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Fat Transfer to Face


Fat transfer is a booming area of plastic surgery.  Why? Because we have come to realize facial aging is a combination of

And we are discovering the abilities of stem cells.  What I have found with my younger patients (read anyone under age 50) is much of their facial aging is volume loss.  This accounts for the popularity of nonsurgical soft tissue fillers to the face: Restylane, Perlane, Juvederm, and Sculptra among others. These have been deemed the liquid facelift or nonsurgical facelift.

A facelift or eyelift can tighten the skin, but it does not correct volume loss.  You see this in people who have tight skin but still look old.  Why?  The surgery only addressed the skin.  If you look at a child they have a full face.  Not plump or fat, but full.  This fullness of youth is part of what needs to be fixed when doing surgery.  Thus VOLUME must be part of a successful rejuvenating surgery for the face and eye.

How to add volume?  Again, nonsurgically we have been doing this for years with HA fillers and Sculptra.  What has happened though over time is the improvement in fat transfer techniques.  How to remove the fat, process the fat, and inject the fat to insure the fat lives.  When you do fat grafting, you need the fat cell to live in the new location.  I use techniques I have learned to minimize damage to the fat cell and place using a micro fat injection technique.

The other benefit of fat?  Not only is it using your own tissue to reconstruct you (and you get a little liposuction sculpting to boot), but it has stem cells.  Stem cells are currently the fairy magic dust of plastic surgery.  We don’t quite understand what happens when we transfer the fat with stem cells- how it does it and how to optimize it.  But we do know fat has a rich store of stem cells.  And we do know we see things we can’t explain just from the volume alone of the grafted fat– the area fills, but the skin looks better.  This change is slow and subtle, but there.

I too was a skeptic, but I had a patient who I experienced the magic of fat transfer with first hand.  She was a woman with tough acne scarring on her cheek.  She had asymmetry of her cheek volume, so years ago I did fat transfer to try to even out the volumes of her cheek.  My technique then was not as refined as now, but it worked.  The amazing part was the change in her skin.  I had the opportunity to work on her cheek again about 4 years after her initial fat transfer.  Not only were the acne pits shallower and cosmetically improved, but her skin — which had been hard and leathery before– was now soft and stretchy. I can’t account for that change by volume alone.  I attribute it to the stem cell effect.  There are clear studies which show with histologic biopsies this stem cell effect.  Nothing else does it.

People worry the fat may be lumpy or uneven.  I do not see this.  There are scientific studies which also support fat survival is consistent and even within a patient.  Please see someone who does a lot of fat transfer.

Where to transfer fat?

I find I am using it as a stand alone procedure and as an adjunct to my surgical procedures like eyelid surgery and facelifts.  You need to think of fat grafting to the face as a surgical procedure.  I perform the surgery in the operating room, as I need sterile technique and the centrifuge.  The procedure is usually done under local anesthesia.  Recovery is not painful, but you will have swelling and some bruising.  For those of you with busy Bay Area lives, this swelling means you may want to take a week off work or work from home.

For more information of fat and stem cells, please see my many blogs on the topic.  You will find many of the fat grafting and fat transfer blogs in the breast augmentation section as I do fat transfer for breast augmentation as well.  Stem cells and fat transfer tenets are the same regardless of where I put the fat.

This is a growing interest and part of my practice.  It seems most of my colleagues are now jumping on the bandwagon.  At our recent Aesthetic meeting, many topics were all about fat and the benefits of transfer.

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