Fat Grafting

When we age our underlying collagen and elastin begin to break down and wrinkles emerge. We also tend to lose some subcutaneous fat on our faces. This brings about a haggard, hollow, or even skeletal look.

Fat grafting is a natural approach to restoring a youthful look to the face that does not involve removal or stretching of the skin. It is about the restoration of volume, rather than tightening and can be combined with a face lift, or as a stand-alone procedure, depending on your aims. The use of autologous materials, which is essentially tissue taken from one part of the body and moved to another, is not a novel idea and has been used widely in treating many serious conditions or defects due to disease, trauma or birth defect. Although fat grafting and other types of grafting are still not perfect, they have certainly come a long way in recent years and can now be applied to many different areas of the body, including breast and buttock, but it is in the face that it has become a well-established rejuvenation technique.

Surgeons are continuing to discover new methods of aesthetic improvement through facial fat grafting. It is becoming more dependable in most patients and convenient since most people of average weight have more than enough fat tissue to be used in facial procedures. Because this is an area with a lot of development and rapid improvement, there are surgeons and physicians out there who may not have kept up with the latest developments and patients should not be afraid to ask specific questions about a surgeon’s experience with this technique.
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What Is Fat Grafting?

Fat grafting is also called facial fat rejuvenation, fat transfer, free fat transfer, autologous fat grafting or transfer, micro-lipoinjection, liposcupture, lipostructure and fat injections! For simplicity, I’ll just call it ‘fat grafting’.

Fat grafting is the process of taking small amounts of fat from one part of the body and re-implanting it elsewhere, where it is needed. This fat can be implanted to the lips, the nasolabial folds (the folds from the corners of your mouth to your nose), the under eye areas, the cheeks and other parts of your face and body. It is minimally invasive and can help correct problems such as acne scars and restore a youthful look to an aging face.

As an injectable filler, your own fat is almost perfect. It is soft and feels natural, it’s permanent and it does not cause immune problems. The fat is harvested from some other part of your body, such as you abdomen, and can be a by-product, if you will, of a liposuction procedure.

The main downside to fat grafting is that your body tends to absorb it at least to some degree. The amount of fat that is implanted and then absorbed by your body varies depending on who you talk to. Some studies have found that almost all the fat is absorbed, but there have been a lot of improvements in harvesting, treating, and injecting the fat and many cosmetic surgeons are reporting very good, lasting results. A lot depends on factors including how the fat was removed, how it was concentrated and treated, how much was injected, where it was injected, how still you kept the treatment area in the time right after treatment, and your metabolism and how well your body heals itself.
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The Best Candidates for Facial Fat Grafting

To be a good candidate for facial fat grafting, you have to be in good health, not have any active diseases or pre-existing medical conditions, and must have realistic expectations of the outcome of this procedure. Fat grafting can make you look more youthful, but it will not change anything else about your life. If you think anything else will change, you don’t have realistic expectations.

You need to talk to your cosmetic surgeon about what you want and make sure the he or she understands your needs. Discuss you goals with your surgeon so that both of you can reach an understanding of what can realistically be achieved.

You must be mentally and emotionally stable to undergo a cosmetic procedure. Please consider this before committing to a procedure.

You may not be a good candidate for fat grafting if you have a history of poor wound healing or if your overall health is poor.
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Facial Fat Reshaping: Most Popular Treated Areas

Fat grafting can be done on almost all areas of the face and body. However, the most common treatment sites are the areas under the eyes, the tear troughs under the eyes, the temples, the cheeks, the chin, the lips, the jaw line, the forehead, and the glabella (the area just above your nose in between the brows). Fat grafting can also be used to help fill in scars on the face and has been used on the buttocks and hips and the sternum.

The site being treated must have good blood circulation and enough capillaries and larger blood vessels so that the injected fat cells are nourished and can form their own blood supply. This is a key factor in getting the best and longest lasting results.
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What to Expect at Your Consultation

I will explain the technique and incision placements for fat removal and the re-implantation methods that are most appropriate for you. I will discuss all risks, including the risk that the fat will be absorbed by your body, which would mean that any improvement does not last.

