I am a 48 year old woman and I am starting to get the droop on my cheeks. I do not wish to have surgery. I have had Scuptra, Juverderm and Radiesse injections and all have helped, none are permanent. I have been hearing that fat can be injected to lift the cheeks and that this is permanent. Of course, I understand that this would have to be performed by a board certified plastic surgeon. If this true, can you recommend the best plastic surgeon to do this Los Angeles?
Do Fat Injections Work As a Facelift?
Doctor Answers 8
In mild Facial aging, Fat Grafting CAN act as well as a Facelift
Facial aging is the result of several processes which act together at different speeds to bring about the collective spectrum of appearances we associate with aging.
Our cheek and mandible bones reabsorb and thin out making the overlying skin now appear like a table cloth which has been placed on a smaller table. Attachments of the facial skin along certain parts of the skull thin out causing facial sagging along specific points causing the familiar deepening of the lower lid cheek junction (Tear Trough), the appearance of the nose to mouth (Nasolabial) lines, the drool lines, the down turned corners of the mouth and the jowls. Finally, we lose fat from out faces which results is a deflation and accentuation of the lines and the sagging. The overall appearance is the transformation of the face from a youthful upside down pear, to the older oval or square face.
Filling the face and replacing lost volume WILL rejuvenate the face immensely. In the early stages of aging, adding volume to the face is all that is really required to restore the youthful look. When significant sagging is present the mere addition of volume cannot reverse the sagging and depending on the extent of aging various Facelift techniques may be needed.
While fat grafting does have shortcomings in predictable survival, need for a donor site and post grafting swelling, fat is by far the most ideal filler we have. If it does take it has a much longer survival than other fillers and unlike all other fillers fat contains a large number of stem cells which improve the color and feel of the skin above them making it more youthful. In my opinion, you should consider fat grafting before other techniques.
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Fat injection to the face vs alternatives
It sounds as if you have had many temporary fillers and some semipermanent fillers.
Our philosophy about fat injections is that fat that is used for fat injection is first obtained by a suction process. This damages the cell walls of many of the fat cells. The fat is usually centrifiged at high speed and then injected through a needle. It is no wonder that most of the cells that are injected are already dead when they are injected. The viability of fat injection specimens varies from 5% to 25% in carefully done studies. Our studies were done with dye exclusion methods and showed viability around 20-25% in very carefully harvested specimens. Other studies done with metabolic uptake methods showed viability much lower. Some studies that just use microscopes to tell how viable cells are are not, in my opinion, valid because they are not exact enough.
For this reason, we use primarily nontraumatized fat fascial grafts for facial volume augmentation. These consist of strips of tissue that are untraumatized when they are harvested. They are then placed in pockets within the face. each area is treated slightly differently and has certain requirements and limitations. We have termed this process LiveFill(TM).
In patients your age who are noticing the changes you describe, a facelift is usually necessary to achieve the best result, along with the grafting technique above. However you have decided not to have "surgery", so fillers alone will still give you a good result, just not the best result.
There are many fine surgeons in the Los Angeles area, and it is wise to consult with several you feel to be the best before making your final decision.
Facial Fat Injections for Face Lift Results
Some plastic surgeons use fat injections in combination with face lift surgery, while others use fat injections alone. Cosmetic facial treatment is largely based on the specialty of the physician and specific needs of the patient. While beneficial, fat injections have some disadvantages too. Down sides of fat augmentation include feeling lumps & bumps where fat is injected and requiring repeat treatments.
Another alternative to fat transfer to the middle face includes silicone cheek implants. Speak with a plastic surgeon who specializes in multiple methods of cosmetic facial enhancement to help find an appropriate treatment for you. Best of luck.
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Fat transfer results depend on your face
I have been doing fat transfers to the face for over 7 years. Patients who have a lot of thinning but good skin tone may get by with fat grafting alone to rejuvenate them. Patients who have thinning and a lot of skin aging as well as laxity of the tissues will typically not get as much improvement with the fat. The simple way to view this is: fat is great at treating the thinning problem, not great at treating sagging due to skin and facial laxity.
Fat injections for facial filling
Fat injections have been used for many years, with improvements in techniques allowing the fat to be injected as smaller doses per area, leaving a smoother result and a better chance for survival. Although it is not guaranteed to survive, fat injections do have a chance to provide long term survival as it is a graft and the cells can live in their new area. Both dermatologic and plastic surgeons are known nationally to provide excellent pan facial augmentation with fat injections. Fat injections may require several treatments as all the cells won't necessarily live after the first treatment.
Fat transfer to the face when done right and in the right patient is sometimes superior in results to face lifts. I tell patients What I have achieved with fat transfer to the face is better than the results of a face lift.
Need to choose the right patient candidate, moat important do your home work to chose an experienced Board Certified Plastic Surgeon. There can be bad results as well and those are moch more difficult to repair and more expensive to repair
The Liquid Facelift is the way of the future
Fat is the oldest filler ever used. The main problem with it is that it is unpredictable. It requires multiple sessions and if it stays can last forever, making the natural aging process appear less natural. The current trend is to use filler material that is synthesized using strict production codes, such as hyaluronic acid or calcium hydroxylapatite or even poly-L-lactic acid.
The concept of facelift has also changed with many practitioners realizing that there is a need for volume rather than just lifting. Thus the term liquid facelift has been coined to describe a facelift effect performed by volumizing fillers. Areas are filled using about 10-15ml of filler material and requires continuous touch-ups with time. Though at times cost-inhibitory, the liquid facelift provides the most natural effect when it comes to creating a youthful appearance. Different fillers can be used at the same time in different planes to help provide that natural look. A dermatologist or a plastic surgeon can perform the procedure, though one has to be wary as some plastic surgeons might opt for a facelift given their historical training.
As filler companies realize this, we will be seeing more filler made in more than the just 1ml syringes we are used to.
Facial fat grafting
There are three issues which must be addressed in the aging face. Facial structure, volume and skin quality. Surgical facelifts can restore tissue to there appropriate positions and remove lax inelastic skin. Volume can be replaced with fillers or your own fat and the skin can be addressed by skin care, peels or laser.
You may not need to have all three to rejuvenate your face but your surgeon wil be able to advise you at your consultation.