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Fat Grafting: Face
Fat grafting has become a mainstay of the cosmetic surgeon’s armamentarium, allowing several facial aging changes to be corrected using less invasive techniques. Patients benefiting from fat grafting techniques include:
- Patients who desire improvement in their cheeks which may have become sunken in appearance
- Patients who desire augmentation of their lips
- Patients with hollowed-out eyelids do to over resection of fat during blepharoplasty
- Patients who desire increased facial volume through-out.
Fat grafting can be performed in the office with no sedation or can be combined with more invasive surgical procedures such as a face and neck lift. All of the above patients benefit from the ability of fat cells to be used, much like putty, to correct small soft tissue deficits as well as subtle contour irregularities. First, liposuction is used to harvest and collect fat material using sterile conditions.
Next, the fat material is processed to remove an oily and aqueous liquid layer and to pack the desired fat cells into 1 ml syringes. Finally, the fat cells are transferred back to the face by feathering the cells into the desired areas requiring volume replacement. In order to appreciate what fat grafting can do for you, please review our before and after gallery.
Procedure
Improvement of facial wrinkles, folds, depressed cheeks, poorly defined jawlines, and lips
Length
Ranges between 20 minutes to 30 minutes.
Anesthesia
The local anesthetic solution only.
Place of Treatment
Outpatient surgical suite or office procedure room.
Side Effects
1) Prolonged swelling up to 2 to 3 weeks is not uncommon due to the overfilling of fat that is performed to compensate for an expected 30 to 40 % of fat graft loss that is observed over the first year following the fat transfer. Most patients will notice aesthetically pleasing results at 2 weeks following surgery and stable volumes of correction and filling at one month following surgery.
2)Temporary bruising is often associated with fat grafting surgery due to the extent of tissue trauma that is created by fat harvesting and injection techniques. Bruising is minimized ensuring that patients due not have any blood clotting disorders or on any blood-thinning medications/foods/supplements such as Ginko Biloba, ginger, Fish oils, or Omega-3 fatty acids.
3)Temporary numbness is not uncommon and secondary to inadvertent injury to small sensory nerves which are traumatized by the mechanical action of fat harvesting and injection cannulas. Fortunately, patients should expect a full return of sensation as these nerves even if traumatized will regenerate and reestablish sensation.
4)Under correction of void spaces, wrinkles, folds, or contour deficiencies may not be uncommon as patients should tolerate 30 to 40% of volume loss that becomes apparent over the first year following surgery. Despite this expected volume loss, most patients are ecstatic with their postoperative observed volume improvements.
Risks
1) Local skin or fat infection is rare and associated with individual patients with poor healing tendencies secondary to medical illnesses.
2) Diabetes, nutritional deficiencies, and smoking are to blame for local infections. Well controlled sugar levels in diabetic patients, optimizing nutrition, and cessation of smoking are critical to avoiding infections.
3) Skin tissue compromise leading to skin loss is rare following fat grafting surgery and is associated with filling of scarred tissues due to increased degree of undermining and tunneling required. Smokers are urged to stop smoking for 4 weeks prior to and for 6 weeks following surgery in order to minimize risk of skin tissue compromise.
Recovery
The recovery period for fat grafting surgery with a return to most daily activities ranges from a few days to 1 week. Patients are asked to forego physical activities and exercise for approximately 2 weeks following surgery. Finally, patients are asked to forego important social engagements for approximately 1 month until volumes of contour correction are stabilized.
Duration of Results
Patients who have undergone fat grafting surgery can expect aesthetically pleasing results for life. Patients will observe 30 to 40% of volume loss over the first year following surgery. However, volume corrections one year following surgery should be considered stable.
FREQUENTLY ASKED QUESTIONS
How Do you transfer the fat into the face?
Our Surgical Team specializes in micro and macro fat grafting cannulas on the face. The diameter of the injection cannulas range from 3mm to 1mm depending on the area being grafted.
How much volume of fat can be grafted into the face?
Volumes of replacement range between 5cc to 30cc of fat injected in a single session! Our Surgical Team provides you a comprehensive facial analysis which will determine precise location and volumes of fat grafting which include:
| Area | Volume of Fat transfer |
|---|---|
| Upper and lower lips | 2 to 4cc |
| Nasolabial folds | 2 to 4cc |
| Nasojugal creases | 2 to 8cc |
| Central cheek | 2 to 8cc |
| Lateral cheek | 2 to 4cc |
| Upper nose(Radix) | 2 to 4cc |
| Infra-brows | 2 to 4cc |
| PreJowls | 2 to 4cc |
| Jawline | 2 to 8cc |
How can results of grafting be optimized?
Your results following fat grafting are dependent on several factors. First, the fat material needs to be handled gently as the fat cells are fragile and vulnerable to damage. The fat is gently handled from the extraction phase, to the processing phase, and then to the transfer phase. Our Surgical Team avoids all pressure exposure to the fat cells which has been associated with fat cell death. As a result, he avoids centrifugation of fat cells; instead, he utilizes only gravitational purification of cells. More importantly, he minimizes the processing and transfer duration (this is the time during which the fat cells spend outside the body). Think of fat cells as fish that are pulled out of water and start suffocating! Our Surgical Team completes transfer of the fat cells within a few minutes of extraction from your body to minimize fat cell suffocation. Finally, Our Surgical Team uses micro fat transfer technique placing each fat particle in 0.1cc aliquots. This process is very meticulous but it maximizes the surface area to volume of fat cells transferred, further ensuring delivery of nutrients back to the fat cells that have been temporarily displaced from their home. The above measures are critical in obtaining effective and natural results.
