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Filling out my Thin Face - Should I Get Fat Transfer or Implants?

I would like to fill out several areas of my face permanently. Fat transfer sounds most natural to me, but I've heard that only about 50% of the injected fat tends to remain where it is injected, and even that 50% eventually disappears after 5 or 10 years. I'm 31 and I don't want to keep having fat transfers at age 40, 50, etc. Are implants a better option for me?

Doctor Answers (8)

Fat Transfer Vs. Facial Implants

+3
There is  a wide range of techniques, instrumentation and experience among the surgeons that perform this surgical procedure.  Because of the tremendous variability in all of these factors, there is tremendous variability in fat grafting results.  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.

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.
A wide variety of facial implants are currently available for the enhancement of the skeletal elements of facial aesthetics. The most commonly used facial implants are used to enhance the profile of the chin and the cheeks. Facial implants very widely not only in shape and style, but also in terms of the materials from which they are fabricated.
My preference is to use structural fat grafting, as much as possible, to enhance facial features. In many cases, the need for a solid implant can be eliminated by the careful and meticulous grafting of a patient's own fat. While the incidence of complications with facial implants is not high, certain problems may develop which require implant removal including infection and implant migration. Bone resorption (bone loss) has also been reported below solid facial implants. Neither of these problems are an issue with structural fat grafting.
The only setting in which I currently use a solid facial implant is for chin implant augmentation. Some patients with a 'weak' chin profile can be adequately improved by structural fat grafting alone. However, when the chin protrusion needs to be enhanced by a half centimeter or more, a chin implant is absolutely required. I prefer to use a soft, flexible, anatomic chin implant that conservatively enhances the anterior projection of the chin in profile. The chin implant is placed through an incision hidden underneath the chin, an area where many people already have a scar from a fall in childhood.
Moderate enhancement of chin projection in appropriate patients can dramatically enhance the profile, in a manner that is completely natural-appearing. It is remarkable how increasing chin prominence in some patients will reduce the apparent prominence of the nose, and restore an overall sense of harmony and balance to facial features.
For enhancement of the cheek bone area, I rely exclusively on structural fat grafting. Careful and meticulous fat grafting not only avoids some of the potential complications of solid cheek implants, but it also allows more precise 'customization' of the aesthetic improvement that can be obtained for each individual patient. It is also my opinion that structural fat grafting produces a more natural-appearing enhancement of the cheek area than what is generally achieved through the placement of solid implants over the cheekbone.
 
 


Raleigh-Durham Plastic Surgeon
4.5 out of 5 stars 42 reviews

Fat transfer

+2

Any procedure you choose will require further surgery in the future if you want to maintain the results.

You will continue to age and loose fat in the face whether you have any thing done now or not.

Fat transfer may need toutch ups, Facial implants will need maintainance. Implants can move, get infected, become more visible etc.

Discuss all your concerns with your Board Certified Plastic Surgeon. your options alternatives and potential risks. Then make your decision based on facts.

Samir Shureih, MD
Baltimore Plastic Surgeon

Implants Best for Significant Augmentation

+1

I think it sounds like you have various areas that you would like to consider filling. Implants are best used for significant augmentation of a specific area such as the chin or cheek bones. If you are looking to soften folds and fill creases, fat is a much more flexible treatment and can be used in the small quantities that some smaller areas require.
 

Thomas Buonassisi, MD
Vancouver Facial Plastic Surgeon
5.0 out of 5 stars 61 reviews

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Facial Harmony

+1

I believe there is a place for both fat and implants.  If you are trying to make up for a bone deficiency and have good tissue cover, an implant is a really good, long lasting choice.  For many people, they are coming in with loss of facial fat volume due to aging.  The expert return of fat to the face can often be done under local anesthesia with a high degree of persistence, more than 5 years.  The key disadvantage is the fact that some  of the fat injected gets eaten by the body, typically around 25 %.  More fat can always be injected as needed, better to under correct than over correct!!

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Fat injections

+1

In reality,  implants may need to be readjusted as you get older and the bony framework upon which they sit get thinner. Fat injections may need to be repeated years later also. Fat injections, however, can be placed in areas that have lost volume for which implants can't be inserted.

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Facial Implants

+1

It is ultimately your choice.  Fat transfer is easy, effective and less expensive (atleast in my practice).  It can be often done in an office under local anesthesia rather than operating room.  It may need redoing but it looks more natural and has fewer potential complications.

Siamak Agha, MD, PhD, FACS
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Volume enhancement for facial rejuvenation

+1

Which area of your face do you want to add volume to.  Both are great options.  For the malar/submalar region, implants are a far better options for the long term.  Today's implants are excellent and completely natural appearing.  For the tear trough implants can be done but fat is a better option.  For the chin and jaw implants are by far and away a better option giving superior results that are also permanent.

Jason B. Diamond, MD
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Try it first, then place implants

+1
Fat is a great starter if you would like to see how you'll look with a plumper face. You would need multiple sessions, but can last for many years. An implant may be placed if a patient realizes that this is the face they are willing to keep. Implants are more time consuming and cumbersome. Try fat transfer, you may like it to actually keep it.

Hassan Galadari, MD
Dubai Dermatologist

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.