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Can Fat Injections Replace Injectable Filler Treatments?

How successful are fat injections to the nasolabial folds of the face? Within the last two years, I have had Restylane, Perlane and Juvederm injected into the face. They worked well, but of course, don't last. A doctor suggested I try this more permanent type of injection. What is your feeling about this procedure? Is it similar to the gel fillers only with some fat removed from my body first? What is the down time and the average cost?

Doctor Answers 31

Fat grafts are not the best solution for nasolabial folds

Although fat transfer is revolutionizing facial and body aesthetic surgery, there are some regions were fat grafting is not as effective as other fillers on the market. One fo those regions is the nasal labial folds. Fat grafts don't seem to persist very long in this location. This could be due to a number of factors. For patients in our clinic, our recommendation is to use an HA filler like Restylane, or a 'permanant' filler like Artefill.

Fat is not like the fillers named!

As the inventor of the Viafill Fat Transfer system, I have a large body of experience with fat transfer. However, I still love Juvederm and Radiesse.

Each filler has its purpose.

Juvederm is great for fine lines and wrinkles. It is also great for lips and nasolabial folds when small volumes of fill are necessary. The downside is the short length of action.

Radiesse is great for filling deeper folds in areas like the nasolabial when small volumes are necessary. It also has the benefit of lasting longer than Juvederm.

Fat is great for large volumes and in areas that need to filldeeper areas. I like it for;

  • Tear Troughs
  • Temples
  • Cheeks
  • Hands
  • Breasts
  • Breast reconstructions

Robert M. Freund, MD
New York Plastic Surgeon
5.0 out of 5 stars 25 reviews

Fat grafting is a nice alternative to fillers

Linda,

Fat grafting is a nice alternative to fillers. It can achieve the same results as the fillers, but has the potential to last much longer and, possibly, permanently. Make sure that you go to someone with extensive experience in fat grafting, since you want to get it done correctly the first time. Basically, the fat is harvested from your abdomen or thigh with a mini-lipousuction technique. The fat is then processed (we use a centrifuge in my office) to isolate or concentrate the fat cells. The fat is then put into syringes and injected in a similar way as the off-the-shelf fillers. You should expect a bit more temporary bruising and swelling with the fat grafting than with the fillers. This is due to the fact that the fat should be injected into multiple levels and directions for a smooth, even look. Additionally, this helps increase the chance of the fat lasting since it will be distributed closer to the micro blood supply of the skin and subcutaneous tissue. If they are suggesting that you have fat grafting around your eyes, question them extensively about their experience and ask to see several before and after photos of their patients. Injecting fat in the lips and nasolabial crease is fairly routine. However, injections around the eyes can lead to big problems in inexperienced hands. The fat grafting procedure usually costs a bit more than the fillers, but it has the potential to last much longer. So, your cost savings in the long run is great. In my office, the fat grafting procedures generally run between $2000 and $4000 depending on the areas grafted (nasolabial crease, lips, cheeks, periorbital, pre-jowel, etc). Good luck with yoru procedure.

David Shafer, MD

David Shafer, MD
New York Plastic Surgeon
5.0 out of 5 stars 64 reviews

Try LiveFill - also is tightening needed?

Fat injections are considered by most doctors to have some permanent benefit. In our practice, we have studied and presented another option which has given superior results, LiveFill. Fat injection technique involves removal of fat cells from the body via liposuction. The cells are then usually spun in a centrifuge. They are then injected through a needle back into the face. This process kills (depending on the study you read and the technique used for measuring viability) most to nearly all of the cells. These dead cells cannot resurrect themselves.

LiveFill uses nontraumatized cells shaped into grafts which are then placed directly into hollow areas. The percentage of dead cells is very low, 12% in our studies (vs. 75% dead cells for Coleman technique fat aspiration). That means the number you are starting out with is higher, and your eventual success rate is higher as well. We demonstrated this with 3-dimensional CT scans measuring volume, presented the results at ASAPS and ASPS meetings, and published the results in Plastic and Reconstructive Surgery.

So yes, LiveFill is an alternative to temporary fillers.

