The Surgeon Minute

Counteract Facial Volume Loss with Fat, Fillers, or Both

Counteract Facial Volume Loss with Fat, Fillers, or Both

One of the most important components of facial aging is the loss of volume that occurs in key areas of the face. When you think about a “baby face,” it is round and full, creating youth. In order for facial aging to be counteracted, a return to days of more volume is paramount.

To treat facial volume loss, fat or fillers injections are employed. While each procedure has its pros and cons, both are extremely effective either on their own, or as part of a surgical procedure such as a facelift. Dr. John Cook of Chicago, IL has spent the last 20 years studying facial volume loss as well as the best methods for combating the issue.  He discusses facial fat grafting and fillers and why he thinks of the two as a team.

Facial Aging = Volume Loss

There are any number of culprits when it comes to facial aging. Genetics and lifestyle choices such as diet, sun exposure, and smoking certainly play their part. The major villain, however, is something of which we have no control: volume loss. As we age, we start to lose volume in certain classic areas, such as:

  • the juncture between the upper cheek & lower eyelid
  • the mid face
  • the framing zone around the lips
  • along the chin (leading to jowling)

As these areas deflate with time, it can make a person look tired and less energetic. Dr. Cook started addressing this volume loss with facial fat grafting about 20 years ago; he was an early adopter. Now, the field of plastic surgery realizes that the restoration of volume is crucial in any kind of facial rejuvenation procedure.

In terms of the face specifically, it “has really been integral to my whole facelifting technique,” explains Dr. Cook. If you’re just lifting and restoring the position of the facial structures, you’re still missing something if you don’t restore the volume. Of course we’ve all seen pictures of celebrities with scarily overblown faces, so it can be overdone. “Any decent idea carried to extremes can have negative consequences,” explains Cook.  That said, fat grafting to the face has truly been revolutionary.

Fat Grafting, the New Gold Standard?

Fat grafting is a procedure that can be performed under local anesthetic in the office. It involves removing fat from one area of the body where you have too much (usually the stomach, thighs, or buttocks) and placing it in an area where you don’t have enough. In the case of reversing facial volume loss, areas of the face are targeted to soften and/or dramatically reduce fine lines, wrinkles and hollow areas. For Dr. Cook, fat is always going to be the gold standard because it’s so malleable. It’s also the most natural replacement, and carries the additional benefit of being a rich source of stem cells.

The downside of fat grafting is, in the hands of someone without a lot of experience, it can be less predictable than filler. Not all of the injected fat takes; some of the cells die off. It may also take more than one session to achieve your results. Unlike filler, however, the results are permanent.

Fillers for Every Need

One of the nicest things about plastic surgery today is that it’s an exciting era in terms of volume replacement. There are just so many options. In addition to fat grafting, there exists an ever expanding array of fillers, each with their own unique character and use. “I like to think of them as deep fillers, intermediate fillers and very superficial fillers,” explains Dr. Cook. The deep fillers have a heavier, more robust structure. This makes them ideal for replacing large amounts of lost volume in areas like the cheek.

Facial volume loss - deep fillers.

However, for a little bit hallowing at the corner of the mouth or to soften the nasolabial folds, the best option is going to be an intermediate filler.

Intermediate fillers.

Finally, the superficial filler is ideal for addressing fine lines such as crow’s feet.

Superficial fillers.

Different Fillers, Different Techniques

Just as there are different fillers, there are also different techniques for injecting these fillers. Typically, a patient is going to need a combination of fillers to achieve optimum results. The needle technique is the classic technique for injectables, but oftentimes, Dr. Cook will use the cannula technique. For this, he takes a tiny, hollow metal tube that has been used in liposuction and fat transfer for years. He then makes a tiny knick in the skin with a needle, and uses the cannula to deliver the filler.

Nano Fat

Both fillers and fat are incredibly versatile. The only thing that fat transfer to the face couldn’t address were very fine lines and wrinkles. However, now we have nano fat. This is a procedure where the surgeon takes the fat and runs it through a series of filters that eliminates a lot of the other elements that make the fat thick while still catching the stem cell-rich components. The result is fat that has “a very nice, light handling characteristic,” says Dr. Cook. This allows him to treat very fine lines and re-volumize areas such as the lips.

In addition, Dr. Cook uses a unique delivery system that allows them to place the nano fat into the dermis or deeper layer of the skin. Once there, the stem cells send out all kinds of good messages to the factory cells of the skin, such as the fibroblasts that are essentially knitting collagen, elastic fibers, and hyaluronic acid. These are the things that give that deeper layer of the skin its resiliency and plumpness.

Facial volume loss results - Dr. Cook.

It’s Not Necessarily One or the Other

While some plastic surgeons like to speak about fat versus filler, Dr. Cook feels that “[fillers and fat] are both very much on the same team.” A patient may come in for a fat transfer to the face and then, maybe 6 months later, an area might need a little touch up, so he’ll use filler. For him, the two are a team, working, “wonderfully together” to solve facial volume loss.

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