Fat Grafting on Face

Hi I am 26 years old and about to do fat grafting to make my oval shape face more fuller. I am very worried what if my face looks asymmetry or one side looks bigger than the other side. Or as I get older the fat moves downwards. Is the procedure safe? I haven’t had any consultation yet but I was told by a friend of mind who has experienced; after care requires keeping the face upwards and not talking for 2weeks, is that correct? Best regards Jennifer

Doctor Answers 15

Survival of fat grafts

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There is a belief that survival of fat grafts is skill dependent.  This is probably true, to an extent.  You are still sucking living human cells through a tube and then injecting them through a needle.  How many cells survive?  If you use very precise measurement techniques such as matabolic uptake studies, the survival is very low indeed, often below 10%.  If you look at whether the cells are broken or not, the survival is closer to 20-25% if carefullly aspirated.  Our studies used the dye exclusion technique and found numbers in that range.  Some people claim 100% survival.  I doubt that.

There is no getting around asymmetries after fat injection, even in the very best of hands.

The survival of fat grafts is vairiable, and not fully predictable.

For those reasons, we prefer a technique of directly placing fat-fascial grafts into pockets, minimizing trauma to the cells.

Patients and surgeons should go into the procedure with that in mind.  To guarantee a patient symmetry after fat grafts, or to guarantee the survival of fat grafts, is simply not realistic, in my opinion.

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 194 reviews

Facial Fat Grafting

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My would strongly advise you to find a plastic surgeon who provides natural conservative looking results. Do not overfill. Look at many before and after images to find a plastic surgeon with expertise, specialized surgical instrumentation, meticulous surgical technique and many, many photos that demonstrate the efficacy and longevity of fat grafting. 

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 considering

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

Fat grafting to face at an early age for contour change

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Trying to change the overall shape of the face with fat grafting alone is not a wise choice at your age. Even with excellent intial placement and survival of the grafts,  your subsequent weight gain and loss as well as hormonal fluctuations with pregnancy may produce unpredictable changes in the volume of the grafted areas and make some grow disproportionately to others resulting in an undesireable contour irregulariy.

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

Fat injections

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At your young age it is wise to be conservative and remember, you can always add more but it is difficult to remove unwanted fat. Asymmetry is better addressed by adding more to the undertreated side than removing it in an overtreated side. NOt speaking for two weeks is extreme. Fat injections can be capricious and despite the surgeon's excellent care, there are many variables in the processing, harvesting and implanting and your body's response that create the final effect.

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

Asymmetry can occur after fat grafting.

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Tha fat won't move and you can talk but asymmetry can be a problem. Unless you have major depressions avoid having this done.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

Concerns about facial fat grafting

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You are right to have these concerns, all of them!  This is not a procedure where totally predictable results can be promised.  Fat sometimes takes 100% and sometimes not regardless of what the doctor does.  It's long term look has yet to be determined too.

Fat grafting for facial rejuvenation- Looking younger in a natural way!

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fat grafting or micro-fat grafting of the face has significantly improved the results of facial rejuvenation. Aging causes loss of facial volume as well as sagging of the soft tissue and skin. replenishing the lost facial volume with a patient's own fat can rejuvenate the face in a very natural and balanced way. My personal experience with facial fat grafting for my patients has been amazing, so has been the long term experience of my patients.

Sean Younai, MD, FACS
Beverly Hills Plastic Surgeon
4.3 out of 5 stars 51 reviews

Fat Grafting for Younger Patients

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Fat grafting is a procedure designed to restore facial volume, and is less successful for altering facial shape. As a younger patient, you should be aware that transplanted fat may change years down the road: if you gain significant weight, the fat transferred to your  face may change dramatically.  For some patients facial implants or injectable fillers may provide a more targeted solution- and one that can be reversed if desired down the road. Consult with an experienced surgeon who will give you all the options.

Roy A. David, MD
San Diego Facial Plastic Surgeon

Fat Grafting

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Fat grafting is an art and a difficult one at that.  The problem is twofold: you must have the artistic vision to know where to place the fat and the technical skill to make sure that it lives after it is transferred.  This is definitely a procedure where you want to go to someone with experience and a great track record.  Risks include asymmetry, loss of graft and the usual surgical risks (bleeding,infection, etc).  There are not any special restrictions necessary after the procedure, such as not talking for 2 weeks.  Once the fat has established a blood supply it will be no more likely to move than your native fat but remember that your native fat normally sags as you get older.

Joseph Campanelli, MD
Portland Facial Plastic Surgeon

Fat transplantation is a wonderful, safe method for restoring facial symmetry.

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Fat transplantation is a wonderful, safe method for restoring facial symmetry. The recovery is rapid and many patients are able to socialize within 48 hours. See link below.

William P. Coleman III, MD
Metairie Dermatologic 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.