The Skinny on Volumizing: From Fillers like Restylane, Radiesse and Juvederm to Sculptra to Fat Transfer to Cheek and Chin Implants

Bay Area facelift, neck lift, Dr. Mitchell Blum, facial plastic surgeon Before and After
Before & After facelift, neck lift and chin implant by Dr. Mitchell Blum, San Francisco Bay Area, CA

You wouldn’t normally think that ‘plump’ would be the best way to describe the aesthetics of the youthful face.  For most of the 20th century, the aging face was treated by lifting.  All sorts of inventive ways of doing a facelift were devised.  In the last 15 or 20 years facial volume loss came into the consciousness of aesthetic surgeons and fillers came into vogue.  Based on body substances like hyaluronic acid, fillers like Restylane and Juvederm became popular.  Soon Radiesse, based on a different body substance, came on the market.  Sculptra, which is not technically a filler, was introduced.  Each has its own strengths in adding volume to the aging face.

Articles were written proclaiming the loss of volume to be a key ingredient of the aging process. Still, a lot of what was written was not based on good research.  A recent paper, however, described a prospective review over 15 years of a cohort of individuals who had CT scans performed periodically and various measurements taken which better described the loss of bone and fat volume in various parts of the facial skeleton.  This was scientific justification for what is now an important part of the treatment of the aging face:  restoring lost volume.


There are several options available to get the plump back from injecting fillers, both natural and artificial, to stimulating new collagen to implants.  They each have their advantages and disadvantages. The decision on which to choose depends on the degree of volume loss, the location of the volume loss, the availability of the best approach for a specific problem, cost, longevity of correction, naturalness of results and safety.

The most common treatment today is injecting hyaluronic acid fillers.  Hyaluronic acid is a naturally occurring chemical in the body.   Hyaluronic acid fillers are absorbed over time.  A number of manufacturers have taken this molecule and cross linked it in various ways to affect their fillers’ thickness, elasticity and longevity.  The choice of which product to use depends on the area to be corrected and the amount of correction needed.  The cosmetic surgeon has a large number of choices.  The list is long:  Restylane, Restylane Silk, Restylane Lyft, Restylane Refyne and Defyne, Juvederm and Juvederm Voluma to name a few.  Radiesse is a somewhat longer lasting filler also derived from a normal body chemical: hydroxyapatite.

fillers, Juvederm, Restylane, Radiesse, Dr. Mitchell Blum, facial plastic surgeon, San Francisco, Bay Area, California

Longer Lasting Solutions

Fat transfer from the belly, thighs or flanks offers a longer lasting way of volumizing.  It is a living graft and in certain parts of the face are close to being a permanent option.  Obtaining the fat is mildly invasive and also depends on enough fat being available.

Sculptra, Before and After, Dr. Mitchell Blum, facial plastic surgeon, San Francisco, Bay Area, California
Before and After Sculptra injections by Dr. Mitchell Blum

Sculptra is an injectable that is not technically a filler.  It stimulates collagen growth in the areas that have lost collagen.  Two to three treatments over 3 to 6 months are needed to get results that last several years and only need an occasional “booster”.  This is a very good alternative to fat transfer or fat grafting in those individuals that don’t have enough fat.

Finally, permanent implants can be the best option for long term correction of bony loss, especially of the chin and cheek.

chin implant, facelift by Dr. Mitchell Blum, facial plastic surgeon, San Francisco, Bay Area, CA, Before and After
Before and After facelift plus chin implant by Dr. Mitchell Blum


Each method of restoring lost volume has its uses, as well as its pros and cons.  What will work best for you?  A discussion with an experienced facial plastic surgeon or plastic surgeon can help you determine the way to go.  In addition, the degree of invasiveness and the number of treatments you’re willing to have must be balanced.  Surgical options like implants get lasting results with just one treatment, but they’re more invasive.  Less-invasive treatments like fat transfer can last a long time, but may require more than one session to get the results you want.  The least invasive treatments, collagen-stimulating injectables like Sculptra and fillers like Restylane, Radiesse and Juvederm, must be done on a set schedule to obtain or maintain the youthfully rounded face you desire.

The first step to restoring volume the right way is finding out your personal best options.  To do that in the San Francisco Bay Area, you can meet with me privately in my Tracy, CA or Menlo Park California offices.


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About Dr. Mitchell Blum, MD, FACS

Dr. Michell Blum is a highly experienced expert facial plastic surgeon. He is board certified in Facial Plastic and Reconstructive Surgery and Otolaryngology - Head and Neck Surgery. In his career, Dr. Blum has performed more than... ( read more )

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