Q: Dr. Eppley, Do you know anything about Ultherapy? I had it ten months ago and had my ass handed to me. I developed not just volume loss (a ton) but it shrunk my eyes. I’m not sure if it was just the muscles or the vitreous humor as well. I’ve seen this with quite a few women. Not sure if you know medically/technically what is going on, but even if it is impossible to fix, I’d love to have a scientific explanation.
A: Like many facial skin tightening devices, they work by driving various forms of energy into the skin. This almost always results in the creation of heat whose effects will pass some distance below the skin. Thus the scientific explanation is simple….the energy driven below the tissues causes fat loss/atrophy. It is a simple function of heat and its effects on the fat cells. Fat cells are very sensitive to heat that exceeds 40 to 45 degrees Centigrade and such temperatures have well known fat atrophy/loss effects and is even the basis for devices who are for treating excess fat. Why Ultherapy would cause periorbital fat loss when that area was not directly treated I can not say.
Dr. Barry Eppley
Q: Dr. Eppley, I have lost a lot of the fat in my face particularly in the cheeks which has left them very hollow and sunken in. The area below my cheeks looks too full because it is indented above it. I havhe been told that fat injections would be the way to go even though fat transfer may not always stay. I know that cheek implants are permanent becuase they can not be absorbed. But I didn’t know of they come big enough to fill out the entire depressed cheek area. What sizes do they come in and do you think they are big enough to fill out the whole cheek area?
A:Your concept of considering cheek implants for helping restore facial volume loss is only partially correct. Cheek implants are not a substitute for fat injections when it comes to facial fat volume loss. The submalar style of cheek implant can help fill out the buccal area of the cheek (right below the cheekbone) but this represents only part of a larger surface area of the cheek and surrounding tissues which makeup the gaunt or skeletal facial look. Therefore, the use of this type of cheek implant may be a companion strategy with fat injections but is not a stand alone treatment for refilling out the deflated or fat-depleted face. Fat injections are more versatile because they can be placed anywhere. Cheek implants, even the submalar style, can not go very far from the edges of the bone and are more limited as to the facial area that they can cover.
Dr. Barry Eppley