A Natural Beauty

Twenty years ago, plastic surgery had a reputation for expensive, recovery time-intensive procedures that were likely to make you look as artificial as Joan Rivers. Today, however, the hallmarks of great plastic surgery are natural, often imperceptible changes that aim to make you look just like yourself, only better.

So what’s changed?

Where surgeons once nipped and tucked wrinkled skin, today the goal is to revolumize the cheeks and midface thereby softening lines, not simply pulling them tight. But, cautions Dr. Julius Few, you don’t want to simply add volume where a surgical lift may be necessary. Overfilling the face creates just as an unnatural look as overpulling.

Finding the Sweet Spot

According to Dr. Few, there are three variables of the aging process, which determine the nature and extent of the cosmetic procedures:

1. Skin changes (wrinkles, age spots)
2. Volume loss (flattened cheek area)
3. Facial sagging, or ptosis (skin that literally hangs, eg, jowls)

Dr. Few’s approach to each face centers around his surgical and nonsurgical "blending" concept, which essentially limits surgery or the extent of surgery by addressing variables 1 and 2 with nonsurgical solutions. (Less surgery with better results? Now that's sweet!)

Surgery out of the question?

If you’re opposed to surgery or simply don’t have time for it, and you’re willing to accept limited results, then Dr. Few advises using hyaluronic acid (HA) as a bridge to surgery. Not only will an HA filler provide a roadmap for permanent results if and when you decide surgery is part of the solution, but it’s also reversible if you don’t like your results. (The proverbial cherry on top!)

Facing Fat Facts

Whether it's your own fat, synthetic fillers, or both for your facial rejuvenation goals, the same adage applies: One size does not fit all

Despite the aesthetic industry’s evolving attitude toward fat as functional facial filler over the past several years—from cynical to skeptical to accepting—Dr. Few has been fat grafting for more than 12 years. Today, no doubt about it, fat is fabulous. (Who’d have predicted that?)

Fat, says Dr. Few, may be uniquely “green” (a great way to recycle that unwanted collection from the waistline, no doubt), and offer a nice, long-term facial result, but, he points out, it isn’t a filler that completely transcends the overall filler category. In other words, just as certain synthetic fillers are indicated for specific components of facial rejuvenation, (ie, hyaluronic acids are used to fill lines, plump lips, put the apple back in your cheek), fat too has it’s strengths. Unfortunately, that doesn’t include filling fine lines.

“Fat is only good for volume, not superficial wrinkles,” says Dr. Few, a fact he often points out to counter the misconception among his filler patients.

While fat is routinely used for cheeks, chin and jawline, if you’ve got fine lines to fill, those are best left to the HA fillers (Restylane, Juvéderm, Perlane). In Dr. Few's hands, it's Restylane. And if fat just isn't your thing (or if you simply don't have the tissue to spare—ahem, nice problem to have!), Dr. Few says you can opt for Restylane all the way.

Side by side, here's generally how fat and Restylane stack up (all that's left is to decide is, which one is right for you?):

Fat vs Restylane

	Procedure Time, min	Cost	Longevity
Fat	45	$4000	Indefinitely*
Restylane	15	$1500 (2 syringes)	up to 18 months

*75% patients won’t need another filler for several years; 25% patients will need another round of fat in 3 to 12 months.