There are a lot of things from dated clothing to gray hair that can make you look older, but one that has traditionally been harder to fix has been the problem of aging and drooping facial skin. Caused by the gradual breakdown of the skin’s collagen and elastin, this aged look is characterized by diminished volume in the face and can even lead to a gaunt appearance. It happens naturally to everyone with age, but it can be exacerbated by genetics and weight fluctuations as well as by lifestyle choices like smoking or sunbathing.
Fat transfer, also called fat injection, provides a way to fix this lack of volume by taking your own fat from elsewhere in your body and putting it into your face to restore volume and bring back a more youthful appearance. It can be used to improve wrinkles and creases, plump up thin limps, add volume to shallow facial contours, and fill skin depressions such as scars. Not only is it used as a filling agent, it also helps to restore stem cells and collagen to facial tissue to give a rejuvenating glow. Fat transfer is typically used to fill under the eyes and in the tear troughs, to plump up and rejuvenate the temples, cheeks, chin, jawline, and lips, and to smooth lines in the forehead and between the eyebrows.
Your first step for this cosmetic procedure will be a consultation with Dr. Masri. In this consultation, you’ll discuss your goals, and Dr. Masri will examine your features and determine where to place the fat for best results. You will also discuss which donor sites to use to supply the fat. In most cases, this will be the abdomen, thighs, or buttocks, but it can come from anywhere on your body. During your consultation you will probably also take some pre-surgery photographs both to use as a tool to sketch out where the injections will take place and to give you something for comparison after the procedure is done.
In addition to the technical details of your fat transfer, Dr. Masri will also discuss with you important pre-surgery preparations like stopping smoking for several weeks to maximize healing and avoid scarring, as well as avoiding aspirin and other drugs that might cause excess bleeding.
Fat transfers are usually performed with just a local anesthetic and a sedative to keep you relaxed, but general anesthesia is an option for patients with a strong preference. Once the anesthesia has been taken care of, fat will be removed from your donor site and prepared for the transfer in a way that keeps as many fat cells alive as possible. Once the fat is prepared, it will be carefully injected into the recipient sites with attention paid to balance and symmetry. The procedure is often completed within an hour, although it will of course take longer if you’re having more fat transferred.
Patients can expect to experience some swelling, bruising, and redness at both the donor and recipient sites. There may also be some discomfort that can be treated with medication. Some patients will need to wear a compression garment over the donor site in order to help shrink the skin down.
Fat transfer is a simple outpatient procedure, so you will likely go home almost immediately. Although you should feel physically ready to resume work within a day or two, most patients prefer not to resume work or social engagements for a week or two because bruising and swelling will be somewhat obvious. The swelling will become less readily apparent within two weeks, and your final results will become clear in about four weeks when the swelling has receded completely.
Possible Risks and Complications
While fat transfer is a safe procedure, there are some risks with the outcome. The most common and unavoidable one is fat re-absorption. No matter how much care is taken with the fat extraction and preparation, some percentage of the fat will not adapt to its new location and will not be as long-lasting. It will fade away, and the skin in that location would return to its original contours. Not enough fat is used to stretch the skin out and cause sagging, though, and the remaining skin will likely still look better due to the tautening effect of the stem cells and collagen. If the new contour is not acceptable, another injection will be necessary to correct the re-absorption.
Another risk is of inadequate correction or over-correction. If not enough fat is put in, there may need to be a follow-up procedure to put more in. Over-correction is a slightly more difficult fix. If it’s just a small over-correction, a fat-dissolving solution may be tried, but if that is not effective, the excess fat will require surgical removal via excision or liposuction.
The final potential issue is asymmetry. In this case, either more fat is put in on one side than the other or the same amount of fat is put over asymmetrical features, leading to an asymmetrical result. This is easiest to correct by injecting a little more in the smaller side.
Other much more rare risks include damage to underlying structures and bleeding. Dr. Masri will be happy to discuss these with you at your consultation.
Q. How long will the results last?
A. Unlike temporary fillers, the results from fat transfer can be permanent, since the majority of the transplanted fat reestablishes itself in the new location and establishes a new blood supply there. While the exact percentage of fat that doesn’t establish itself will vary, typically only minor touch-ups will be needed after the procedure.
Q. Will the scarring be noticeable?
A. Fat transfer is done by injection and leaves no scarring on your face. The only location for scarring is from the small incisions at the liposuction sites. These incisions are quite small and will be placed in hidden locations, making them practically invisible, especially after they eventually fade.
Q. Does fat transfer hurt?
A. There is generally some discomfort, but pain is fairly minimal, especially since there will be a local anesthetic for both the face and the donor sites. Any discomfort after the procedure can be easily removed with medication.
Q. Can I get the same lower-eye results from fat transfer as from lower eyelid surgery?
A. Well, yes and no. A traditional blepharoplasty, or eyelid surgery, involves an aggressive combination of excision, fat pad reduction or transposition, muscle redraping, and canthal support. It can work wonders with severe aging, but it’s quite invasive. For those with more moderate aging, fat grafting to fill in the tear troughs and enhance the lid/cheek contour can create a very natural and youthful look. The added fat will also support the lower lid, decreasing sagging. It may require several brief procedures to carefully layer the correct amount of fat for the results you’re looking for with no lumpiness, but we frequently see very good results in the lower eye area. Please discuss your concerns with Dr. Masri during your consultation to help you decide which procedure better suits your needs.
Q. Will my new facial fat disappear if I lose weight?
A. It depends on how much you lose. Minor fluctuations in weight should not impact your fat transfers, but the fat will retain the metabolic characteristics that it had in its original location, so if you lose a lot of weight, you may lose these new fat deposits. Likewise, it’s possible that if you gain a lot of weight, they may grow a bit. For that reason, we recommend that only patients who are happy at their current stable weight get fat transfer done.