breast augmentation after 50 years old

thank you for your question. you’re 35-years-old. you’ve submitted with your question severalphotos that are very helpful and you state that you’ve had radiesse injection in thecheeks and chin and you mentioned the volumes. and you state that you really like the resultsand 2 years later, things have deflated. and you want to ask about other options whethera surgical fat grafting or whether to stick with fillers. well, i can certainly give you my perspectiveon a question like this for people like yourself who come into my practice.

a little bit of background, i’m a board-certifiedcosmetic surgeon and fellowship-trained oculofacial plastic and reconstructive surgeon. i’ve been in practice in manhattan and longisland for over 20 years and the evolution of solutions for what you describe has beensomething i’ve been very actively involved with over the 20 years in my practice. now understand, when you ask this question,every doctor comes to the table with their own personal experience and bias and certainlyi can share with you the basis for what i would recommend and see if this makes sensewith you and then you now decide whether that’s the approach that you want to take.

so prior to the injectable fillers, therewere facial implants and fat grafting. now the advantage of facial implants likea cheek implant is that it was being placed on the bone structure directly on the structurewhere there is a relative volume deficit which i believe may be part of what your situationis. and so, that made a lot of sense because itwas really augmenting the bone. the challenge sometimes is with relative thinskin and the shape of those implants. sometimes people felt that they were too large,not the look they wanted and that is one potential drawback. now when it comes to the area like the chin,it is fairly straightforward because chin

augmentation with a facial implant is a verygood approach for long-term benefit in this area. so it’s something that is probably worthwhileconsidering. now when it comes to the other options suchas fat grafting, fat grafting has improved as a method and with better understandingof the physiology of fat. what unfortunately still remains a constantis the predictability, the challenge is the predictability. no matter who does this type of procedure,there is always going to be a certain amount of fat that makes it and a certain amountthat does not.

i personally feel also that for the type oflook that you’re trying to achieve, you’re probably better with something that is closerto the deeper structures, closer to the bones. so with fillers like radiesse which was placedprobably just under the skin, you were happy with that result. i think that with fillers like radiesse andas i prefer such as newer hyaluronic acid fillers that are thicker and last for longerperiods of time like juvederm, voluma, we use a method called structural volumizing. this is kind of a balanced and a hybrid approachwhere you get the benefit of the principle of cheek or i should say implant or breastaugmentation where you place something on

the bone but you get the reliability and thecustomization that you can do with the filler. so i think that in your situation, i wouldgo with structural volumizing with a filler like juvederm ultra plus or juvederm voluma. you can get similar longevity of approximately2 years and let’s say you wanted a little bit more, you can come to the office and ina few minutes, a little bit more can be placed. that type of customization is really great. you’ve eliminated the unpredictability offat, you’ve eliminated the surgical element of surgical implant placement which is a verybig deal and again it depends. these procedures for implants can still bewithin a short period when it comes to recovery.

but when it comes to thinking of predictabilityand customization, it is really wonderful being able to do structural volumizing. this is different from placing the fillerunder the skin where there is some benefit for you as well because there is obviouslyor apparently a relative layer of skin between the skin and the underlying bone structure. you are very lean. so it can be at the bone level between thebone and the muscle and then just below the skin level between the muscle and the fat. so there is a lot of opportunity there andan important element to your physiology is

that it is continuously changing. and so in terms of facial structure, you mightlose a little bit of weight, gain a little bit of weight and in that respect, the fillerscan be really adjusted to compensate or to be adjusted to not place as much. so, i think that you were probably startingwith a good thing and i would say injectables is the way to go. but understand that there are different methodsto doing these injectables and so that is where, i think structural volumizing is somethingmaybe worth exploring for you. so i hope that was helpful, i wish you thebest of luck and thank you for your question.