Different Techniques for Facial Fat Transfer?

I am wondering if there were different techniques for fat transfer in the facial area, i.e. cheeks, lower eyelids, nasolabial folds and lips. If so which technique is better? I have researched about it a bit and different doctors do it differently: one takes the fat directly from an area to your face; others freeze the fat then inject it in different treatments over time. I'm confused.

Doctor Answers 8

Fat Transfer Techniques

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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 responding in this thread 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.
I think that the primary reason that fat grafting is rated low in RealSelf is that there is such 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 consi

Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Fresh fat vs Frozen fat

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An overwhelming majority of plastic surgeons transfer freshly harvested fat. Techniques for harvesting, processing and implantation may differ. The reason fresh fat works is simple. Blood flow keep the fat cells alive. Once harvested, cells lose nutrition and begin to die (ischemia). If transferred after harvest they are placed in an area surrounded by good blood flow which in theory reinstates the longevity of fat and enhanced the "take" (decreased ischemia time).  Many other fields operate under this same principle (microsurgery and breast reconstruction, organ and tissue transplantation, trauma and amputation, etc..) If we can halt ischemia time with freezing then there would be no need to rush transplant harvest limb salvage or in this case implantation of fat.  Pl visit with a board certified plastic surgeon. All are well equipped to answer your specific questions and explain their method of fat transfer.  

Fat transfer

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there is no evidence based scientific studies proving one technique is better than the other, however, gentle handling of the harvested fat and injecting very small amounts improves the results

Christopher K. Livingston, MD
Houston Plastic Surgeon

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Fat transfer techniques

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You are confused because so many doctors do this procedure differently as you state. There are no convincing studies that state that frozen fat doesn’t work as well as fresh fat, nor any evidence that indicates only one method is appropriate. Just make sure that if the fat is frozen, the doctor has a mechanism to safeguard the fat if a power outage occurs, and that there is a mechanism in place to ensure that you receive your stored fat and not someone else’s by mistake! There should also be a limit to the time the fat is stored. You wouldn’t want to use fat that is stored for a couple of years in case there is a greater chance of bacterial infection.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 38 reviews

Facial fat graft transfer with micro grafts

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Facial cosmetic surgery with autologous (your own) fat is a key procedure that many plastic surgeons perform, with or without additional cosmetic surgery. Fat may be transferred to many areas of the body, although the face is the primary location for rejuvenation.

Fat injection with micro grafting has many subtle variations in technique. The surgeon harvests, processes, and injects fat with methods that ensures that most of the fat is preserved and with minimal damage to the tissue. Fresh is always better than frozen. However, your plastic surgeon may freeze fat to allow touch up procedures as needed, without requiring another fat harvest. Best of luck.

Micro fat grafting, facial contouring

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Dear Intears, I am delighted that you ask this question. Fat transfer has been a controversial topic for many years. A lot of Plastic Surgeons refused to adopt the technique of fat transfer for facial contouring due to historic reasons and techniques. Obviously the test of time has born out that tranfsering fat does work to add volume to an area of the body. The principle is to transfer small amounts to each tiny location- so that the fat can take on a new blood supply. There is a lot of discussion about the transfer of 'stem' cell which help improve the quality of the tissues in the area.

There has not been comparative studies of the techniques in humans- to show differences in cosmetic surgical outcomes, There are claims by individual that one technique is 'better' than another technique and that 'their' technique has les risk of complications...... this is mainly in the realm of injected fat over fat placed in chunks into the tissues.

Micro fat transfer is an essential component of facial shaping and restoring a youthful appearance. I have been using this for 11 years and have had consistant results in multiple areas- facial contouring, under eye hollows, cheek augmentation, shin augmentation, jawline shaping, forehead shaping, breast augmentation and contouring, buttocks augmentation, correction of liposuction deformities, correction of surgical deformities.

With Warm Regards,

Trevor M Born MD

Fat Transfer, Fresh or Frozen. Like Seafood, Go for the Fresh

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Hi InTears,

There are many different techniques of fat transfer. Freshly harvested fat is best to use and has the best longevity.

Some physicians do freeze and store the fat that is left over to use it for touch ups 5 to 6 months after the initial procedure. The percentage of fat transferred that survives, and the percentage of viable fat cells are much lower in frozen fat.

Good luck and be well.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

Are there different techniques for facial fat transfer?

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Although there are indeed many different techniques for fat transfer to the face, or for that matter anywhere else, the principles of successful fat grafting are now well known. The American Society of Plastic Surgeons has published a position paper on this on their Journal's June issue.


Extraction under low pressure system

Centrigugation at low G forces and for less than 3 minutes

Minimal manipulation of fat or exposure to air and contaminants

Injection with small cannulas using a micro droplet technique.

See more at the link below

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.