Facial Fat Transfer

1. 1. It is the most natural “filler”, since it is your own body tissue. Furthermore, it is replacing the volume loss that is secondary to fat atrophy. So you are replacing the fat that has been lost. When done properly, and with good take, it provides the most natural rejuvenating result.

1. 1. It is a more permanent solution that filler, because once the injected fat has vascularized, it doesn’t melt away. The aging process does not stop, however.

1. 1. It is more expensive because it is a surgical procedure that has longer lasting results.

1. 1. It is less predictable than filler injection. Our expectations are that, on average, 40-60% of the fat cells survive the transfer process. However, this is not a guarantee. Some patients may have minimal results because the fat cells do not survive. In general, the older you are the less fat survives. It is also thought that smokers have worse outcomes. This means that sometimes more than one fat transfer may be required to get your final result.

1. 1. If you are unhappy with the fat transfer results, such as too much fat is injected and survives, it is challenging to reverse. Sometimes injections with steroids might help, and some have advocated micro-liposuction to remove excess fat. And sometimes fat can be directly excised in cases of specific lumps/bumps

1. 1. There is “delayed gratification” with this result because the final results can take 6-9 months to finalized due to the process of need for some overfilling at the time of surgery in anticipation of 50% volume resorption. And the fat cells that survive can take some time (6-9 months) to reach their final volume as they will plump up once the vascularization is complete.

The procedure can be done on local anesthesia (tumescent) with oral sedation, with IV sedation (“twilight sedation”) or under general anesthesia depending on patient and surgeon preference. Dr. Amadi will determine the regions of the face that may benefit from fat transfer (cheeks, temples, brow, lateral cheeks, and sometimes upper and lower lids depending on surgeon technique/experience). Based on that presurgical determination, he will have a goal of how much fat needs to be harvested and will examine the body for areas that can provide the required fat. This may be the inner knees, inner or outer thighs/saddlebags, or abdominal region.

The area to be harvested is then injected with tumescent solution that provides local anesthesia. IV sedation or general anesthesia can also be utilized. Once the local anesthesia has had a chance to fully provide its effects (numbing and vasoconstriction) the fat is harvest though a suction technique through a few tiny stab incisions via a suction technique. Most surgeons feel hand vacuum with a syringe traumatizes the fat cells less, so motorized liposuction is usually not used for face fat harvesting. When extremely large volumes of fat is required, motorized vacuum liposuction can be used.

The fat cells are then processed via drainage or centrifuge (surgeon preference) and then transferred to smaller syringes to be injected into the face. Newer technology is now available to facilitate this process but does have an increased cost for patient and physician. Some surgeons also advocate the use of Platelet rich plasma to improve fat survival, but this is still controversial. The fat is then injected into the facial regions in a multiplanar fanning technique, usually in the deep tissues to minimize risk of contour irregularity. The face is often numbed with local anesthesia to make the patient more comfortable if IV sedation or General anesthesia is not used. The procedure can be combined with other surgeries such as eyelid, brow, face and neck lifts.

The recovery is usually relatively easy as it is minimally painful, and without much bruising (unless other surgical procedures are combined). Most surgeons do not recommend ice as we want to maximize fat survival. The donor site is often sore as a result of the fat harvesting. The face will seem puffy or overfilled in the first couple of weeks.

Most surgeons will overfill in anticipation of fat loss, so in the first 2-4 months, the face will seem overfilled/puffy in the areas that were injected. Between 1-3 months some of the fat cells will die off. At 3-4 months, the volume will be in its lowest state and then from 4 to 9 months the fat cells that have survived will start to plump up so that I generally tell patients that the results aren’t finalized until about 9 months.

There are other regenerative properties that are associated with fat transfer as the fat also has growth factors/cytokines that seem to improve skin texture and scars. This is an area of new research and “the jury is still out”.