The concept of removing fat from one part of the body and injecting it into another part of the body is one of the most exciting to be added to the field of plastic surgery in the past decade. While fat transplantation has been done in various ways for some time (it was first recorded in the late 1800's, and is essentially the technique used for the first breast augmentation), the concept of fat transplantation by micro-injection is relatively new. Facial fat grafting has been increasing in populatrity and use for the past several years, and is a very effective way to fill in deep facial lines, nasolabial folds, and sunken eyes.
Why would we want to use fat as a grafting tool? For one thing, we should realize that one of the main causes of facial aging is the apparent loss of volume in one’s face. Typically, we think of the aging face as one in which the skin and underlying muscles have stretched out in response to long term exposure to gravity. While this is true (to some extent) and can often be repaired with more traditional procedures (such as with a face-lift), we have found that the loss of volume may be an even greater contributor to the appearance of facial aging. If we examine the round cheeks of a baby, and compare that with the more ‘hollowed’ appearance of an adult, it is clear that there are tremendous changes that develop with regard to distribution of fat and facial volume as we age. The skin can be thought of as an envelope, and the underlying fat and muscles as the contents. As these contents thin out, then there will be a relatively larger (and more empty) envelope. In the case of the face, this will result in an appearance of more facial sagging and wrinkles. By restoring fat in these areas, then we restore a more youthful and attractive appearance. While 20 years ago the emphasis for facial rejuvenation may have been on “lift” alone, current understanding has demonstrated that restoration of the youthful volume (via fat grafting or other methods) is a critical component in restoring the youthful facial contour, which has a major impact on the results that we are able to achieve for our patients.
Fat grafting is a natural approach to restoring a youthful look to the face that does not involve removal of skin, stretching the skin, or the risk of an unnatural looks that can result from a face lift. Fat grafting can be combined with a face lift, if that is what you need. The use of autologous materials (“your own tissue”), which is essentially taking tissue from one part of the body and moving it to another, is not a novel idea and has been used widely in treating many other serious conditions and defects due to disease, trauma or birth defects. As an injectable filler, your own fat is almost perfect.
It is soft and feels natural, it does not cause immune problems, and typically you already have plenty of donor material! Dr. Concannon performs fat grafting in conjunction with most of his facelift patients, to address both major causes of facial aging: sagging (gravity) and deflation (loss of volume). The sagging is corrected by the facelift, and the volume that has been lost with age is replaced, to create the most natural and realistically youthful look possible. This procedure (fat grafting) can also be done as a “stand-alone” procedure, as a less invasive way to restore your youthful look when a face lift (and its resultant downtime) is not required. It is a very valuable adjunct to other procedures as well, such as blepharoplasty (eyelid tuck). Facial aging involves both drooping of the skin and a loss of volume. While the loosening of the skin is usually most evident by the time you reach your forties or fifties, loss of volume can be seen as early as your late twenties. Loss of volume, or a “gaunt” look to the face, is most often seen in the lips, the cheeks, and under the eyes: this is best treated by fat grafting.
Fat grafting can also be used anywhere on the body. The “aging hand” appears that way because of loss of fat under the skin, and this condition also lends itself well to fat-grafting. Fat grafting can also be done to build up areas such as the buttocks. If there is excessive fat around the hips or thighs, this can be suctioned, cleaned and implanted into the buttocks to sculpt out a rounder silhouette.
Although you might think Dr. Concannon 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, as well as and any damaged fat cells. Whole, healthy fat cells are best used for reimplantation to maximize the chance for success. Therefore, Dr. Concannon manually aspirates the fat to be grafted, which is then spun in a centrifuge to remove excess fluids and the damaged fat cells, which are separated out. The fat (which looks like a yellowish liquid in the syringe) is then injected using a separate, smaller hypodermic needle.
The procedure uses minimally invasive methods and requires minimal downtime. Your own fat is extracted (usually from the hip, using a syringe, in an area that is numbed with local anesthetic) and then specially processed in the operating room before it is injected deep within the structures of the face to accentuate the cheekbones, midface, lips, cheeks, chin, nose, temples and/or jawline to reshape or restore the youthful facial configuration. This grafting is an “inexact science”: the transferred fat cells need to survive to maintain their volume. It is nearly impossible to predict the amount of potential graft take in any particular person, because there are many variables that can impact final graft “take”. Therefore, Dr. Concannon typically ‘overcorrects’ the area to be treated, understanding that there will be some volume loss after ultimate healing of the area. The common saying among plastic surgeons is that “what you see (with regard to results) at 4 months, you will see at 4 years”. That is because at 4 months, any volume that remains is the result of successfully grafted fat cells: since they are your own tissue, they will (at that point) continue to live indefinitely. Nevertheless, after this procedure we may find that you have not maintained the initial volume that gave such a nice initial result. In these circumstances, the grafting is repeated, without cost to the patient, in our office under local anesthesia. Dr. Concannon’s policy is that revisions to work such as this are done without further surgeon’s fees to the patient.
