A well recognized component of facial aging is loss of fat volume. This loss results in a sunken, hollow appearance to the face, which may be difficult to describe, but is easy to recognize. The face looses its round contours and sharp demarcations develop between different regions of the face. Volume augmentation is a large component of comprehensive facial rejuvenation.

Facial volume restoration can be achieved in several ways. There are many commercially available injectible fillers to augment the face. Products such as Restylane, Juvederm, Scupltra, and Radiesse are now a part of the popular culture lexicon. Although these fillers are easy to administer, they lack permanency. Fat grafting is a permanent technique for restoration of facial volume, and an attractive alternative to the commercially available facial fillers.

Dr. Khosh performs fat grafting in Manhattan, as an office based procedure. Small amounts of fat is gently harvested from the lower body, prepared carefully, and then meticulously injected into appropriately chosen areas of the face. Fat transfer can be used to enhance the appearance of the cheeks, brow, temple, and the orbital regions. Patients notice not only improved facial contours, but also more vibrant and healthier skin. A secondary benefit that has been postulated to be due to growth factors or stem cells present in the fat graft.

Historically, procedures for rejuvenating the face have entailed surgical treatments designed to remove excess fat or skin, and elevate or suspend descending tissues. In the last two decades, great strides have been made in non-surgical facial rejuvenation techniques. These advances were guided by our increasing understanding that facial aging involves not only gravitational descent, but also volume loss, muscular over activity, and skin changes. Non-surgical facial rejuvenation entails the use of injectable fillers, injectable muscle relaxing products, and medical lasers. In younger patients without significant skin sagging, non-surgical facial rejuvenation is an attractive alternative to facelift surgery. In older patients, non-surgical facial rejuvenation may not replace surgery, but it can still have a remarkable effect.

The three main components of non-surgical facial rejuvenation are: injectable muscle relaxers (Botox Cosmetic or Dysport), injectable fillers (Juvederm, Restylane, Radiesse, or Sculptra), and skin resurfacing lasers (Fraxel). Botox Cosmetic and Dysport help erase wrinkles in the forehead and the Crow’s feet. Injectable fillers restore volume to highlight the cheeks, plump the lips, rejuvenate the lower eyelids, and erase the naso-labial folds, the marionette lines, and the jowl folds. Resurfacing lasers restore tone, color, and elasticity to the skin.

Sculptra is the only FDA approved injectable filler for general facial augmentation and volumization. Sculptra stimulates the body to replace collagen over time, and restores lost volume and helps to fill depressions or hollowness around the face.

Unlike other facial fillers such as Restylane, Juvederm, and Radiesse, the aesthetic results from Sculptra are not immediately evident. It typically takes several weeks to notice the improvement from Sculptra injections. The enhancement is gradual and subtle. It typically requires two sessions of Sculptra injections to achieve the final desired outcome. Sculptra is longer lasting that other facial fillers, and the results usually last up to two years.

We are offering one session of FREE Sculptra injections to a limited number of patients. Interested patients should contact my assistant Betty at 212-262-0056 ext 209 to schedule a treatment.

Facial aging

A new study by Dr. Howard Lanstein at the University of Rochester confirms long standing plastic surgeons’ assumption that changes in the shape of facial bones, specially the mandible, has a significant impact on facial aging.

In this study, CT scans of the facial bones were obtained in nearly 120 patients. The patients were then divided into three groups: young (ages 20-36), middle (ages 41-64), and old (65 and older). There were equal numbers of male and female patients in each group. Comparison of these groups showed that with aging, there is a significant reduction in length and height of the jaw. This leads to reduced chin projection, and loss of jaw-line definition.

The study findings confirm our updated understanding of facial aging, where multiple factors including loss of skin elasticity, soft tissue volume loss, and bony loss are responsible for changes that occur in the face. In regards to bony loss in the jaw, new treatments for tooth loss such as dental implants could help maintain more bony volume. Otherwise, chin implants have a long standing history as an adjunct to facelift surgery, and neck liposuction to enhance lower face and neck appearance.