The Surgeon Minute

Fat Transfer for the Aging Face

Fat Transfer for the Aging Face

Many people would argue that less fat is a good thing. Others – especially now and especially plastic surgeons – would suggest that fat is a GREAT thing. Surgeons are excited by fat when it can replace the need for temporary facial fillers and restore lost volume in the cheeks, plump up the lips or hide wrinkles and folds. With all of the hype around fat transfer for a better butt, fuller breasts and a fresher face, many people are beginning to look in the mirror and ask the question, “What can fat transfer do for me?”  

While the seemingly magical concept of fat transfer is very real, it does need to be wielded with restraint and deep anatomical knowledge. Board certified plastic surgeon Dr. Michael Lee of Park Cities Cosmetic Surgery cautions patients against trying to use fat transfer as a stand alone procedure to camouflage an aging face. “It’s a slippery slope, because you can overdo it,” he explains.  

To achieve a natural looking rejuvenated face, it’s important to consider how each person looked in their youth. “If you fat graft patients that don’t need it, they can look different and not like themselves,” explains Lee. “If they haven’t had much fat their entire life, and then all the sudden they have really big fat cheeks, people are going to know they had something done.”

Restoring the Foundation of the Face

As a face ages, volume is lost and that which remains is pulled downward by gravity. Early facelift techniques involved removal of the sunken volume followed by removal of excess skin and tightening of the remaining skin. This strategy often left patients looking unnatural and stretched, instead of rejuvenated. Faces appeared bony and thin, and the tightened skin made it look as if they were standing in a wind tunnel.

Long gone are the days of the pulled-tight facelift. Today, plastic surgeons take a three dimensional approach to restoring a youthful face. The fallen volume and underlying structures are repositioned back to where they used to be in youth. To determine how a patient has aged, Dr. Lee encourages his patients to bring photos of themselves ten, twenty, even thirty years ago with them to the consultation. He then decides which procedures will best restore the aging face. “Most of the time I will do eyelids – upper and lower, with a facelift and a neck lift,” says Lee. “I think that the majority of patients do really well with treating the whole face.”

The aging face.

Fat Transfer Does Not Replace a Facelift

Only a facelift can address the fallen foundation of an aging face. While surgeons and researchers have realized volume is one of the most critical components to a youthful look, if tissues are stretched and loose, adding volume will do little. A facelift is where loose, excess skin and tissue can be tightened or removed, providing a rejuvenated foundation from which to then add volume.

When a surgeon adds fat to a face without lifting the underlying tissues, the face will appear fuller, but not necessarily more youthful. “Essentially, fat has got a weight to it,” shares Lee. “In my experience, if you fat graft that patient and those tissues aren’t restored, corrected and reinforced, things just go back south.”

We want to restore them first and put everything in the correct position,” continues Dr. Lee. “In patients who are really deflated, then you can fat graft them at the time of surgery. If it’s the patient that has never had a lot of volume in their face, and you don’t think they’ve lost a lot of it, I don’t think you want to fat graft that patient.”

Benefits to Fat Transfer

Many people like the idea of having their fat, already a part of their body, transferred to another location. Another advantage to using your own fat to restore lost facial volume is the fat will live after being transferred. This means that part of the volume restoration is permanent. “With fat grafting, you may have 60% to 70% of it live in some patients,” says Lee. “In other patients, you may have less or more. We’ve come a long way in fat grafting, but it’s still not a hundred percent absolute result every time.”

Fat transfer to the face.

The Downside to Fat Transfer

The fact that not all fat lives after being transferred means that the results are not as reliable as using a temporary facial filler. Surgeons do not know exactly where the fat will take and where it will not take, making the results unpredictable. In addition, the fat that does live is prone to change with future weight fluctuations. If a person has fat transferred to their cheeks and later gains ten or twenty pounds, the cheeks may end up looking puffy or overdone. For this reason, many surgeons choose to only use fat transfer deep underneath the skin so that weight fluctuations will be more hidden while the fat still provides the requested volume.

The Key to Facial Rejuvenation

When it comes to facial rejuvenation, there is an appropriate time for facial fillers and other less-invasive treatments options. However, a time will come in the aging process when surgery is the best approach. “If you continue to treat a surgical problem with a non-surgical solution, one day you look in the mirror and you don’t look like yourself anymore,” says Lee.

The Role of Your Plastic Surgeon:

  • Oversee your surgical and non-surgical treatments
  • Let you know when it’s time for a surgical approach
  • Decide if fat transfer is a good option for you

Fat transfer, in the hands of an experienced plastic surgeon, is a useful tool to restore youthful volume. A plastic surgeon can best advise you when the time is right to restore the foundation of your face, and will determine if fat transfer should be done at that time. “It’s appropriate to use it, but you have to use it in the right situation and you have to be judicious and conservative with it because you don’t want to cause a problem,” shares Lee.

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