I'm a 27 y/o female with a gaunt looking face due to loss of fat and deficient cheekbones. I want to add volume to my face, but I'm terrified of getting permanent unnatural/bad results with fat transfer. I'm considering getting my cheeks filled with a filler first. If I like the results, then I'll get fat transfer since for permanent results. I was wondering if a doctor can give me the same results as facial fillers using fat transfer? What kind of facial fillers should I get?
Can a Doctor Replicate the Results of Fillers with Fat Transfer?
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To perform fat grafting successfully and reproducibly a surgeon must employ careful preoperative planning, appropriate instrumentation and meticulous surgical technique. It is not something you can 'rush through' or spend just a few minutes on during a larger surgical procedure. The unfortunate reality is that not everyone who performs fat grafting is willing to put in the level of education, training, investment in instrumentation and operative effort required to produce aesthetically ideal results.
One must also have an aesthetic vision for ideal and youthful-appearing facial fullness. Just like traditional facelift surgery can be overdone or performed incorrectly to produce an unnaturally tight, pulled, 'windswept' look, fat grafting can be overdone to produce an excessively full and even bizarre postoperative appearance. Too much fat grafted into any area (or any fat placed where it doesn't belong) looks unnatural. It's analogous to breast augmentation results: if the surgeons selects an appropriate implant volume and positions the implants correctly, the patient gets a beautiful, natural-appearing breast enhancement. If the surgeons stuffs a pair of 500cc implants behind the breasts of an average-sized patient, then that patient ends up with a cartoonish 'boob job'. I think many of the unfavorable results in fat grafting are from the overzealous placement of excessive amounts of fat, which may have been the inevitable response to the recent paradigm shift in aesthetic facial surgery: away from the 'wind tunnel look', and towards the restoration of soft tissue volume.
Here is one patient’s experience with fat grafting posted to RealSelf:
Fat is great when used JUDICIOUSLY and CONSERVATIVELY, but too much of a good thing becomes a nightmare and deeply regrettable. Make sure your surgeon listens, draws up precise operative plans beforehand and makes plenty of time for you and your concerns. Do NOT take it lightly.
I couldn’t agree more with this patient’s response to her experience with fat grafting. Just like breast implants, or liposuction, or browlifts, too much of a good thing is not at all a good thing. And cosmetic surgery (and this includes the preparation for surgery) of any kind without attention to detail and a focus on natural-appearing results will leave patients feeling disappointed at best and feeling disfigured at worst. Now regarding whether or not fat grafting is a surgically sound concept…
For transferred fat to truly qualify as a 'graft' the following must happen: living tissue must be transferred to a new location, and that tissue must gain a blood supply at the new location which provides oxygen and nutrients which allow it to persist indefinitely as living tissue. We know that with appropriate instrumentation and technique this is achievable, so one of the opinions expressed in this thread that "most of the cells from fat injection are dead " is simply untrue (and structural fat grafting, to be clear, does not involve 'injection' of fat). MRI studies have shown that with appropriate technique grafted fat persists long-term as living, vascularized tissue in the recipient site.
It is also well-established that adult human fatty tissue contains stem cells that have the capacity to repair damaged or injured tissues, and stem cells can be concentrated during the fat harvesting process. This effect has applications in both cosmetic and reconstructive surgery. Fat grafting is now being used, for example, as a means to stimulate the repair of chronic, non-healing wounds. Several centers have reported on fat grafting immediately below non-healing chronic wounds resulting from radiation therapy for cancer, with rapid improvement and eventual healing of wounds for which no other wound treatment was successful. The development of stem cell therapies involving the harvesting and processing of viable human fatty tissue is one of the hottest topics in both clinical and experimental medicine today.
When performed correctly fat grafting actually has the capacity to heal, revitalize and rejuvenate the local tissues at the recipient site. I have treated a number of patients with facial fat atrophy following overly aggressive 'non-invasive' rejuvenation treatments including Thermage, Fraxel and IPL. Most of these patients report not only an aesthetically pleasing and permanent improvement in facial soft tissue volume, but also an improvement in the quality and vitality of their facial skin.
I perform extensive facial fat grafting during most of my facial rejuvenation procedures, and it is the very first thing I do - before making any incisions to lift the brows, eyelids, face or neck. Fat grafting allows me to obtain results that are simply not possible with conventional, subtractive surgical techniques alone. Patients frequently return for grafting of additional areas after their initial experience with strucutral fat grafting. To characterize it as the pointless and potentially harmful placement of non-viable tissue is an opinion only, and it is an opinion with which quite a number of plastic surgeons who successfully rejuvenate faces (and breasts and bodies) with fat grafting would vehemently disagree, myself included.
Solid fat/fascia and fat dermis grafts are another means by which facial soft tissue volume may be significantly and permanently enhanced. As with fat grafting, survival of the grafted tissue is variable and some of the graft material is reabsorbed. As with fat grafting, potential complications such as infection and cyst formation are possible. And as with fat grafting, appropriate preoperative planning and surgical technique are required in order to obtain ideal and lasting results. In my opinion structural fat grafting is more versatile, as fat can be easily and rapidly added to any tissue plane (level); and it has the added benefit of the ‘stem cell effect’ which is difficult to quantify but unquestionably present in many cases.
Both structural fat grafting and fascia-fat (or dermis-fat) grafting can be competently performed (or not) by Board-certified plastic surgeons. Neither should be trademarked or considered proprietary.
As with any surgical procedure take time researching your plastic surgeon. Schedule several consultation, view many photos from many patients, each from multiple perspectives (start by looking at photos on this website) and speak to former patients of any plastic surgeon you are considering.
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Smart To Try Fillers First Before Fat Transfer To Face
Thank you for your question. Fat Transfer to the face can produce excellent results for adding volume to the cheeks and a gaunt face. However Fat Transfer is usually a permanent correction and you will be stuck with the result if you do not like it.
We typically recommend that our patients try facial filler injection first to see if they like the result before proceeding with a permanent correction.
There are many fillers available. We use Retylane for a short term-3-6 months or Perlane for a longer-9-12 month result. If you like the results and choose to stay with fillers, Sculptra can create a more permanent correction.
The skill of your surgeon is the most important factor for a good result. Inquire how often the doctor does facial filler injections and ask to see photos of his/her results.
Try temporary filler before fat grafting
If unsure about fillers, try a degradable filler first. Once it dissolves away you can get fat grafting which is both permanent, natural and reproducible to any filler on the market.
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Facial Augmentation with Fat Grafting
Fat Grafting for facial augmentation is a far superior procedure compared to utilizing artificial fillers. I feel that fat grafting by an experienced surgeon will provide you with far better augmentation especially in the areas you refered to. Taking a first step with filler is not a bad idea, as the results are temporary. I would suggest fillers such as Restylane or Juvederm, which can also be dissolved with Hyaluronidase injections if you are truly not happy with the results.
Cheek fat transfer
Yes. It is possible to perform cheek lipoaugmentation with fat. Typically about 5 to 7 cc of processed fat is needed per cheek. I my opinion, the results obtained can exceed that of any filler in terms of costs and the natural look. Also, the results are permanent. To learn more, please visit the following link.
Cheek fillers vs fat transfer.
Facial volume enhancement with fat transfer
You can absolutely replicate the results of facial injectable fillers with fat transfer. If you would like to do a 'trial run' with filler first, use a hyaluronic acid-based filler such as Juvederm. If you see a surgeon who is experienced with fat transfer, you should not expect issues such as lumpiness or an unnatural result. The key is the aesthetic, with the idea of balancing your face, not changing you into a different person.
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.