Fat Transfer, Part 1: Facial Rejuvenation – Will Fillers Become Obsolete?

fat grafting

Hyaluronic acid fillers need no introduction. If you watch the Kardashians, know who the Kardashians are, or simply have a pulse in 2016, there’s a good chance you know what “fillers” are, as they’re colloquially known.

Second to botox, “soft tissue fillers” were the number two non-invasive procedure done in the United States, reported by the American Association of Plastic Surgery, with 2.4 million procedures done in 2015. A number that increased by 6% since 2014.

This dramatic growth reflects a shift in the cosmetic world that has taken place over the last decade as plastic surgeons have moved away from the over stretched, wrinkle-less visages of the past (which can actually make someone look older) and towards a focus on replacing lost volume to create the look of youth.

Cosmetic surgeon Dr. Alexander Rivkin explains, “When you are a teenager the focal point of the face is the eyes. As you get older and the face sags, the focal point of the face moves down and the more it moves down the older somebody looks. When we replace volume and lift the face physically but also lift up the face as perception, almost an optical illusion, we lift up the center focal point back up to the eyes and make someone look younger.”

Durable hyaluronic acid fillers like Juvederm, Voluma or Sculptra are the most common implements for replacing lost volume, but a growing procedure where live fat cells are transferred from one area of a patient’s body to the face is growing in popularity. Mainly, because unlike fillers, which last 6-12 months after which point need to be re-injected, “fat transfers” or “fat grafting” can last for years.

“We often find that transferring fat to a patients face unexpectedly and positively causes great improvements to their skin simply because of the regenerative properties of fat,” explains Dr. Berger.

The process begins by removing fat from an undesirable area of the body. The abdominal or thigh area are ideal, says cosmetic surgeon Dr. David Mashhadian of Rodeo Surgical Art in Beverly Hills, since “the fat quality is very good; it’s easy to harvest; and the cells are pluripotent – meaning the cells have the the capability to do other functions. Similar, but not the same as stem cells.”

Once removed, the fat is cleaned (sometimes mixed with PRP; platelet rich plasma) and the thick liquid is injected with a cannula (blunt needle).

“Fat is actually not lumpy,” says Beverly Hills based cosmetic surgeon Dr. Andre Berger, whom has written extensively on the subject of fat grafting, “Although you may think that. When you take the fat out it’s very liquid-y and almost like an emulsification. It’s injected like a thick fluid with tiny droplets little by little to build up and create that volume. It’s a beautiful technical art and skill.”

The quality of the fat and how it is injected is instrumental in the success of the procedure. Around 20-40% of the fat cells transferred will not “take” due to various reasons: how well the fat has been harvested and cleaned (free of impurities, like blood), the quality of the tissue it’s being injected into (scar tissue from previous facial procedures could interfere with the fat survival rate, explains Dr. Mashhadian), the injecting technique and health of the patient.

“Fat is live tissue,” explains Dr. Berger, “so it needs nutrition and oxygen to survive. If you put too much in one area and it doesn’t have enough space to get the nutrition and oxygen, it will not live.”

Smokers may want to stick with fillers or quit for a period of time before opting for fat grafting, since smoking can dramatically impair results.

“Cigarette smoke affects the micro blood vessels that are in the tissue, the skin, and underneath the skin,” says Dr. Berger, “Fat transfer is not something that should be done on current smokers because immediately they are going to comprise the fat graft’s ability to get nutrition and oxygen, and the graft won’t take well.”

But if you’re a non-smoker, have enough excess fat (very lean patients may not have enough fat to give for this procedure), and are looking for long-term results, fat grafting can produce a very natural look with a simple in-office procedure requiring in most cases only local anesthesia.

“Most patients walk in and walk out,” says Dr. Berger, “Within a week any swelling will dissipate and within three months most patients will see their final result. At the 90-day point, they can decide if they want to add a little more or if they’re happy. If the patient’s weight remains stable and they’re healthy, that fat is going to stay beautiful and retain that enhanced volume for many years to come.”

In addition, fat grafting can greatly improve skin quality due to it’s rich source of stem cells: Fat contains more stem cells than any other tissue in the human body, including bone marrow. This inherent quality allows fat to act as regenerative material enhancing surrounding tissue, including the skin.

“We often find that transferring fat to a patients face unexpectedly and positively causes great improvements to their skin simply because of the regenerative properties of fat,” explains Dr. Berger.

“I look at fat grafting as a broad brush,” says Dr. Mashhadian, “You use it on someone who needs a lot of volume replacement.”

Perhaps you’re thinking – will this make fillers obsolete? No, not anytime soon according to Dr. Mashhadian. Aside from being more cost accessible (fillers cost around $400-750 per 1ml syringe versus the roughly $2,000- 4,000 cost of fat grafting), fillers play a crucial role in rejuvenating the face in ways fat grafting cannot.

“I look at fat grafting as a broad brush,” says Dr. Mashhadian, “You use it on someone who needs a lot of volume replacement. You cannot get good definition with it, so on certain areas of the face it doesn’t work very well, like the lips or under the eye.”

And fat grafting is a little unpredictable, says board certified facial plastic surgeon Dr. Sarmela Sunder, “Every once in a while there is someone who will grow the fat a little bit more and asymmetries can happen.”

When irregularities happen with fillers or a patient is unhappy with the result, doctors have at their disposal hyaluronidase; an enzyme that dissolves hyaluronic acid fillers. Unfortunately, there is no quick fix like this available with fat grafting.

“If a patient has lots of weight fluctuations,” explains Dr. Mashhadian, “it is possible the injected fat grafts could increase in size and create future lumpiness.” And correcting these irregularities can be difficult. “If there’s a deficiency, you can add, but removing is very challenging,” he explains.

Injecting small amounts of fat over multiple fat grafting sessions avoids most irregularities, but if “lumpiness” does occur there are ways to correct it: massaging or injecting steroids into the area, and selective very small lipo-sculpture.

While growing interest is surrounding facial fat grafting, fat grafting to the butt (Brazillian Butt Lifts) is currently the most popular fat grafting procedure (thanks to a certain reality-tv star). And a new procedure in it’s infancy, fat grafting for natural breast enhancement, is also growing in popularity. Read more about it here in, “Fat Transfer, Part 2: Breast Enhancement – The Natural Alternative To Implants.”

Written by Amy Chang, founder + editor; Image source: cos 

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