Fat Transfer to the Cheeks Longevity?

I have lost a lot of volume in the buccal area, below my cheekbones--Abraham Lincoln style. Does fat transfer last well in this area?


Doctor Answers 9

Longevity of fat injections

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Fat injection grafts are aspirated through a syringe, centrifuged and then injected. Is it any wonder most of the cells are dead when they are first injected into the patient?

The reason survival of fat is so unpredictable is that you cannot tell which of the fat cells are alive and which are dead.

So when different groups of cells are analyzed under a microscope with various staining techniques, there are some areas where the viability is high (up to 50%), and other areas where is is almost zero, right next to each other.

Next, what happens to the combination of live cells, dead cells and free fat that is injected is also variable. Sometimes the fat (liquid dead fat) stays in bubbles and is walled off as fatty cysts. These fatty cysts can be broken by trauma, i.e. pressing on the area. At other times, there is an inflammatory reaction, eating away gradually at dead cells. This is called lobular panniculitis and is commonly seen in fat injection specimens.

So as you can see, predictability of fat injections is.... not predictable.

For this reason, we prefer to use fully live grafts of fat-fascia. In our practice, we have called these grafts LiveFill(R) grafts.

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 194 reviews

Fat Transfer to the Cheeks

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reatment of facial aging changes with fat grafting must  be carefully individualized to match each patient's aesthetic needs and desires.  I always examine and assess how each aesthetic area or 'unit' of the face contributes to an individual's overall appearance: the brows and eyelids, the cheeks or 'midface', the lower face and chin, and the neck. An individualized surgical plan is then developed which addresses each patient's specific concerns and needs.
Therefore, the price of a facial fat grafting will depend on exactly what each person needs and the time required to perform surgery. To select a plastic surgeon, take your time researching , visiting websites, view many, many before and after photos and speak to former patients.

Beware of doctors who discount their fees. Discounting the value of professional services, especially surgery, is not good marketing - it is a sign of desperation. The best plastic surgeons are still busy in this contracting economy, and they are not discounting their fees. At the same time, the most expensive surgeon is not necessarily the most talented, so as a consumer you still have to research this carefully. There is much more to consider than just the price in dollars that you pay: is your surgeon actually listening to you, do they truly understand the appearance that you hope to achieve, do you feel that he or she will be easily available and attentive once the surgery has been performed. If you don't have a good feeling, don't stick around to 'save money', go somewhere else.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Fat Transfer can be Unpredictable

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This is a question I hear often in my practice.  As a general rule of thumb, fat is unpredictable and your body may choose to reabsorb it within 3 months time.   I prefer to use Sculptra or injectable fillers for the cheeks because they are predictable in terms of duration and placement. Fat also requires harvesting and sedation.  With Sculptra and you can fill the area gradually- over time- for a softer, more natural look.  Best of luck, Dr. Clevens

Ross A. Clevens, MD
Melbourne Facial Plastic Surgeon
4.7 out of 5 stars 124 reviews

Fat Transfer longevity is hard to predict

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I am not a fan of injecting fat into cheeks for cheek fullness. Longevity is difficult to predict. It is difficult to achieve symmetry by injecting fat into the cheeks. Even if symmetry is accomplished, the fat may resorb in an asymmetrical manner requiring subsequent fat injections to fill-in the resorbed defects. I prefer injecting long lasting fillers--much easier to accomplish the desired results.

Fat transfer

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Fat transfer can be an excellent approach to the problem. There should be enough fat in other areas to supply the donor fat. One excellent technique is the FAMI technique, where the fat is placed alongside the facial muscles to provide adequate blood supply & hence longevity of the transferred fat.. I usually do 1-3 sessions, & the results are stable for 2-5 years.

Khaled El-Hoshy, MD
Detroit Dermatologic Surgeon

Fat grafting as a long term solution for cheek hollows

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Fat injection is a technique which has yet to be perfected. It is not a risk free procedure but it does have the potential to yield excellent results.

If and when the fat cells survive the results can be long-lived. There are reports of fat grafts living well over a decade. The problem is the diffiucult in predicting graft survival.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Fat injections can last for many years

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Of all dermatologic cosmetic procedures I perform, I have found that the results from fat injections, also called fat transfer, are the most capricious and unpredictable. Most patients undergo a series of injections. Some surgeons use the fat harvested and then frozen to reinject the same patient monthly. Other surgeons remove the fat each visit and reinject the fresh fat into the desired area immediately.

I have seen some patients derive a good response after the first treatment while other patients may not get a good response until after the third, and some don't obtain a satisfactory result. The fat is considered a graft. That is, the tissue must develop a new blood flow in its new environment so that it obtains oxygen and can live. Some fat cells will die. The smaller amounts placed per volume of deficit increases the chance of survival by increasing the surface area around the new fat cells to absorb more oxygen.

Some patients have longstanding results, more than five years after fat injections. They like the fact that it is there tissue. It can feel very natural. There are always risks to procedures and your doctor should discuss this with you. Many doctors prefer to use off-the-shelf fillers, such as Restylane, Juvederm, Perlane, Radiesse and collagen stimulators, such as Sculptra, rather than peforming a fat removal, processing the fat and then reinjecting the fat. With the development of these new fillers, there has been less fat injections done in my practice, but there still is a demand for it.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

Fat Transfer is unpredictable but excellent results are possible

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Fat Transfer to the face is unpredictable, but excellent long term results are possible (especially in the cheeks). Fat can be harvested from several different areas and processed in a number of ways. Since a large volume may be necessary, temporary fillers are often not cost effective for the cheek area.

Kevin Ende, MD
Manhattan Facial Plastic Surgeon

Longevity of fat grafting

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Basically, once the fat has been harvested and is in a syringe, it is dying on the vine for lack of blood flow into and out of it. Once it has been processed (no one knows the best ay to do this) it is injected into an area where the blood vessels must reconnect over the next few days in order to bring the fat back to life and "take." If it does not take, it will be reabsorbed by the body over 3 months. So, what's there at 3 months is relatively permanent.

Because of variable survival of the fat, it is often more popular to use injectable fillers. These always work, don't require surgery to harvest them, and some will last 1-3 years. Just avoid the "permanent" ones because they will cause long term problems in some patients.

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.