Fat Grafting Overview

When we age our underlying collagen and elastic 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 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; some surgeons are also performing stand-alone stem cell facelifts that involve fat grafting. 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.
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.

History of the Procedure

Although the popularity of fat transplantation is a relatively recent development in plastic surgery, the concept of fat transfer is not new. As early as 1893, free fat autografts were used to fill a soft tissue defect. The use of autogenous abdominal fat to correct deficits in the malar area and chin was reported in 1909. Throughout the early part of the 20th century, attempts were made to correct other conditions, including hemifacial atrophy and breast defects, but modern fat grafting did not develop until the early 1980s with the popularity of liposuction.
Illouz reported the transfer of liposuction aspirate fat in 1984.¹In 1986, Ellenbogen reported the use of free pearl fat autografts in a variety of atrophic and posttraumatic facial deficits.²With refinements in technique, fat grafting has become the procedure of choice for an array of problems, including facial scarring, lip augmentation, and facial rhytides (such as several otherwise difficult-to-address areas such as the nasolabial fold and glabellar furrows).

What Is Fat Grafting?

Fat grafting is also called facial fat rejuvenation, fat transfer, free fat transfer, autologous fat grafting or transfer, micro-lipoinjection, and fat injections. For simplicity, we'll just call it fat grafting.
Fat grafting is the process of taking small amounts of fat from one part of the body and reimplanting 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 does not cause immune problems, and you already have some! The fat is harvested from some other spot on your body, such as you abdomen, and can be a by-product, if you will, of liposuction.
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.

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.

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.

Preparing for Your Procedure

You will probably be given an information packet that explains everything you should do and know before your procedure date. The packet should include a list of any medications you should not take before your procedure. These will include any products containing aspirin or ibuprofen. Make sure your doctor has a complete list of all medications that you take, including dietary supplements and herbal products.
You may be asked to have blood tests done in advance of your procedure to check on your health. This is usually an out-of-pocket expense.

How Fat Grafting Is Performed

This 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 epinephrine. If you are having liposuction for body contouring and will be having some of that suctioned fat injected, you will probably be under intravenous sedation. (You can read more about liposuction at our sister site, Liposuction4you.com).
If all you are getting is fat injections, the fat will probably be removed from a site treated with a local anesthetic. 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 or treated in some other way 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.
Rather than inject fat cells, some surgeons implant individual strands of fat cells one by one. This procedure takes time, but is said to last the longest. The down side is that there may be extremely small incisions.
After the procedure, you will be brought to the recovery room where you will be monitored until you are ready to be released. Most people are released about 2 hours after the procedure is finished. Your face may feel tight and quite tender as the anesthesia 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. However, if you believe your pain to be out of the ordinary once you get home, call your surgeon or the on-call staff immediately.

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 reimplanted fat cells can be given a better 'chance at life', if you are careful not to move the area around.
Some surgeons recommend that you do not use ice packs or cold packs on the treated area. However, conversely, other surgeons recommend using cold packs for the first 24 to 48 hours. Do what your surgeon recommends.
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! Take your temperature regularly. An elevated temperature could mean an infection.
With fat grafting, anywhere from 10% to 90% of the fat may be absorbed by the body. Most surgeons who offer fat grafting offer repeat treatments to their patients at a discount. May 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 probably be asked to see the surgeon 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 to 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.

The Risks and Complications of Fat Grafting

The most common problems with fat grafting are aesthetic ones. You may have too little fat tissue reimplanted or 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.
Other risks include an allergic reaction to the anesthesia or local anesthetic. There is a risk of infection, bad bruising, and asymmetry. 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 a rare and 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 needed.

The Average Price of Fat Grafting

The average prices for fatgrafting varies with the technique used, where it is being done (both where in the United States and where on your body), and the surgeon. Average prices for this procedure can range from $450 to $750 for the face and $900 to $1200.US for the lips. These prices may or may not include later touch ups. Find out what the fee includes beforehand.