Interestingly, it has been discovered that liposuctioned fat is rich with stem cells. These are the undifferentiated cells that when placed in contact with the other tissues will actually create or repair them. We have seen for years that fat (which contains stem cells) injected into the face has corrected problems with skin pigmentation, wrinkles, loss of facial volume secondary to decrease in bony size, and other aging effects.
1. What is fat grafting?
Fat grafting is a cosmetic procedure where your own fat is used to rejuvenate the face, augment the cheeks or lips, or correct problems such as hollowness around the eyes or acne scars. Many people lose facial fat as they age and develop a hollow or gaunt look. Fat grafting can be used to correct this and give a younger, more refreshed look. Fat grafting is also referred to as free fat transfer. Some of the fat reimplanted is reabsorbed within a few months, but some of the augmentation will be permanent.
2. At what age can fat grafting be performed?
Fat grafting can be performed at any age. For lip or cheek augmentation, it is usually done anywhere from age 20 up. It is often done on people in their 40s or 50s for correcting the hollowness that can come with age (or to correct the removal of too much facial fat in a previous cosmetic surgery).
3. What does a typical fat grafting consultation entail?
A consultation is your chance to meet and interview a plastic surgeon. Dr. Concannon will go over your desires with you and explain your options. He will discuss what can realistically be achieved with fat grafting, discuss with you the risks, and determine the amount of augmentation you will need. The two of you will also discuss your medical history. You will have the opportunity to see photos of his patients to give you a realistic idea of what you might expect.
4. How is fat grafting performed?
The fat used in fat grafting is taken from elsewhere in your body. This fat is treated to concentrate viable and whole fat cells, which are then carefully reimplanted in the treatment area. The reimplantation is done by injection with a small blunt needle. This is a simple in-office procedure in most cases and done under local anesthesia.
5. What should I expect postoperatively?
You can expect to be swollen, a bit bruised, and a little sore both at the treatment site and the donor site. This is normal. You should keep the treatment area as still as possible for the first few days to allow proper healing. Avoid high-impact exercise or activities for the first 2 to 3 weeks, depending upon the extent of the surgery.
6. When will the stitches be removed from my donor site?
Typically stitches are not used at the donor site (not needed). There may be a single suture at the corners of the mouth, if Dr. Concannon releases the attatchments to the nasolabial fold.
7. When will I be able to see the results?
You will be a bit swollen at first and it might look like you were too augmented. This is usually just due to the swelling. The swelling will subside and you will usually be able to see your true results in 3 to 4 months. At about 4 months we will be able to see the final results: any volume remaining should be the result of viable (living) fat cells, which should be quite long lasting. “What you see at 4 months, you’ll see at 4 years”.
8. What are the risks of fat grafting?
The risks for fat grafting include infection, asymmetry, fatty cysts, hematoma, fat embolism, seroma, and permanent discoloration from the bruises. Most complications are rare.
9. Are the results permanent?
It depends. Fat grafting is an inexact science, and it is difficult to predict precisely how much of the graft will “take” and survive. Fat grafting typically survives better in areas with little movement (under the eyes) than in areas with a great deal of movement (lips). Discuss these issues with Dr. Concannon at your consultation: if further grafting is necessary, there are no additional fees to the patient.
- Natural, non-allergenic.
- Outpatient (in-office) procedure.
- Injections may last from several months to permanently.
- Minimal discomfort, which can be controlled with medication.
- Because fat is from the patient’s own body, no pre-testing is required and the fat cannot be rejected, though it may be resorbed.
- Good alternative if the patient is allergic to bovine collagen.
- Can be used together with other synthetic facial fillers such as Restylane or Radiesse.
- Longevity of results can vary significantly from patient to patient.
- Moderate to considerable swelling, bruising—usually about 48 hours. Patient should avoid the sun until the condition subsides.
- Not every area is appropriate for fat injection. Injecting fat into the breast, for example, makes cancer detection via mammography more difficult and is strongly discouraged .
- Lasts longest when injected in relatively stationary areas (such as the cheeks).
Question: What are the other different types of fillers (besides my own fatty tissue) that are available for use for restoring facial volume?
Collagen is a natural protein that supports the skin. Injectable collagen formulas derived from human dermis include Cosmoderm® or Cosmoplast®. Zyderm® and Zyplast® are forms of bovine collagen that, unlike human derived collagen, require prior allergy testing. The results may last 2 to 4 months.
Hyaluronic Acid (Restylane) is a natural substance found in our bodies. It is well suited to plump thin lips and fill facial creases such as nasolabial folds. It may also be appropriate for some surface wrinkles and concave scars. The results may last 6 months or longer, but are not permanent.
Hydroxylapatite is a mineral-like compound found naturally in human bones, suspended in a gel-like formulation. It is the heaviest of facial fillers and is recommended to fill deeper creases such as nasolabial folds, marionette lines and frown lines, as well as to enhance fullness of the cheeks and other facial contours.
Injectable fillers (including fat grafting, or injection with artifical fillers such as Restylane (c) can:
- Plump thin lips
- Enhance shallow contours
- Soften facial creases and wrinkles
- Improve the appearance of recessed scars
What it won’t do: Soft tissue augmentation with these does not stop the aging process. If you wish to change the elements of your face, surgery such as a facelift, brow lift or eye lift may be the answer.