Fat Transfer/grafting for Cheeks? (photo)

I have always had a long, narrow face. However, with age and with weight loss, the volume in my face seems depleted. I am considering fat transfer for my cheeks. I was wondering if my expectation of a fuller face is reasonable with this procedure as I am hoping to avoid implants. Does this procedure need to be performed under full anesthesia? What is the aprox cost/range? And lastly, are there any doctors that you can recommend that specialize in this technique (NY, Dallas, Atlanta, LA)

Doctor Answers 13

Excellent candidate for fat transfer

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You are an excellent candidate for fat transfer to your face. Sometimes however patients that are super thin and muscular will not have much fat to harvest from other parts of their body.

Most women have a little reservoir of fat on the inner or outer thighs, but if you are in tremendous shape, this may not be the case.

Having said that, most surgeons will do fat transfer with deep sedation, though I've done the procedure with light sedation and local anesthesia only.

The cost is usually between $5000-10000 depending how many regions of the face are injected, and what part of the country you live in.

Seattle Oculoplastic Surgeon
5.0 out of 5 stars 41 reviews

Fat Grafting the Cheeks

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Whether the goal is to restore volume to the lips or cheeks or temples, or to fill in a crease or depression such as the nasolabial folds or marionette lines (or all of the above), the ideal material is quite clearly the material that one wishes were there in greater abundance in the first place: your own fat. To be the ideal filler material it must also make sense from a cost perspective, which it does. The fat supply, from the standpoint of the volumes required for facial enhancement, is essentially limitless. A multi-area facial enhancement by fat grafting costs about the same as several syringes of ArteFill, Radiesse or Sculptra. And fat has the distinct advantages of not inciting an immune response, producing a more natural soft tissue consistency, and being well tolerated immediately below the skin (even within the deep dermis itself). So in my practice, there really is no place for the 'semi-permanent' soft tissue fillers.

The process is actually quite straightforward: fat is harvested from the abdomen, thighs, hips or buttocks using specially-designed instruments and a specialized technique, processed (by centrifugation, which eliminates all components of the harvested material which are not viable fat), and meticulously introduced into the facial areas to be enhanced using a second, smaller set of fat transfer cannulas. This procedure does not require an operating room and deep sedation or anesthesia - it can be performed in the office procedure room under local anesthesia and oral sedation.

A number of terms are currently used to describe varying techniques for harvesting and delivering fat in small quantities to produce long-lasting soft tissue augmentation: structural fat grafting, microfat grafting, lipostructure, orbital pearl fat grafting, etc. These terms all describe techniques for harvesting living fatty tissue with minimal trauma, refining the fat (in most cases) in some manner such as by centrifugation, and meticulously introducing the fat into the recipient area a small amount at a time to produce new soft tissue structure.

When is a graft truly a graft?

For fat grafting to truly represent 'grafting', the grafted tissue must gain a blood supply in its new location which provides a source of oxygen and nutrients and allows the tissue to persist indefinitely. If the grafted fat does not acquire a blood supply in the first few weeks after surgery, the body will gradually break it down and dissolve it, and no long-term benefit will be achieved in terms of soft tissue augmentation. Successful fat grafting surgery therefore requires a great deal of focus and attention to detail, to ensure that the fat which is harvested is viable tissue (i.e. not damaged by the harvesting process), and that the fat is delivered in such a way that the potential for ingrowth of blood vessels is maximal. If this process of blood vessel ingrowth (neovascularization) does not occur, then the injected tissue cannot truly be considered a 'graft' and is instead just another 'soft tissue filler' of limited duration.

Fat grafting has been performed by plastic surgeons for decades, but it is just in the last ten years or so that techniques and instruments have been refined to the point that it can be accomplished reproducibly and reliably, making it an increasingly important part of facial rejuvenation surgery. The term 'structural fat grafting' refers to a specific surgical technique in which small amounts (less than 0.1 cc at a time) of fat are carefully microinjected in a series of discrete layers to gradually 'build' new soft tissue structure. As there is space between each microinjection, new blood vessels are able to grow into the grafted fat, allowing it to persist long-term.

Structural fat grafting requires specialized training and specialized surgical instruments, as well as patience, finesse and attention to detail on the part of the surgeon. When performed properly, permanent and natural-appearing improvements in facial contours are possible. This revolutionary technique provides a means for restoring a youthful facial appearance that cannot be accomplished by means of traditional facial cosmetic surgery techniques, which have in the past focused primarily on skin excision for the purpose of 'tightening' facial features.

