I am 51 and would like fat removed from my flanks, bra line and/or stomach and placed in my marionette lines. Assuming that my marionette lines lend themselves to be done either with fat or non fat fillers, what pros and cons is there to using fat over non fat fillers as far as lasting, injection frequentcy, safety, price in the short or long run, healthier with stem cell production, etc.) Also, can fat transfer to/from the areas noted be done successfuly under local anestetic without sadation?
Can Fat Transfer Be Done Sucessfuly with Local Anesthetic Without Sedation? What Benefits is Fat over Non Fat Fillers?
Doctor Answers 7
Fat vs. Non-Fat Fillers
Atrophy or deflation of the subcutaneous fat in the face can lead to a gaunt, tired appearance with eccentuated lines around the nose and mouth. There are several ways to fill in the areas of deflation and lines.
1. Fillers - Popular fillers such as Juvederm, Restylane, and Radiesse offer a great short term solution to to facial volume issues. Fillers generally last about 9-12 months. The can be placed in the face without an anesthetic.
2. Autologous Fat injections - The use of your own fat offers a long lasting solution to volume loss. It does require surgery to harvest the fat. This surgery can be performed under a local anesthetic. The fat that is collected is then injected into volume depleted areas much like the fillers described above. Although, fat can last "forever," it may take several minor touch up procedures if there is some resorption of the injected fat after the initial surgery.
An evaluation and discussion with your plastic surgeon is the best way to come up with your optimal treatment plan.
Thanks for your question.
Gregory C. Park, M.D.
Facial fat transfer/grafting
Fat grafting/transfer can be performed under local anesthesia safely and effectively. Fat is more durable and natural as compared to synthetic fillers. It also has stem cells, which is believed to make the surrounding skin more youthful as well.
Fat over fillers
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Fat transfer and local anesthesia
I only perform this procedure under local anesthesia and patients go home right after the procedure. The procedure takes just over an hour and patients can drive themselves home afterwards. Once the local anesthesia is in, the procedure should be painless. Fat transfer is a wonderful filler for all the reasons mentioned: natural volumizing results, improvement in skin tone from the stem cells transferred with the fat and the longevity of the results. If you are considering fat transfer, speak with your chosen surgeon about other areas on your face to treat at the same time as I rarely perform the procedure just for the marionette lines. (I commonly place the fat under the eyes and cheeks to name a few areas). The amounts required for the face do not usually require harvesting the fat from more than one area. The pros of the temporary fillers are that they are less invasive (don't require any harvesting from another area), however results are temporary.
Fat transfer versus Fillers
I frequently perform fat transfer under local anesthesia. I always offer sedation, but many patients elect not to have sedation and simply drive themselves. To treat the marionette lines, it is unlikely that you would need to remove fat from all of the areas you have described. Both fat and fillers are safe, but the fat that survives in a fat transfer can be permanent, making it a more cost effective choice. A benefit of filler is that you can typically return to activities immediately after a filler injection while you may have some swelling and bruising after fat injection.
Fat grafting is a more longer lasting option than fillers and in experienced hands, results are more natural appearing. In the long run, the price will likely be less as well. There is some belief that the stem cells in the fat can also improve the skin quality of the overlying skin as well, though this is somewhat controversial.
Fat injection can be done under only local anesthesia, and I often do this if a bit of touch up is needed, but the harvesting of the fat can be quite uncomfortable, though some surgeons do this as a way to decrease cost to the patient.
Fat Transfer to Marionette Lines
Fat transfer can be performed under a local anesthetic depending on patient tolerance.
I prefer to have some i.v. sedation or a general anesthetic for fat grafting if possible to minimize discomfort.
The advantages of fat transfer are that a larger quantity of structural material can be transfered and the results are longer lasting than fillers.
-Dr. Jamil Asaria
FACE Cosmetic Surgery