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Fat Grafting or Implants for Cheek, Chin and Jawline Enhancement?

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Fat Grafting vs Facial Implants

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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.

Obviously it appears as though there are as many opinions on fat grafting as there are plastic surgeons, and this must be profoundly confusing to prospective patients.  A number of physicians have made dogmatic statements about various procedures that may very well represent their own personal experience and preferences, but that do not necessarily provide interested laypersons with a balanced and accurate view of the options currently available for restoring facial soft tissue volume.

There are 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.

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.


Raleigh-Durham Plastic Surgeon
4.5 out of 5 stars 37 reviews

Fat grafting vs implant for facial enhancement

+2

A cheek or chin implant composed of silastic plastic is the best choice for cheek and chin augmentation, and jawline enhancement.  The implants are made of silastic and they are a bony augmentation.  The chin implant is inserted through a submental incision while the cheek implant is inserted through an intraoral incision above the upper teeth.  They are tapered so that patients cannot feel them.  Fat grafting leads to irregularities, lumps, and inconsistent results.  

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 55 reviews

Fat grafting to the cheeks, chin and jawline

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Fat grafts can be used to enhance the cheeks, chin and jawline.  These areas can also be enhanced with implants or by cutting and repositioning the underlying bones (mandible and zygoma).  Each option carries its own advantages and disadvantages.  Ones individual anatomy may also help determine which option may work best.  A board certified plastic surgeon should be able to evaluate your situation and give you an idea of which option would be best for you.

Vincent D. Lepore, MD
San Jose Plastic Surgeon
5.0 out of 5 stars 16 reviews

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Fat grafting or Implant for cheek, jaw and chin

+2

Either fat grafting or implants can be used to improve the projection of the cheek, chin and jaw. For the chin I definitely lean toward an implant (or sliding genioplasty) as the result is more consistent. The implants are designed to improve the prejowl region (in most cases) as well.

For the cheeks I prefer fat grafting overall, though this does depend on patient age, how much projection is needed and how much fat a patient has to donate. The fat is carefully placed in a mult-dimensional fashion to create a natural, balanced result.

 

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

Fat grafting aka fat injections for facial sculpting and volume and rejuvenation

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Fat cells can be grafted from another part of your body such as the lower abdomen, buttock or outer thigh with concurrent liposuction in these areas or by syringe removal if liposuction is not being done.  The fat cells are processed and then transferred to the desired areas such as the cheeks to increase volume which is lost over time and causes the lower face to fall.  In addition, rather than getting a chin implant, fat grafts can augment the chin if your chin is receded and causes a less than optimal angle of the neck on profile.  The jaw line can be straightened and rejuvenated to smoothen out the prejowl sulcus and the angle of the jaw in the back of the cheek.

Ronald Shelton, MD
Manhattan Dermatologist
5.0 out of 5 stars 31 reviews

Fat Grafting or Implants for Facial Augmentation. Fat augmentation is an excellent technique that

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Fat augmentation is an excellent technique that I've been doing for over 20 years. However , in a young patient  I prefer the use of implants to improve cheek, chin, and jaw projection and contour.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 14 reviews

Fat grafting of the face is one of the most exciting and successful techniques available today

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Not only can fat grafting increase or restore volume to the face, there is the added benefit of stem cell transfer that seems to add to the volume but also to the quality of the tissue including the skin. Fat grating to the face has been done successfully for years but requires a expertise that is only gained with time an experience. young plastic surgeons should limit their fat grafting to areas that are most forgiving. However some of the more recent areas of grafting such as the check, the eye brow and the temple have been increasingly beneficial and exciting. Make sure that the plastic surgeon has a good deal of experience with fat grafting and ask to see before and after photos. The bad results can be quite distressing. The good results are rejuvenating and seem to be long lasting or permanent. 

Carl W. "Rick" Lentz III, MD
Orlando Plastic Surgeon
5.0 out of 5 stars 10 reviews

Fat Grafting or Implants for facial enhancement

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For congenital problems where the facial bones are not developed, implants work very well. However, if the problem is aging or lack of soft tissue fill, then the best solution is fat grafting. Both require extensive expertise. See a Plastic Surgeon who has significant experience in both.
 

Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 4 reviews

Cheeck and jawline enhancement

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For multiple area enhancemnt, cheeck, jaw line and chin I prefer fat transfer. Implanta are possible but need maintainance.

Fat grafting require extreme expertise, Go slowly even if you have to do the fat fraft more than once.

Fat graft is technique dependant  fat has to be harvested gently, so that the fat cells are alive, and minimal trauma to the fat cells. the fat transfer has to be in small aloquets precisely inserted and layered in different planes.

Samir Shureih, MD
Baltimore Plastic Surgeon

Fat grafting for chin and jaw augmentation may not be the best alternative.

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The problem with fat grafting is that it is not as reliable as implant placement. It can be accomplished often with multiple procedures and with persistence.

Although I do fat grafting frequently and I am a firm proponent of this technique, it may not be your best option.

Although it is not as exotic and new, a standard chin implant or a sliding genioplasty may still be the best option for you. These are tried and tested techniques that accomplish predictable results.

Rodney A. Green, MD
Cleveland Plastic Surgeon
5.0 out of 5 stars 14 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.