I will also discuss the anaesthesia that will be used for your procedure. Most fat grafting procedures are performed under local anaesthesia for the site where the fat is harvested and regional anaesthesia for the treated area.
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Preparing for Your Procedure

You will be given an information packet that explains everything you should do and know before your procedure date. The packet will include a list of any medications you should not take before your procedure. These will include any products containing aspirin or ibuprofen. You may be asked to have blood tests done in advance of your procedure to check on your health. This is usually included in the price of the procedure.
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How Fat Grafting Is Performed

The procedure involves both a donor site (where the fat is taken from) and the treatment site (where it is being put). You may be given an oral sedative and receive injections of sterile saline, lidocaine, and possibly adrenaline. If you are having liposuction for body contouring and will be having some of that suctioned fat injected, you will probably be under general anaesthesia.

If all you are getting is fat injections, the fat will probably be removed from a site treated with a local anaesthetic. Usually, the donor site will be the buttocks or abdomen.

Although you would think they could just use a syringe to suck out the fat from one spot and use the same syringe to inject it where you want it, this is not done. The fat must be treated to remove blood and other fluid and any damaged fat cells. Whole healthy fat cells are best for reimplantation. So the surgeon suctions out a little fat and this fat is then spun in a centrifuge to remove excess fluids and the damaged fat cells are separated out. The fat (which looks like a yellowish liquid in the syringe) is then injected using a separate smaller hypodermic needle.

After the procedure, you will be brought to the recovery room where you will be monitored until you are returned to your room, ready to be discharged. Most people are discharged about 2 hours after the procedure is finished. Your face may feel tight and quite tender as the anaesthesia wears off and your donor site may be sore as well.

You will need to be driven home by a responsible adult because you will not be able to drive yourself home. Most patients do not have too much pain or discomfort.
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The Road to Recovery

You shouldn’t wear cosmetics until at least the day after. You will be told to try not to move the treated area or massage it for a few days after a fat grafting procedure. I know it is impossible to keep it totally immobilized, but try. The re-implanted fat cells can be given a better ‘chance at life’, if you are careful not to move the area around.

I recommend that you do not use ice packs or cold packs on the treated area as there seems to be some evidence that the cold damages the delicate fat grafts.

Some patients report mild or moderate bruising, although swelling can be pretty moderate to severe. Most of the swelling will last anywhere from 24 to 72 hours; although it should be gone completely in 2 to 4 weeks. If you have excessive pain, redness, pus or other symptoms that do not appear normal, contact your surgeon immediately.

With fat grafting, anywhere from 10% to 90% of the fat may be absorbed by the body. Some patients may need more than one treatment. The benefits of fat grafting can last anywhere from 3 months to 3 years, and probably more.

You will be asked to see me about 6 to 8 weeks after your treatment. This is when most swelling has subsided and early results can be evaluated. If you need more treatment, you will probably be asked to wait about 3 months after your first treatment to allow all swelling to resolve and blood vessels to grow and support the fat grafts.
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The Risks and Complications of Fat Grafting

The most common problems with fat grafting are aesthetic ones. You may have too little fat tissue re-implanted or, very occasionally, too much. You may also be happy with the results for several weeks or months, but then have most of the transferred fat be absorbed.

However, the answer to fat absorption is not simply injecting large amounts of fat the first time, assuming some of it won’t last. Placing too much fat in a particular area can overwhelm the growth of new blood vessels and the fat cells can all die at once, leading to irregularities or migration of fat out of the area where you want it.

There is a risk of infection, bad bruising, and asymmetry, though this is very rare. Occasionally, bruising caused by a ruptured superficial blood vessel at the treatment site may be permanent. Fat embolism, where some of the injected fat enters the bloodstream, is an extremely rare but serious complication, and can result in stroke or heart attack.

You may simply be unhappy with the results for many reasons, whether it is due to the decreased longevity of the graft, improper placement, or the overall outcome. Choose your surgeon wisely and your chance of a positive outcome is certainly increased. However, even the best doctor can’t perform miracles. If your body just doesn’t “take” the fat transfer, there is not much that can be done and another form of filler will be considered.
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