatest. Cosmetic plastic surgery being such a competitive industry, then whatever sells and whoever sells the most wins the game.  Unfortunately, sometimes it's the naive and innocent patient that ends up the loser.

A scientific article published in Plastic and  Reconstructive Surgery, August 2013, following 440 consecutive patients over nine years, sums up the hype and misconceptions surrounding these implants as follows:

These "gummy bear" type anatomic implants feel firmer and stiffer after surgery than round gel implants, Consequently, they must be inserted through a larger surgical incision at the bottom of the breast, called inframammary.  

On photographic evaluation after breast augmentation, it was impossible to to tell the difference between teardrop and round implants, for surgeons and lay observers alike. 

When female evaluaters and plastic surgeons were asked to score the results based on beauty, there was no difference between shaped and round implants.  With regard to naturalness and upper pole fullnes, round implants scored significantly higher over shaped.  

The shaped implants were designed to position one way only, right side up.  After surgery, the implants can rotate and sit sideways.  This usually requires another operation to correct.

​The authors conclude that there is no "best" implant, and that shaped implants were not demonstrated to be any better than round implants.  

Off the record, and on a more intimate level, consider this:  A shaped anatomic implant will still look "teardrop" and feel stiff even when the woman is lying on her back. Think about this carefully.  While having sex, these breasts will still look teardrop and feel stiff, and there will be a visible scar at the bottom of her breast.

Oh did I mention, these "anatomic" implants cost about double the price of a pair of round implants?

Ultimately, that a woman can have soft, desireable, natural shaped breast augmentation depends on the surgeon and the surgical expertise, not the implant.  I believe that the subfascial "Goldilocks Breast Augmentation" which I have been performing for 12 years now can deliver those results consistently, safely, and with minimal trauma to the woman.  

Best Regards, 

Dr. Oyama   June 18, 2014