American Academy of Facial Plastic and Reconstructive Surgery
American Academy of Facial Plastic and Reconstructive Surgery

Subcision

Can anyone recommend this technique for removal of deep melomental folds? How about in conjunction with PRP or Adipose derived stem cell transfer?

This Web site is not intended to recommend a procedure or not unfortunately. It is meant to make very broad statements that may help you understand options that are available. I personally do not have any experience with subcision for melomental folds but I have had bad experiences doing this for nasolabial folds. I don’t think PRP or stem cells would add a significant benefit.

clinical trials

Hi my name is Anthony Campfield. I have been taking antiretroviral drugs over 20 years. I have developed atrophy. My face has sunken in on both sides and on the temper region. I have tried sculptra but to no avail. Is there a clinical trial that i could get into to restore my face to almost permanent? This condition has cause me to have low self esteem and confidence. Thanks, your help would be deeply appreciated.

I am currently unaware of any “clinical trials” for corrective HIV related volume loss. however, there are many fillers that are both temporary and permanent other than Sculptra that may be able to work better for you. i would consult a facial plastic surgeon in your area. see the list of members on this Web site.

possible complications of non surgical nose job in a weak nose could any complications

Question: Hi, wanted to ask a question about the possible complications of non surgical nose job.In a weak nose, could any complications or permanent nasal disfigurement occur from needle trauma to the soft tissue in the tip and mid vault area,particularly in atypical case where fillers have been injected from inside the nose.Thank you.

Answer: It is highly unlikely that a filler would damage a reportedly weak nose. However, rarely a needle injection can be injected into a blood vessel in which case you could have a major problem but this is exceedingly rare. It is important that the physician injecting you use a very careful method of drawing back on the hub during injection to minimize that risk.

i am considering plastic surgery due to a congenital problem

Question: Hi, I am considering plastic surgery due to a congenital problem. My face has no dimension and appears flat. I have seen a few doctors regarding my concern, but I feel they both have steered me into what they feel most comfortably performing. One says surgery, (cheek implants) and the other says injections of restaline, juvederm, or sculptra.. I am desperately looking for a Doctor who specializes in facial reconstruction and would be willing to travel out of state. Can you tell me what type of Doctor’s advice I should be seeking? Should they be certified in both maxio-facial as well as cosmetic? I’m so confused. One Doctor I saw only has the title of MD but yet does cosmetic procedures for the entire body. Thank you.

Answer: Unfortunately, there is an inherent bias with every surgeon who will offer what he or she thinks is better for you based on what procedure they are good at, like aesthetically, etc. Implants may be the right option but they also may be the wrong option for you. This forum is not the venue for one surgeon (me) to voice my opinion regarding this matter. You must find someone you trust, look studiously at the before and after photos, maybe speak with one of his or her patients and find someone you trust to do the work. I cannot speak as to a surgeon’s qualifications but this Web site features those who are facial plastic surgeons who are part of the American Academy of Facial Plastic & Reconstructive Surgery (AAFPRS) and/or who are board certified by the American Board of Facial Plastic & Reconstructive Surgery (ABFPRS).

i asked a surgeon online to take a look at my photos how i can address my facial concerns

Question: Hi, I asked a surgeon online to take a look at my photos and tell me how I can address my facial concerns in relation to mid-face deficientcy. After his assesment, he sent me an email telling me how he would approach the problem. He said that I would need a small anteriorly based cheek implant with a paranasal, and/or premaxillary implants. I cannnot afford all implants along with the cost involved in hotel and flight reservations. Ever since this evaluation, I cannot find a Doctor who is able to assess me in the thorough way that this out-of-state surgeon did. I feel that the out-of-state surgeon nailed it. I feel that his way of thinking is right. I am having a difficult time finding a Doctor who has come to the same conclusion or even close. I don’t know what to do. I cannot tell a surgeon how they should do their job. How can I get an unbiased point of view so that I can be sure that I have exhausted all possible options available to me that will properly address my concerns? This is my face, and I do not have a lot of money to have to have revisonal surgery because it wasn’t done right in the first place. Please help me or guide me. The Doctors that I am meeting with are only leading me to what they feel most comfortable doing. One Doctor said that I could solve my problem with sculptra alone. I knew that couldn’t be right. Thanks.

