I am concerned about the long-term results of fat transfer to the face. Is it really permanent?

I've noticed a lot of controversy among many plastic surgeons regarding the effectiveness and longevity of fat grafting/transfer to the face. Does the fat really survive and stay there permanently? Or is it the same as a temporary filler in which it will just dissipate away with time?

Doctor Answers 11

Long Term Results of Fat Transfer to the Face?

There isn't really any controversy as to whether fat grafting is very long lasting (permanent), but the success and durability of the results is very dependent on the skill, technique, and experience of the surgeon doing the fat grafting. There are far too many untrained and unqualified physicians today who have re-invented themselves as "cosmetic surgeons" after attending a couple of weekend courses. If/when they attempt something like fat grafting, the results are predictably poor, and then because they are really only capable of just doing filler, they then try to discredit fat grafting techniques and instead steer you towards filler. Filler materials can be very useful for limited situations, but most are not long lasting, and excessive use of filler can result in very unnatural results. 


Facial fat grafting involves carefully harvesting, processing, and implanting of fat cells from one part of your body where you have them in more abundant supply, to an area where you are actually experiencing fat atrophy (loss of fat cells). It is your own living tissue and the fat cells will take up residence in their new location and provide a long lasting positive change when done properly. When it comes to living tissues there is really nothing that is "permanent", as all body tissues change with time. In fact, anything that is permanent has an unpleasant tendency to start to look unnatural as the living tissues that surround the implanted material do change with time. 


Another benefit of facial fat grafting is that most patients have an almost unlimited supply of donor site fat when it comes to the relatively small volumes that are needed for facial grafting. Still, the number of cc's of fat that can be harvested and transferred is much greater than the number of cc's of filler that can be placed without spending many thousands of dollars. And this doesn't even take account of the fact that fat transfer frequently results in an improvement in the quality of the overlying skin. So facial fat grafting has number or real benefits when compared with fillers, but it is still a surgical procedure which carries some downtime and for which the results depend greatly on the surgeon doing the procedure. 

Fat Grafting - Is it Permanent?

Fat grafting can be permanent. There are many variables that determine the longevity of fat grafting. I would encourage you to start by viewing many, many before and after images and pay close attention to patients who have retained fat for six months, a year or more.

Fat grafting being permanent can be a blessing or a curse. There is no way for a plastic surgeon to know exactly how much fat will be retained. This is why it is imperative never to over-correct.  Look at many, many photos as everyone has a different aesthetic ideal. I personally think people look odd and unnatural when their face is overfilled with fat. Truly, I think most patients with that result were hoping for something different. However, there pare people who desire a very, very full appearance. That is a procedure I simply do not perform. I would encourage a prospective fat grafting patient to look at many, many before and after results. if the after results posted by a plastic surgeon you are considering appear natural, and you are seeking a natural looking result, that is a good place to start. Also important to check on education, experience, record of safety, and the surgical environment and the surgical tea.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 110 reviews

Long term results of fat transfer to the face?

There is little remaining controversy among experienced plastic surgeons about the safety, long term effectiveness and value of fat grafting to the face.  There does remain disagreement on what is the best place to harvest fat, what instrumentation and methods have the greatest success.  Some areas of the face such as the tear trough area, along the orbital rims, there is an extremely high reliability of the fat.  Other areas such as the lips or depression areas around the mouth, called marionette lines, there is less predictability.  Clearly, fat grafting to the face is extremely valuable and one of the biggest advances in cosmetic plastic surgery in the past 20 years.  I hope you find this information helpful.

Thomas Hubbard, MD, FACS
Virginia Beach Plastic Surgeon
4.9 out of 5 stars 32 reviews

Fat Grafting Longevity

Although fat grafting or fat transfer is considered permanent, it responds just like normal fat in the body and will dissipate through natural aging. It is still a superior treatment for restoring volume vs hyaluronic acid fillers.

Gilbert Lee, MD
San Diego Plastic Surgeon
4.8 out of 5 stars 22 reviews

Fat grafting and its' longevity

This is a great question. The reason you are feeling confused and that there is controversy is because there are academic and stimulated disputes about the percentage of fat that survives, the best way to transfer fat to maximize results and how long the outcomes will last amongst surgeons. 

The truthful answer is that fat survival is variable in many ways. As I mentioned about the harvest technique, dilution technique, layer of application, blood supply and patient health status are just a few of the variables involved in the success of this procedure. 

My recommendation is to talk to as many people as possible that have had the procedure (this site is great for that exposure) and meet with a few different surgeons to get a feel of what they can offer you. 

In my hands fat grafting is one of the most satisfying procedures we perform. Patients are happy, the results can be dramatic and it is a great adjunct to many of the other procedures we perform. Skin texture improves, facia volume improves, and the transition from facial subunits can become harmonous. This is all extremely beneficial. 

My discussion with patients goes something like this, "Fat take rate can vary. Clinical studies show fat survival ranging from 20-60% in variable locations. I average that out (~40%) when deciding how much and where to inject. An important point is that this results in a slightly overdone look for the first month because I need to inject 10mL for every 4mL I wish to be permanent and use to contour and mold the face."

Every patient is different, each subsite has a different blood supply. Whether the fat is placed deep or superficial to the  muscle makes a difference. All of these many different variables come into play and cloud the picture of permanent vs. temporary in the sense of how we think about synthetic fillers. 

Best of luck,

DrC

Benjamin Caughlin, MD
Chicago Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews

Fat Transfer

Thank you for posting your question. On average, half of the transferred fat will eventually be absorbed by the body. The remaining fat will act just like other fat cells in the body. For example, they will expand or shrink just like any other fat cells in your body in respond to change in weight. Best of luck.

Jan Zemplenyi, MD
Bellevue Facial Plastic Surgeon
5.0 out of 5 stars 15 reviews

Fat grafting to the face

When fat grafting is done properly, it will be permanent; in fact, I have had to remove some several years after placement as it grew too much; this is proof that fat grafting is a permanent solution rather than fillers which are temporary cures.

Arian Mowlavi, MD
Orange County Plastic Surgeon
4.9 out of 5 stars 44 reviews

Fat Transfer, Final Results? TEMPLES / FACE

If the fat is there at 6-12 weeks it stays forever and functions similar to fat where it came from.  I suggest PRP/sculptra post fat transfer to maintain the results.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 165 reviews

Fat grafting?

having done fat grafting for more than 35 years and been able to follow my patients  for that time I can tell you that approximately 50% of the fat will remain forever.  However, it depends on the experience of the surgeon and how the fat is harvested etc. I would not use a otherwise permanent filler since these are difficult to reverse. See a very experienced fat injector can show you excellent results but also discuss complications from this  surgery. 

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 32 reviews

Fat transfer

Thank you for the question and the fat transferred has to survive to be permanent.  If it doesn't then over time it will be lost but usually som percentage survives


Dr Corbin

Frederic H. Corbin, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 59 reviews

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.