The Best Filler: Your Own Fat?

Our surgeons are constantly learning by keeping up to date on the most contemporary advancements in plastic surgery. A great practice is highlighted by surgeons who continually refine and stay at the “cutting edge” of their specialty. Our surgeons meet monthly and discuss these advancements as more clinically proven results are tested and discussed in the medical literature. Recently, a panel of surgeons presented the most current literature on facial fat augmentation using one’s own body fat. This is not a new concept, but as plastic surgeons get better at obtaining and purifying fat for use as a natural filler, patients are the ones reaping the benefit. Here are some common questions we get about fat grafting:

Q: When should you consider facial fat grafting?

A:  When we age, there is a decrease in facial fullness due to changes that occur in the structure of the face. For instance, the prominent bony protrusion of the cheeks decreases as the bone is absorbed, and the fat pads begin to thin and droop. This is seen starting in the late 30’s and early 40’s. As this occurs, we begin to see patients in the office looking for a non-surgical restoration of volume with injectable fillers. After successful restoration of volume with fillers, patients love the new “re-volumized” look and continue to come in yearly for repeat injections. At some point, transitioning a patient from injectable fillers to natural long lasting fat volume does come up in the consultation. If you have been happy with the results of facial fillers, now may be the time to discuss fat grafting with your surgeon.

Q: Can I have fat grafting at the same time as eyelid or face surgery?

A:  As an adjunct to eyelid, brow, or facelift surgery, fat is truly the best substance imaginable when harvested and injected appropriately using reasonable quantities. Fat grafting adds youthful, long-lasting volume to the face, while surgery removes the excess skin and improves the drooping of the facial structures. In addition, there is an incompletely understood rejuvenating effect of the transplanted fat to the skin itself. Studies demonstrate that stem cells, which are naturally present in harvested fat, can have a dramatic improvement in skin thickness, collagen production, and stimulation of new blood vessels. The look, texture, and feel of the skin all improve. These are all key components of regeneration and restoration of facial volume and youthfulness. In fact, sun damage, smoker’s lines, prior injuries, scarring, and pigmentation can all be improved through fat volumization. By recreating cells that are lost as a person ages, fat and stem cells are apparent keys to slowing, even reversing, the aging process. At Ponte Vedra Plastic Surgery, all of our surgeons agree that the addition of fat to facial surgery can dramatically improve the post-operative results. In addition, the fat forms new blood vessels and becomes living tissue, in turn growing along with the patient. This may decrease the need for additional fillers over time as the patient ages.

Q: How is this procedure performed?

A:  Fat is obtained from other sites on the body through a gentle extraction system similar to liposuction.  The fat is then washed, cleaned and then injected in very small amounts to the desired area (face, old scars, breasts, etc.). When done in combination with other surgery, the patient is usually asleep. However, this can also be done as a stand-alone procedure using only local anesthesia when appropriate.

Q: How long will fat grafting last?

A:  Fat becomes living tissue when injected carefully and correctly into a new location. This fat then stays with you permanently and, therefore, provides a long-lasting result. However, of the total fat injected, only about 40-60% remains behind and becomes permanent. This “fat survival” amount varies based on the characteristics of the tissue to which it is injected. For example, areas that are scarred or that have received radiation do not “take,” as well as areas rich in collagen and blood vessels.  For this reason, we tend to slightly overcorrect the treatment area hoping for around a 60% “take.” In some cases, a second treatment is necessary 4-6 months after the first as a touch-up procedure.

To learn more about structural micro-fat grafting, facial rejuvenation, or anything else, call our office to schedule a consultation  with one of our six board-certified plastic surgeons.

By Erez Sternberg, MD