Fat Grafting or Cheek Implants?

Question

I am 41 years old, and was thinking of refining my lower eyelids. I also have some loss of fullness in the lower area of my face, but I have nice cheeks (only they're not as full as they used to be). I wanted to know, will fat grafting or cheek implant (or a combination of both) help?

Michael A. Persky, MD · Answer

Hi Sigal,

There are many non-surgical treatments that can make you look younger, rested, and healthier.

I would not recommend cheek implants unless you like that Wayne Newton/ Dionne Warwicke full and unnatural appearance (works well for Las Vegas strip entertainers).

Fat transfer is an excellent choice, but is also a surgical procedure.

Sculptra injections by an experienced well trained injector gives very good results without anesthesia, the operating room, surgical scars, or the risk of surgical complications. It is not yet FDA approved for cosmetic use, but some physicians are using it off label. I believe that it will be the filler of the future.

Fractionated CO2 (Fraxel re:pair or Deep FX) will correct all of your concerns, plus give you refreshed skin tone, texture, and color, again without the surgeons scalpel. Again, as with any procedure on your one and only face, it is extremely important to choose your treating physician most carefully.

Good luck and be well.

Dr. P

Vito C. Quatela, MD · Answer

Either fat grafting or cheek implants could be a potential option for you. There are advantages and disadvantages to each procedure. I encourage you to meet with a certified plastic surgeon in your area who can discuss your concerns, see your volume loss in person, and recommend the best procedure(s) for your specific concerns and situation.

Raffy Karamanoukian, MD, FACS · Answer

Cheek implants will address the midface, while the fat grafting procedure can be customized to address the entire face in small increments to provide a nice overall improvement. Raffy Karamanoukian Los Angeles

Larry S. Nichter, MD, MS, FACS · Answer

An exam will be required to see if you would be a good candidate for either fat transfer or an implant. Both are highly successful tor the right person. A full discussion re: pros and cons of each would take place at your exam with your plastic surgeon. In my practice most patients now choose to have fat transfer.

Alejandro J. Quiroz, MD · Answer

I used to used many facial implants but  some years ago I have change to the used of fat with good results.  Not always is possible but is my first option

Trevor M. Born, MD · Answer

Dear Sigel Hillel
Micro Fat Grafting is a very good procedure for facial contouring. It can be used to contour the cheeks, jawline, temples and forehead.  It involves harvesting the fat from an area such as the tummy of flanks and the fat is prepared and injected in small amounts to add contour.
I combine fat grafting with eyelid surgery, face surgery, and for general facial contouring.
Cheek implants are an option- and in the right hands can give good results.
 
Good Luck.
With Warm Regards
Trevor M Born MD

Brent Moelleken, MD · Answer

With the combination of areas that concern you, from lower eyelid aging to cheek fullness to cheek position, it is difficult to know exactly what surgery would give you the best result.
The surgical plan could run the spectrum from injectables only, to lower eyelids, lower eyelids with fat repositioning, a cheeklift (minimal incision, with autologous tissue grafting to the cheek area), cheek implants of even a facelift, all depending on your anatomy and your wishes.

Sean Freeman, MD · Answer

When I offer a patient a facial aesthetic procedure I want the procedure that I offer to work in the vast majority of my patients with as little morbidity as possible. Fat grafting or injections do not fit this mold. A percentage of patients will get a good result but unfortunately a fairly high percentage will not when followed for over a year. This is due to the inability to quantify from patient to patient the exact amount of fat resorbtion that will occur from patient to patient. This leads to some patients looking over done for an extended period of time, some getting a decent result and some looking good for awhile but when they are examined a year of so latter, the results are less than satisfactory. There are other less common risks such as clumping which although not common can be difficult to repair.

	For that reason when I evaluate the midface and lower lid in the aging face I'm looking to see what kind of patient am I treating, an ectomorph (high metabolism, this dermis, tends to develop mid-face fat atrophy over time), an mesomorph (average metabolism, average dermis, and average in terms of fat atrophy over time) or an endomorph (low metabolism, thicker dermis in general and tends to retain fat). I then look at the 3D bony anatomy of the patient. For the vast majority of patients that have hollowness underneath the eye a SOOF lift blepharoplasty works typically for all body types.

	I can tell you that in my opinion this is the best procedure for improving the hollow look under the eyes that accompanies the aging process. I've been doing nothing but this procedure since I originally published this approach around 1999 in the Archives of Facial Plastic. As far as improving the nasolabial fold a SOOF lift by itself will help minimally. Most of my patients that have midface laxity have laxity elsewhere and have a deep plane minituck or facelift. I would recommend you avoid endotine lifts in the midface and/or "thread lifts" as in my experience neither is very helpful in the long run. To lift the midface solely a malar pad lift is done in my office with good results. It can be done under local. Occasionally a cheek implant is also helpful depending on the patient and pertinent anatomy. Seek a facial specialist and get two to three opinions, look at the doctor’s photos and you'll do alright in most cases.

Scott W. Mosser, MD · Answer

Each procedure has both its pros and its cons. With fat grafting, the fat will usually stay in position, but whether or not all the fat grafted will survive isn&rsquo;t entirely reliable. It depends largely on the skill and techniques used by the surgeon performing the procedure. Additional surgeries are possible for additional corrections.

	With implants, there may be the possibility of future procedures related to the implants, but the main issue with implants is that they tend to change your fundamental appearance just a bit. This can certainly be a good thing, but it&rsquo;s important for patients to be aware of this fact before proceeding. Fat grafting and fillers tend to not affect your fundamental &lsquo;look&rsquo; and instead give you a softer and sometimes rounder appearance.

	For more temporary results, fillers can be used to enhance the cheek area, and are less invasive. However your costs after multiple treatments can often be comparable to the costs of implants or fat grafting, so talk to your Board Certified Plastic Surgeon. They can then help you decide the best course of action based on your particular situation and goals.

Boris Volshteyn, MD, MS · Answer

There are several options for improving appearance of the cheeks, lower eyelid and the junction between them, known as nasojugal fold. 

	More traditional option is implants, and they could be quite reliable,  however, sometimes they create somewhat unnatural appearance, they can also migrate out of position and the surgery involved in placing them could be quite extensive.

	Fat grafting is another alternative. The benefit is that once the fat is placed, it usually will stay in its position.  However, the survival of the fat is not 100% reliable. Some patients may require additional procedures performed for additional filling, or additional correction.
	
	Another alternative pre-made syringes with various fillers.  The procedure of placing them is pretty straightforward and not as invasive as fat grafting or implants, however, the longevity of the results is less. Depending on the amount of filler used, the cost of multiple syringe injections may approximate the costs of fat grafting or implants.

	My preference is fat grafting, however, I always informe the patients that they may require more than one procedure to get the desired result.  I believe, utilization of hyperbaric oxygen therapy treatments can improve the survival of the fat grafts, however, did not feel it has to be done universally.

	Sincerely,

	Boris Volshteyn M.D., M.S.

Fat Grafting or Cheek Implants?

Answers (15)

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