What is fat grafting auto-transplantation?
A fat grafting procedure transfers fat from areas in which you have excess fat, such as under the neck, and injects it into areas that may be lacking in volume, such as your cheeks, lips, etc. Today, fat cannot be transferred from one person to another i.e. you can only transplant from yourself, thus termed auto-transplanation. This safe, long-lasting, well-tolerated procedure produces natural-looking results. Every year, thousands of people undergo successful fat grafting and are pleased with the results.
When should you Consider Fat Transfer?
- If you have facial areas that appear creased and sunken
- If you desire more permanent correction than is provided by temporary fillers
- If you desire larger volume replacement (10 to 30cc) in the face that is not amenable to treatment with conventional fillers (1cc per syringe)
Do patients having fat grafting ever consider related procedures?
Many people who consider fat transfer also consider liposuction of the neck, botulinum toxin injections, and even face and neck lifts.
How is a fat transfer procedure performed?
Fat is harvested from one part of your body, washed and purified, and then carefully reinjected with specially designed needles into the areas that need augmentation. It may be necessary to repeat the fat grafting procedure several times to achieve the desired result. Fat grafting can be explained as a three-stage process: (1) harvesting (2) purification and transfer and (3) placement.
Harvesting: You and your surgeon will select a site for fat removal and will inject it with a local anesthetic. Your surgeon will then create a small incision in the area for fat removal and, using a sterile technique, insert a cannula connected to a syringe to carefully extract fat (liposuction).
Purification and transfer: Once enough fat is obtained from the donor area, your surgeon will process it to prepare the fat cells for transfer to small syringes that will be used for fat injection. Purification for facial grafting is done on Telfa pads which carefully absorb the undesired liquid part of the fat.
Placement: The area designated to receive the graft will then be prepared. Your surgeon will insert a needle or cannula into the incision point of the site being augmented. The injection needle is usually passed in and out of the areas to be augmented multiple times. Each time the needle or cannula is withdrawn, small aliquots(0.1cc) of fatty tissue parcels are carefully deposited into natural tissue planes. This process is repeated until the desired correction has been achieved, creating a grid of grafted fat.
The goal of your aesthetic plastic surgeon and the entire staff is to help you achieve the most beautiful and natural-looking results, as well as to make your surgical experience as easy and comfortable as possible.
What will my fat transfer incisions and scars be like?
- Because liposuction incisions are small, the healed incision lines are also small and are placed in hidden areas.
- The amount or degree of scarring depends on the surgeon’s technique and your genetic tendencies.
- Most liposuction scars fade and are barely perceptible over time.
- Grafting sites over your face and lips are only 2mm in length and virtually heal without any scarring at al.
PATIENT-SPECIFIC QUESTIONS
Which areas of the face can be transferred?
Several areas can now be successfully filled by fat grafting including the cheeks, jawline, laugh lines extending from the corner of the lip (those extending up are called nasolabial folds; those extending downward are called marionette lines), in the hollow of the lower eyelids, temple region, under the eyebrows, under the upper eyelid(if fat was over-resection following upper eyelid surgery), and the lips.
Why is 30% of the fat transferred volume lost at one year follow up?
Fat grafting requires avulsion of fat cells from their residence where they maintain a vascular supply to a new environment where they possess no direct vascular supply. As a result fat cells are required to keep alive by obtaining their nutrients by virtue of diffusion until a direct vascular supply sprouts into them. During this delay prior to vascular supply reintroduction it is believed that approximately 30% of cells do not make it and are eventually reabsorbed by the body over a one year period. In order to optimize fat cell viability, fat cells are transferred in 0.1 to 0.2 ml micropackets so that their surface area to volume ratios are maximized. This allows more of the cells to live by diffusion until the vascular supply is re-established.
Is fat grafting to the face going to be painful?
Fat grafting of the face requires modified micro-cannulas to liposuction fat cells followed by processing of the fat cells, and finally re-injection of fat cells into volume deficient areas. Both harvesting of fat and injection of fat utilize micro-cannulas which are smaller version of cannulas used in breast and body fat grafting. As a result postoperative pain associated with fat grafting of the face is negligible. Patients should expect to be sore for just a few days. Patients often avoid taking any pain reducing medications.
How do I know if I am a candidate for Fat grafting?
Fat grafting has become a mainstay of the plastic surgeon’s armamentarium and allows previously untreatable deformities to be corrected.
Patients benefiting from fat grafting techniques include:
- Patients who have developed breast deformities following failed implant augmentation.
- Patients who have developed contour irregularities following liposuction surgery.
- Patients desiring minimal to moderate degrees of buttocks augmentation.
- Patients who have developed traumatic scarring related divot or hollow deformities.
- Breast reconstruction patients.
All of the above Fat Grafting patients benefit from the ability of fat cells to be used, much like putty, to correct large soft tissue deficits as well as subtle contour irregularities.