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Principles of Soft-Tissue and Hard-Tissue Augmentation

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In this podcast, I really want to talk about understanding soft tissue augmentation and hard tissue augmentation. So as you know, our faces comprised of both soft tissue made of fat skin, muscle, soft tissue, fascia collagen, et cetera, as well as hard tissues, such as bone and cartilage. So if you think about that, what you want is this principle that I talk about in my lectures, like replaces, like, so when you have a soft tissue deficit, it is ideal to replace it with soft tissue. Similarly, if you have a hard tissue deficit is better to replace it with a hard tissue deficit with some exceptions. So, so this is the difference between implants versus fillers or fat grafting, so that so soft tissue replacement would be fat grafting and fillers in a nutshell and hard tissue replacement would be an implant such as a cheek implant, chin implant, eyelid implant, et cetera.

So in general, you have to think about those concepts. And then you also have to think about the concept that it has to be the safest implant for that person, which is a whole long discussion, which I probably don’t have time to get into in great detail. Why, why do we talk about light replaces? Like there’s several reasons. First of all, the, if you put a hard tissue item where a soft tissue should be, it looks like hard tissue. It looks like a piece of bone there. So let’s say someone is getting older, they’re thinning out their cheeks are collapsing inward. And then you decide to put in a cheek implant to fix that. Well, if you see this thin skin wrapping around a hard chicken plant, it actually exposes more bone. And the whole principle of what someone looks like when they’re getting older as bone exposure.

So if you put that cheek implant under this thin attenuated cheek skin, it oftentimes makes someone actually look older because there’s more bone accentuation. Because when people say, look, I like the look of a cheekbone. What they’re really talking about is the cheek mouth, the augmented cheek mound, which as you probably know, I’m very opposed to putting a lot into the anterior cheek. Because it just looks overdone and makes people look weird when they smile. So the, so this is why in general, I’m not a big fan of cheek implants. And also in terms of safety, chicken plants are oftentimes very hard to get symmetric. In addition, there’s a higher chance of infection and mobility. So in general, I think what my colleague out of California has said is cheek implants are a flawed procedure, which I really believe as well. I’ve not liked cheek implants look, I don’t like how they age and I don’t like the complication rate with GI complaints. On the flip side, I’m a big, big fan of chin implants. There’s several reasons I love chin implants. First of all, you know, there’s a big push now to try to do injectable fillers in the chin. As you guys know, I love injectable fillers, but I think that you just put fat or fillers into agenda, create an augmented. Look just looks like a fat chin and it doesn’t look great. So, you know, and it doesn’t create a durable well-defined projection. So you really need a chin implant when you’re looking at a very good level of augmentation of the chin area. So that’s the big difference between the two is that you’re looking at a generally soft tissue augmentation for the midface and generally a chin implant for the lower face, but not always the case, not always the case.

There’s some times, you know, a jowl that I need to put a little soft tissue, fill there, et cetera. But if you think of those principle, like replaces like soft tissue for soft tissue, hard tissue for hard tissue that is the ideal situation. And because our brain has an innate ability to see when something is a hard tissue, something looks like bone and something looks like soft tissue. We can tell the difference. And so when we try to replace a soft tissue with a hard tissue, does it look right? So for example, some, and then it requires so many. So for example, someone wants that people do under eye facial implants. Well, that’s a hard tissue in order to transition to look right oftentimes you have to augment that area with a hard implant. Then you’ve got to do a hard implant of the cheeks so there’s no transition zone there. So you don’t see the step off of the bone. Then you got to play this one on the outside and you’re wound up placing all of these implants hard implants everywhere. We’re really, it just requires a softer, soft tissue contouring. So hopefully this podcast, you have an understanding of how I sort of like to replace, like with like.