Facial Fat Transfer

Fat Grafting has become a very popular and talked about procedure. It is constantly a topic of discussion at my work, in magazines, and at plastic surgery conferences that the surgeons attend.
It is called a new “trendy” procedure, but this is one that has really become a staple in the world of plastic surgery. I see patients have this done on a daily basis in the O.R. as young as 30 years old who are requesting this procedure.

What is fat grafting?

Also called fat transfer, it is a procedure that takes the place of injectable fillers (Restylane, Juvederm, and Sculptra) and silicone implants in the face. It is usually done under general anesthesia. (There are some doctors that will do it under local anesthesia if it’s a small area).

Basically, fat is taken from an area of your body (usually the abdomen, thighs, or knees) with a small instrument called a cannula. It is then put in a centrifuge (spinning device) where the pure fat is separated from blood and any other fluids. The pure fat is then put into small syringes and strategically injected into the areas that you and your surgeon have decided to treat. It takes about one to two hours and the downtime is very minimal. There are no allergies associated with fat grafting because it is your own fat. Also, infection rate is very minimal.
Are you a candidate for fat grafting?

First, it’s important to determine what face type you have and where you are lacking any fullness. There are many different shapes and types of faces in the world, but they can be broken down into a few categories.

1. Gaunt face

This is a person who has lost facial fat because of weight loss, sickness, stress, or has very low body fat. The fat is mostly lost in the mid face to cheek area.

2. Long face

This is a person who has a narrow face and also sometimes has a narrowing in the temples. This is mostly hereditary. Think of a rectangle but vertical.

3. Bottom heavy face

This is a person who has jowls along the jaw line, a heavy, full jaw line and full cheeks, and is narrower around the mid face and temples.

4. Aging face

This is a person who has lost fat from multiple areas of the face…cheeks, lips, temples, under eyes, and the mid face.

5. Chubby face

This is a person who has full cheeks and a round face. Sometimes the surgeon will suggest removing the buccal fat pads, which are actually two fat pads (one in each cheek) that will help thin out the face and make is less round.

6. Asymmetric face

This is a person who has had trauma to the face or a genetic medical issue. Fat grafting to one side of the face will help to make the face more symmetric and even.
The goal in aesthetics and beauty is to achieve a Heart-shaped face. Think of Elizabeth Taylor, Madonna, Liz Hurley, The Olson twins. The heart shape has long been regarded as the most balanced and beautiful face shape. It has a well-balanced forehead and large eyes with round cheeks, and a narrow chin that comes to a point.
With fat grafting, it is possible to change the shape of your face, look more youthful, and restore lost fat back to where it used to be.

It is a great alternative to injectables as it is permanent… you don’t have to keep going back to be re-injected every 3-6 months. It is also an alternative to facial implants because there is no potential for infection or displacement, which can happen with implants but is rare.

Fat grafting can also rejuvenate the skin from the inside out. Now, the surgeon can add PRP, or platelet rich plasma to the fat, which has been shown to add improved texture, color, and glow to the skin.

Fat transfer definitely softens facial features and can get rid of any hard, angles on the face that can happen as a result of aging. Jennifer Aniston looks like she may have had fat grafting done as her face looks much softer and fuller in the last 6 months. Many other celebrities are opting for this procedure because the down time is minimal and it is a scarless procedure.

Recovery

There is some swelling right after the procedure and bruising will probably happen. It is suggested to take 2 weeks off from any strenuous exercise, and you should sleep with your head elevated for the first week. Arnica Montana is a good homeopathic remedy for bruising and is sold in many pharmacies and health food stores. There are a couple of camoflage concealers on the market that can help hide any bruising in case you have to go back to work or want to go out. I love Dermablend and Joe Blasco.

I would definitely try an injectable filler such as Juvederm or Restylane first to have an idea of what it will look like. I typically suggest fat grafting to my injectable patients who have been using fillers for years and want their results to be more permanent.

Fat can literally be transferred anywhere in your face…lips, cheeks, jaw line, temples, under eyes, and the brow bone are common areas. Another common place is the buttocks or what is called a Brazilian Butt Lift. Many women who are flat in this area choose to do this in order to have a round, lifted butt. A decent amount of fat is needed to do it though, so make sure you have enough of your own fat to transfer. 
If you decide to go for this procedure, as always make sure that the surgeon you choose does a lot of this and ask to see multiple before and after pictures. Make sure that your surgeon is properly credentialed and trained, and always ask a lot of questions. This procedure is a great alternative to injectables.

Sylvia Silvestri, R.N.