Unfortunately once fat has been placed it is extremely difficult to try to remove. Sometimes too much volume in the temples and around the eyes can make the eyes seem smaller and more deep set. At times that is desirable especially for patients with bulging eyes or prominent eyes.

At times steroids or 5-FU can be injected judiciously to help reduce some of the fat volume but it is difficult and not very predictable. That is why it is always safer to underfill when it comes to fat or even fillers for that matter. It is always easier to put more in than to remove what's there.

I get many patients coming in for consultation desiring a facelift because they feel it is a permanent fix while fillers or volumization is a waste of money. Some have even gotten upset at me for trying to talk them out of having a facelift and refusing to perform a facelift on them.

On the flip side, I have had patients coming in for non surgical treatments with fillers who I have had to tell them that their issues are best addressed with surgery.

A facelift addresses a completely different issue than volumization with fillers!

I personally believe that a facelift should be reserved for patients with significant neck laxity, jowling, and sagging. It does not address hollowness and volume loss! I feel very strongly about this and will refuse to perform a facelift on someone if it will not address their issues.

The only way to naturally address a face that has lost a lot of volume is by adding volume back! This can be done with fillers, fat injections, or sometimes facial implants. A facelift does not address volume loss.

The reason some people look like they have had plastic surgery is because they were not treated in the best way for their face. Many doctors succumb to patient pressure or desires and will perform surgery that is not right for that patient. Some doctors are also greedy at times and will push patients to have unnecessary surgery.

Please understand that I am a surgeon and would love to operate on someone if it will help them. But I will not succumb to patient pressure when I feel strongly that it will not benefit them. That sometimes makes patients upset.

Hollowing of our facial features is a main contributor to looking older and more tired. This could happen due to weight loss, genetics, having a very low body fat composition, or certain diseases. There are several good options for someone with your issue:

Fillers: Fillers can be used to target the hollowing features. They can be directly injected and you see an immediate result. This group includes injectables like Restylane, Juvederm, and Perlane.

Collagen Stimulators: These include Sculptra and Radiesse. Sculptra is an injectable but is not a filler. It causes your body to build collagen in reaction to it. It slowly works over several weeks and has a very gradual effect. It is usually done gradually over 2 to 3 treatment sessions to achieve an optimal result. Radiesse is a hybrid between fillers and Sculptra. It has an immediate filling component which you will see right away, and a collagen stimulatory effect that is also gradual like Sculptra.

Fat Injections: Fat can be harvested from other parts of your body, purified, and then gently injected back into your face. This is closer to being a surgical procedure but can also be done with you awake in our treatment room.

As we age we loose facial volume and fat in a nonuniform manner. Our cheeks loose volume as well as the area around our eye, temples, and jaw line. This contributes greatly to the aging process. When you were younger you probably had decent facial volume which blended better with the cheek implants. Since you are now loosing more volume around the cheeks, such as in your temples, under eyes, and lower cheek and jawline area, it makes the cheek implants appear more obvious and fake.

You have a couple of choices: one would be to enhance your facial volume around the cheek area, including your temples, under eye area, and brows. This will put your face into greater balance and harmony again.

Your other option is to take out the cheek implants, but then you will be faced with more hollowness and a more aged appearance. Your cheeks will no longer look fake, but instead might look deflated and older. At that point you can decide whether you want to enhance your facial volume. Your choices for doing that include fillers such as Radiesse, Restylane, and Juvederm, or your own fat.

Yes, having an endoscopic brow lift will raise your hairline. In some people it will only be raised by a few millimeters, but in others it might be raised by a centimeter or two. For people with a low hairline it is not usually a big deal, but if your hairline is already high, it could be disastrous to raise it any more.

If I feel a brow lift is warranted in a patient with a high hairline the brow lifting technique I would use is a trichaphitic hairline incision, which will actually LOWER your hairline while raising your brows. The incision tends to heal very well and should not be seen or be obvious once healed.

Sometimes people assume they need a brow lift, when in reality they need volume restoration to their brows and forehead. Those people would benefit most from fat injections, which are less traumatic and produce a very natural result.

You can learn more about brow lifts by visiting the Brow lift Information Page

Certainly I would consider it really rare to need a facelift before age 40 something. I can imagine a rare case If there was a large degree of weight loss--as in over 150 lbs of weight loss. For younger people (and I consider anyone younger than mid 40's pretty young) the main issue tends to be loss of facial volume. The hollowness that you are speaking of is not sagging skin, just loss of facial fat. Some people have a genetic predisposition to loss their facial volume at a young age. A facelift will not make you look like your old face--it will make you look weird and different. For those patients volume replacement is of much greater importance. Using either fillers or fat grafting to the face will not only reverse the hollowness, but will also take up the laxity in your skin and make it more firm.

As we age, we loose facial fat and volume. With time, our temples become very hollow and sunken in. This also happens to young healthy people, usually who are very athletic and lean with a very low body fat percentage.

The hollowness in the temples make us look more gaunt and older. It also helps shift the harmony in out faces and draws more attention to our lower cheeks as opposed to keeping attention at our eyes.

Fortunately, this is a very simple problem to treat quickly and effectively.

The two main options include fillers such as radiesse and perlane, or fat injections. I would suggest fat injections to people who have a high degree of facial fat loss who would benefit from volume augmentation that would otherwise necessitate a very large quantity of fillers.

Otherwise, fillers such as radiesse or perlane work great to reverse the changes in our temple. It is a quick and simple in office treatment that takes no more than 5 minutes to complete with virtually NO PAIN.

Typical upper eyelid surgery, also known as upper eyelid blepharoplasty, or a lid lift, consists of cutting away loose skin and underlying muscle and fat. This is a classic teaching that most plastic surgeons still, unfortunately, subscribe to.

The aging process in the eyelid area mostly consists of loss of volume of fat around our eye, as well as some loss in elasticity of the skin. We do not form "extra" skin. Cutting away the seemingly extra skin is the equivalent of cutting away the wrinkled skin of a raison and expecting to have it look like a grape again.

Restoration of the upper and lower eyelids is more complicated than most surgeons realize. to make your eyes look like they used to you need to understand the aging process.

The way I usually restore the upper eyelids is to cut away a little bit of skin, but to also inject either fat or fillers into the upper eyelid and brow to restore the lost volume.

This gives you a more natural result. It also leads to less hollowness and a HIGHER eyebrow, NOT lower. The fullness of your youth will be restored.

learn more about eyelid surgery by visiting: the eyelid surgery page at www.draharonov.com/eyelidsurgery.html

Aging of the hands is usually due to two main factors: thinning of the skin (dermis) and subcutaneus fat, as well as pigmentary changes.

To deal with the thinning of the skin and fat, there are two main options: Fat injections, or injections of fillers. Fat injections can work very well, but have the downside of prolonged edema (swelling) as well as the potential for lumpiness, and need to add more fat at a later time. With the advent of fillers, the same result can be achieved quickly and easily, with minimal risk and no discomfort.

The pigmentary changes can be dealt with either peels, laser therapy, or creams.

The thinning for the dermis and subcutaneous tissues are usually the first sign of the aging process of the hands and can start in our early 30's. Fortunately pigmentary changes happen later on, especially if we protect our hands from the sun by wearing appropriate sunblock.