The Surgeon Minute

Considering Fat Transfer to the Face? Proceed with Caution!

Considering Fat Transfer to the Face? Proceed with Caution!

One of the best ways to refresh an aging face is to restore the volume that has been lost. From fillers to fat transfer, plastic surgeons have many modern, effective methods available to deliver volume restoration.

Hyaluronic acid based fillers, such as Juvederm and Restylane, offer safe, reliable results with very little downtime. One drawback to off-the-shelf fillers is that the results are only temporary, and only truly work in the right situation.

Another option is the method of fat transfer. In this procedure, unwanted fat from one area of the body is utilized in the face for permanent volume. Many people believe it is the better long-term option for facial volume restoration as it is both permanent and a patient’s own tissue.

That being said, and with all of the positive buzz around fat transfer in general, the potential negatives can easily get lost in the mix. Board certified plastic surgeon Dr. Peter B. Fodor of Los Angeles details fat transfer to the face and how patients need to understands its drawbacks.

Fat Grafting to the Body is All the Rage

Fat grafting is revolutionizing the field of plastic surgery. Surgeons are removing fat with liposuction from areas where patients don’t want it, and are putting it in areas where they do want it. Body sculpting, buttock augmentation, and breast reconstruction are all benefiting immeasurably from the use of fat transfer.

Plastic Surgery Procedures Benefiting from Fat Transfer:

  • Buttock Augmentation
  • Body Contouring
  • Breast Reconstruction

Some surgeons, however, are finding that similar fat grafting techniques have major drawbacks when applied to volume restoration in the face. “Fat grafting into the face remains to be a very controversial subject,” shares Dr. Fodor.  “It’s great in many ways. You don’t have to pay for a filler. It’s your own fat. Most people have enough that they don’t mind getting rid of it. But, there are a lot of negatives.”

Fat transfer to the face drawbacks.

#1 Asymmetry in the Face Due to Weight Gain after Fat Transfer

One disadvantage of using fat in the face has to do with the fact that fat cells fluctuate in size with weight. “Not uncommonly, patients have been found to gain weight after surgery,” explains Fodor. “They gain weight drastically in the augmented areas of fat, and they can be gaining that asymmetrically.”

While the results may look great initially, if weight fluctuates, the fat cells may change and the results change. This can lead to an asymmetrical result in the long term, a condition that is much easier to spot on a person’s face than on their body.

#2 Asymmetry in the Face Due to Uneven Resorption after Fat Transfer

When fat is transferred to a new position, it needs blood vessels to support it for it to survive and remain permanently. Fat that does not develop a blood supply is resorbed by the body. Facial asymmetry can also result from uneven resorption of the fat. “Not all fat lives. It depends on your technique, it depends on a number of things,” shares Fodor. “Fat can resorb from the face asymmetrically. Even from the lips.”

With hyaluronic acid fillers, on the other hand, surgeons can add or subtract from the results to achieve and maintain symmetry. An enzyme can be used to dissolve fillers if the result is more than what the patient desires, and fillers can be added to maintain correction over time as they are evenly absorbed.

#3 Longer Recovery, More Swelling & Bruising

Swelling and bruising associated with fat grafting to the face may last for several weeks or more. This lengthy recovery time is not an issue when fat transfer is combined with a facelift, as that recovery is equally lengthy.

If a patient is looking for standalone volume restoration, they could avoid the extended downtime by opting for fillers instead. Fillers can do the job with very little risk and minimal downtime. Often, any bruising that does occur with fillers can be easily covered up with makeup the next day.

#4 Lumpy Results When Fat is Placed Superficially

Fat in the face, like fillers, require a nuanced approach for the best results. Such nuance is exhibited by surgeons who use different filler for different regions, dilute fillers for the right consistency, and actual placement. There are differing layers of importance that could use certain fillers, while other layers may require others. When this is considered, fat transfer in the face may be useful in certain situatons.

“Now having said all of this, I still use fat in the face, but I use it in a deep approach,” explains Fodor. “If I want to augment the cheeks, or the chin, right on the bone I feel very comfortable using fat. Not quite as much so in very superficial applications, where it can be lumpy.”

When fat is transferred, it does not always “lay down” smooth. When fat is placed deep, there is usually enough tissue coverage that lumps are not an issue. However, certain parts of the face have very thin skin. The area just underneath the eyes and even the lips do not provide much coverage for lumps. In those areas, opt for a filler instead.

Fillers instead of fat transfer.

With both fillers and fat transfer, consulting with an expert will provide you the best option. The profit margins on fillers are high, leading many less qualified practitioners to jump into the market. These injectors may be more casual and are certainly less-skilled in facial anatomy as compared to a plastic surgeon, a situation that could easily lead to “filler face” or “duck lips”.

When patients consult with an expert practitioner, they’ll be hearing a nuanced description of their face and how certain techniques may or may not be the correct option. For those looking to find natural facial rejuvenation, this is the best approach to achieving desired results.

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