I do a lot of both. Let me dispel the notion that fat grafts are unpredictable. When done in a certain way, following techniques well described by Sidney Coleman, fat grafts are predictable.
I love Sculptra, but like Dr. Moelleken states, it is less than ideal in the eyes, lips, superficial areas.
Sculptra is quick and lasts a long time (2-5 years). There is no recovery or down time. But it is not permanent. It can be done in the examining room and I mix it with a local anesthetic to diminish pain and bruising. I find that sometimes I have to do 2 or three separate sessions to get the right amount of fill.
Fat injection is done frequently under local anesthesia but it is a "procedure". I need a nurse and a tech to help me. There is down time where you are swollen. But the result is great and feels great. Even the skin looks better. There is evidence that stem cells present in the fat tissues may help the skin the skin.