Answer: This is a tough one. Like many questions here, I cannot solve your problems. Only a consultation with a qualified facial plastic surgeon can help establish that with you. You have to find someone who is experienced, knowledgeable, and communicates well with you about what you are wanting. But every surgeon has his or her own biases and recommendations. I would look at how many years a surgeon has been in practice, his reputation in the community, his board certification, his before and after photos, etc. I know that is not comforting but there is no easy right answer to a particular problem.

i have two autoimmune diseases lupus and scleroderma

Question: I have two autoimmune diseases, lupus and scleroderma. Due to the skin involvement from the scleroderma the skin on my face has really changed. My lips are disappearing and what lips I have left pull very tight and have a look as if I am a smoker (I’m 30 and have never smoked). I am very self conscience about my face because I do not look the same. Is there anything safe that can be done to help the wrinkling and make my lips a little fuller before they disappear? Thank you, Lindsey Gent

Answer: thank you for the question. this is truly not an easy answer. i think you should probably be safe with some fillers in the lips but i would always defer this question first to your rheumatologist/internist. after they assent to this possibility and you are properly evaluated in person by a qualified facial plastic surgeon or other cosmetic provider then your candidacy can be more accurately established.

i have lost volume in my face i would like to get a filler

Question: I am 49 years old and have lost volume in my face. I would like to get a filler but am concerned about lumps and keloids. The plastic surgeon that I saw recommended Sculptra. What are your thoughts on this filler and how does Sculptra cause keloids? Thank you for your response.

Answer: First of all, your word choice of “keloid” needs to be clarified. A keloid is a thick thick scar that occurs only on the neck, ears, scalp, and body NOT face of individuals particularly Africans and some other ethnicities but can occur in white individuals as well. What you are probably referring to as a lump is a nodule that can occur with Sculptra product particularly in areas of high mobility like around the mouth or if the product is not placed with proper dilution. In the old days this was far more common because of low dilution of Sculptra. Today with proper dilution and proper technique and choice of facial area, the chances are far lower. I would speak with your physician about what his or her experience level is with the product and what problems he or she has encountered in the past.

I’m interested in cosmetic injections

Question: How often do I need cosmetic injections after the first injections?

Answer: This really depends on so many factors.  First, areas of high mobility like the lips, smile lines, and areas around the mouth tend to suffer from absorption more readily than areas that are less mobile like the cheeks, under eyes, and temples.  Secondly, it depends on what products you are using, as some products have longer lasting timeframes in one’s body than others.  Third, it depends on how much product was placed, as placing more product may lead to relative persistence of the remaining product compared with placing very little product there. Fourth, it depends on your body’s metabolism of the product.  I have seen individuals hold products for years whereas other hold it for only a few months.  Variability truly sits with the individual person.  Speaking with your facial plastic surgeon who does your injections can help you determine based on all these factors what the likelihood of your product lasting a certain amount of time would be.

I’ve been reading about cosmetic injections and I wanted to know…

Question: Are cosmetic injections permanent?

Answer: Some cosmetic injections can be permanent; others are temporary.  Most common cosmetic injections like hyaluronic acid (Restylane, Juvederm) are temporary injections.  However, silicone microdroplets can be used for permanent corrections, most commonly for lip augmentation and acne scarring.  However, this method is considered “off-label” as it is FDA cleared for retinal detachments.  Using silicone safely is based on a discussion with a specific doctor’s philosophy and experience.  Another permanent injectable is polymethylmethacrylate (PMMA), marketed as Artefill.  A certain percentage of this product is made of bovine (cow) collagen that is partially absorbed and used as a vehicle for delivery of the product to ensure that it is smooth and does not migrate.  Finally, fat grafting can be considered a permanent injectable by those who are experienced at delivering fat.  If fat is not placed in small microdroplets it can look lumpy.  Since it is truly a “graft”, it needs blood supply to survive.  In experienced hands fat transfer is permanent minus a small percentage that can be absorbed.  There are other permanent injectables that are approved for use outside of the United States but that are illegal for use in the U.S.  Since this Academy is a U.S. based organization and the author of this post is from the U.S., I shall refrain from commenting on the safety, limitations, and efficacy of these other non-approved products.