Having said that, in most 62-year-old patients, there are usually two primary problems going on: loss of volume, and sagging of facial skin. Sagging of the skin cannot be overcome with obtuse amounts of volume replacement, in my opinion. Rather, a combination of a cleverly done facelift with volume restoration (with LiveFill grafts) gives the best long term results.

An old mentor of mine once said that if Plan A fails (i.e. temporary filler, temporary filler, temporary filler), make sure Plan B is not the same as Plan A (i.e. more temporary filler), but think of the problem differently. In this case, consider whether a facelift is the most appropriate way to rejuvenate the face.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 114 reviews

Fat transfer can be a great way to permanently treat wrinkles

Thanks for your question. As you know injectables like Restylane and Juvederm are temporary fillers that the body resorbs over time. Fat transfer is a permanent way to perform the same job that the temporary fillers do. Fat transfer can be a good second operation for patients that have had fillers and liked the effect.

The concept is to remove fat from a less desirable area (usually the abdomen or flanks) using liposuction and transfer it to an area that needs it - in your case the nasolabial folds - using lipoinjection.

Challenges to the procedure include getting the fat to survive, not over or under correcting and creating a smooth contour. Make sure you find a board certified plastic surgeon who has experience with this technique as there is a significant learning curve to produce good results, especially in the nasolabial folds. I hope this helps.

Steven Williams, MD

Fat Does Not Work Well for the Nasolabial Folds

In my experience, fat does not work well for the nasolabial folds. Some surgeons have had success using the Surgiwire to release the nasolabial folds and then injecting fat. Unfortunately, I have treated several patients who underwent fat augmentation in the nasolabial folds and ended up having the fat settle on either side of the fold and actually create a deeper fold.

D.J. Verret, MD
Dallas Facial Plastic Surgeon
4.0 out of 5 stars 13 reviews

Facial fat injection can be very successful

Facial fat grafting can be very successful when used appropriately by an experienced surgeon.  Facial fat grafting can be used instead of synthetic fillers in many areas, but sometimes a combination of different fillers can be beneficial.  The main advantage of fat grafting, other than it is your own tissue, is that larger volumes can be utilized than with synthetic fillers.  This is particularly beneficial in the cheeks, jawline, temples, and other areas of the body requiring larger volumes.  Though fat-grafting may initially may be more expensive, it typically lasts longer than synthetic fillers and you do not have to purchase the product.  Recent experience with water-assisted liposuction (body-jet) for fat harvesting has gained popularity since the harvested fat cells remain intact which can provide better survival and improve the overall result. The presence of viable stem cells within the harvested fat using this technique may also provide an added benefit not realized with other techniques.  The typical downtime with facial fat grafting is a little longer than with the synthetic fillers, so for small volume areas, I would still recommend using Juvederm or Radiesse with predictable results.  Good luck to you. 

Steven L. Ringler, MD, FACS
Grand Rapids Plastic Surgeon
5.0 out of 5 stars 39 reviews

Hyaluronic fillers beat fat injections in the face

My experience was that I could not get fat injections to last very long for the NL folds. I was also unhappy wth uneveness and bump formation in areas where the skin was thinner.

I have not had these issues using any of the fillers, and the results are much more predicatble. Also, there is no need to take fat from another area (which can be quite sore!)

John LoMonaco, MD, FACS
Houston Plastic Surgeon
5.0 out of 5 stars 205 reviews

Fat is the perfect filler

Fat is an excellent filler. The benefits of auto-fat transfer is that it is your own body and you will not have an allergic reaction to it. It is excellent for high volume filling. There is the potential for it to be permanet, since it is transfered as a graft. The exact amount that last long term is variable and really does depend on technique and physician experience. In my experience approximately 50% survives long term in the upper face, I tgend to gett 100% take in the buttock area.

Fat also has a small percentage of stem cells which will convert to the area it's injected into.

The cost is variable. In my practice, a face injected high volume under anesthesia costs roughly $4000. The nasolabial folds under local is $1500

Irvin M. Wiesman, MD
Chicago Plastic Surgeon
4.5 out of 5 stars 31 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.