Take your time in selecting a physician to perform your fat grafting. And be sure to view many, many before and after photos of patients who have had fat grafting with the physician you select 

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

Fat transfer expert

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You are an excellent candidate for a fat transfer providing you have adequate donor fat.  While a full face fat transfer is appropriate you may choose to just have  the cheek/midface.  I have been doing fat transfers for 15 yrs and have performed over 500 facial fat transfers and co authored the standard textbook on facial fat grafting.  The procedure can be done with local or IV sedation and cost ranges from $6000.

Mark Glasgold, MD
Highland Park Facial Plastic Surgeon
4.5 out of 5 stars 46 reviews

Fat Transfer to the face

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Fat transfer to the face can change the shape of your face fill the hollow areas.The results can be very dramatic and nice.

Choosing the right surgeon and the right technique is of utmost importance, to anlyze the face and distribute the fat evenly and in a three dimentional manner.

The picture posted shows long, deflated face. The high hair line does not help either. There is hollowness in the temples, cheeksm cheek bone and nasolabial fold.

The procedure is done under local anesthesia or sedation depend on your tolerance and comfort with local anesthesia.

This is a time consuming procedure, fat is removed, then all fluid is removed, then the fat is centrifuged and more fluid is taken. There are certain portion of the fat centrifuged that contains more stem cells and that fat is used for critical areas. Depending on the amount needed, and the type of anesthesia the cost can be from $5000-8000

Samir Shureih, MD
Baltimore Plastic Surgeon

Fat transfer to the face

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Dear Kiki03,

  • You would be an execellent candidate for the fat transfer procedure
  • It can be placed around the eyes, cheeks, almost anywhere to get a nice result
  • I have had much experience in fat transfer in Los Angeles, and believe it is better than implants as they look and feel natural
  • It is performed under twilight anesthesia
  • The approximate price range depends on your exam and what you need, but procedures can go from about five thousand and up

Best regards,

Nima Shemirani

Nima Shemirani, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 80 reviews

Fat Grafting vs. Implants for Narrow Face

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Thank you for this great question and for posting your picture. Autologous fat grafting is a fantastic option for facial revolumization, though it can be a fickle treatment and in some cases needs to be revised or repeated. As we get older, the fullness and youthful volume of the midface (upper cheek area) is lost. There are multiple ways of addressing these concerns and fat grafting is among them -- other options include implants and lifting techniques. Since you are not interested in implants, the remaining option of an endoscopic midface lift should be considered. A certified facial aesthetic surgery expert can help you choose the best option for your face.

Fat Transfer/grafting for Cheeks

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You appear to be an excellent candidate for fat transfer. The range of anesthesia that is possible ranges from light to heavy sedation. General anesthesia is not the norm for this procedure.

The cost for fat transfer like other cosmetic surgery varies considerably across the country and even in the same area. South Florida tends to have lower fees then more expensive areas such as New York or Los Angeles. We charge starting at $1000 for fat transfer to the face. Since you can get quality work at lower costs, patients will travel from throughout the state, the country, and internationally to have surgery in South Florida.

To ensure that you are receiving quality work with personalized care at the most cost effective prices, consult with board certified plastic surgeons that own their own nationally accredited facilities. The quality must be maintained at the highest level to maintain accreditation. The surgeons also have incentive to hire and train quality staff (to ensure that surgery is efficient and enjoyable), to ensure comfortable and private facilities (to encourage referral), and to eliminate waste (to ensure that these facilities can compete effectively).

Fat Transfer to Augment Volume to Cheeks

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Fat transfer is a recommended option to restore or augment volume to the cheeks.  If you are a very thin person, the fat will likely need to be harvested from several different sites in your body.  The flanks, outer and/or inner thigh, lower abdomen are amongst the sites where fat can be removed to augment the volume of the cheeks.  The procedure can be performed under either local anesthesia or IV sedation.

Excellent Fat Transfer Candidate

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You are an excellent candidate for fat transfer to the midface and cheeks.  Fat transfer is a safe and effective way to add or restore volume to the face.  Unlike implants which have anatomical constraints, fat can be used like a filler to sculpt the face.  The cost of fat transfer is about $2500-$5000.  The procedure can be performed quite comfortably in the privacy, safety and comfort of the office.  Seek consultation for a fat transfer expert.  All the best.

Fat transfer

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You are an excellent candidate for the fat transfer to your cheeks. I recommend sedation since the procedure/injections are many and you will be more comfortable. The fee is around $6,000

Norman Bakshandeh, MD, FACS
New York Plastic Surgeon

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.