Questions and Answers

This issue will be dedicated to answering a few of the questions that have stacked up in the past few weeks.

Reader question: “I have been thinking about fixing the ‘sunken’ look in my cheeks. What is the best filler for my problem?”

Answer: Volume loss in the upper cheek area is a common complaint. During the aging process, not only does the face lose the “apples” in the cheeks; it also suffers from the breakdown of collagen and elastin fibers, contributing to the lines and wrinkles that appear beside the nose (nasolabial folds), beside the mouth (marionette lines) and jaw line (pre-jowl or jowl). Most people actually experience some degree of cheek volume loss, although women seem to notice the problem more frequently than men. Do some people watching. You are not alone; and “sunken cheeks” will not adversely affect your health. That said, if you still would like to address your issue, there is a big difference among dermal fillers. Dermal fillers can be divided into two major categories- hyaluronic acid (HA) and non-HA fillers. HA fillers like Juvederm, Restylane, and Perlane use a cross-linked hyaluronic acid gel matrix to restore volume to areas that have lost the youthful appearance. Non-HA fillers are typically designed to restore volume while also stimulating production of new collagen. (Collagen based fillers have a high potential to create allergic type reactions and are generally not used anymore). While HA fillers like Juvederm can restore some of the lost volume, they don’t have the ability to stimulate collagen and most HA fillers do not work well in the cheek area. Radiesse is a non-HA filler composed of calcium-based microspheres suspended in a gel matrix. The microspheres do a great job in providing extra volume in difficult to treat areas while the gel matrix stimulates your body to produce collagen to extend the results of the filler. Radiesse is less expensive when considering the amount in each syringe, lasts longer, and is a better filler choice for most areas of the face.

Reader question: “I have symptoms of low testosterone that haven’t improved despite taking ‘testosterone’ supplements. Am I beyond help?”

Answer: Failure to respond to supplements that are supposed to naturally increase your body’s testosterone (T) production does not mean that your body won’t respond to real T. I will admit that I have tried the best supplements at great expense in an effort to combat low T. The best supplements did raise my T level slightly, but not enough for me to notice a difference in my symptoms. Genuine testosterone is prescription only and in some cases can be less expensive than the most effective supplements. In most cases, replacing a daily designer coffee habit will cover the cost of T replacement. Don’t give up! I have yet to see a single patient who has not responded to prescription testosterone replacement.

Disclaimer: Dr Stephen Rath, MD, DABA is a board certified anesthesiologist as well as the owner and medical director of Fusion Medical Spa located in Ruidoso, NM. Comments or questions? His email address is: