Synthetic fillers like hyaluronic acid are now incredibly popular to restore lost volume, like fat grafting. We ask Dr. Bryce Cowan to compare the upsides and downsides of each procedure.
First, both synthetic fillers and fat grafting are used to treat volume loss but the procedures serve a very different need, and they both have an important place in the cosmetic marketplace. Cosmetic fillers are most commonly made of hyaluronic acid and are produced by strep bacteria and then chemically cross-linked to add additional stability and longevity. One of the advantages of fillers is that they are synthetic and available on the shelf so there is no donor site required, and therefore, the procedure has little down time. Synthetic fillers can be placed to fill in fine lines and wrinkles close to the surface in a concealed way. They are broken down by the immune system over time, however, and this is a major limitation as retreatment will be required to maintain the appearance. Another advantage of fillers is that the correction is reliable as fillers are used on a 1 to 1 basis, correcting what you see exactly. Finally, fillers can be reversed more readily using an enzyme called hyaluronidase, which resorps the filler, should the outcome not be satisfactory.
Fat grafting injects fat deeper into the skin and lasts far longer. Typically they can survive for a decade or longer, and in theory, indefinitely, far outlasting fillers which typically last 6 to 12 months. Fat grafts are usually used to fill in larger volumes. The procedure is more involved as a donor site is required, although most patients have some area where they don’t mind losing a bit of fat, like the abdomen. The recovery time is more significant, as bruising is more significant than they are with fillers. Again, both fillers and fat grafts have their proper place and uses.
