Why is fat transfer/fat grafting to volumize/contour the face not a more popular procedure? The results look stunning.

Why don't more surgeons to facial fat grafting?  First of all, you go to the head of the class for understanding that there's an issue there. The problem is fat grafting can be variable between the two sides of the face, it can be over filled, underfill, and cause lumps and bumps's which cannot be easily reversed. That's why many of us were very experienced prefer  only using materials that are easily reversed and can be subtle he used to improve the face.  The Photos indeed look quite good but if you were to ask a series of 100 patients did they have any problems and only 10 said yes and those could NOT be easily reversed the problems, you would understand why more plastic surgeon only use facial fat grafting for lips, hands, but not for cheeks since  silicone cheek implants give a one to one correction with only a rare possibility of an implant getting infected. Seeing  Live patients instead of photographs can give you a better idea of results. Having said that make sure you see a good one and a bad one. 

It is still done routinely by the experts. This is a procedure that gets permanent results and amazing if done right.  So cost in long run is low compared to injectables that disappears in 8 months.  Injectables are easier to use, still need to be done by someone that does it daily for at least 10 years to get amazing resutls.   The costs of injectables rack up quickly.

Fat grafting has been around for many years, 20+, and it has gained more and more popularity over the years.   It is commonly used in addition to other procedures, such as face lift, to add volume to the areas that you discussed.  I use it alone on younger patients who want volume under the eyelid, cheek, chin, nasolabial folds, etc.   Fat grafting is very technique dependent and some surgeons have better success than others.  Find a surgeon who has dedicated technology to fat grafting (not just a liposuction canula and a flask), but new devices to help centrifuge the fat and allow for precise placement.  Even though there can be some unpredictability, I have seen patients back from over 7 years now and seen great stability and viability of the fat.   It is an excellent technique that should be used more, and definitely in place of fillers over the long term.

You are correct in your observation that fat grafting to the face may not be as popular as the other options for volumizing and contouring the face- facial implants and tissue fillers (at least not yet anyways). But, fat grafting has become more and more popular more recently (especially with the increased interest in fat transfers to the buttocks (Brazilian butt lift) and breasts (lipoaugmentation) as of late). There has been an exponential increase in interest in what can be done with autologous fat cells, stem cells, platelet derived growth factors and platelet enriched plasma.  I feel that one of the Holy Grail pursuits in plastic surgery is to engineer tissue so that artificial implants will be obsolete one day.  We as scientists and surgeons should never be happy with the status quo and should always strive to achieve best long term outcomes with the least chances of complications.  Fat transfers to the face has actually been around for over 20 years.  It has only gained more interest in the past 10 years or so as we as plastic surgeons have become more aware of the process of aging and the volume that is lost during the process.  We realized that the standard traditional facelift procedure to just remove loose skin (while ignoring the volume loss of the face) does not adequately restore the youthful contours of the face.  The advent of artificial tissue fillers(hyaluronic acid based) in the early 2000's really gave us a great tool to restore some of this volume.  But, these tissue fillers are only very temporary and expensive and have to be re- injected for as long as you want to maintain the effect (which is one guarantee we can give you), and the large volume (and costs) that is typically required for comprehensive facial volume restoration makes it not feasible for this purpose.  Facial implants may be another option to help restore volume in certain parts of the face, but they are more limited in where they can be used effectively(cheeks and chin). Facial volume restoration today is much more comprehensive than that (such as the temporal fossa, tear troughs, superior palpebral sulcus, nasolabial folds, lips, submalar regions and mandibular margin (as well as the cheeks and chin)).  Implants are just not adequate.  They never feel natural.  They do have a higher risk of infection, nerve injury and can migrate (as well as scarring and longer recovery).  Using a solid hard implant to replace soft tissue just doesn't make sense, and should not be the gold standard.  Fat transfers can address all these issues.  It does have limitations and  risks though, just like every different option does.  It also has a very steep learning curve as proper technique is critical for its success.  Good technique and appreciation for its complexities only come with many years of extensive experience.  It also requires a good appreciation for aesthetics as it is basically sculpting with fat. Surgeons who don't have as much training and experience will not promote its advantages and just frankly will not be able to produce the same results- just like everything else do.  In this case, the message and messenger carry the same responsibility.  I recommend you see only board certified plastic surgeons with lots of experience and who can show you lots of good before and after pics.  Best wishes.

dear patient : amazing question! I think this is not such a popular procedure since there are a lot of doctors that are not certified/not comfortable performing this procedure.   Doctors who perform this procedure are less and the ones who should be doing this procedure should be Board Certified Plastic Surgeons.
 There's also the issue of swelling.  When you do a significant Fat Transfer to the face over 100grams, patients usually remain swollen anywherre up to 3 to 4 weeks.  The results are also not as predictable as a standard Face and Necklift.  
When you are looking at Fillers like Juvaderm and Voluma, these fillers look good in photos, but when the patients move their face in real life, the fillers look more artificial than the fat transfer.  Fat looks completely natural as it molds to your face.  Hope this helps.

Hi appleman25,Thank you for your question and attached photo.  I don't think that this technique is "obscure", but many patients do not want photos of their faces posted on the web.  Especially since these patients are going for a soft and subtle, natural look.  If they post pictures, the secret is out. I frequently get patients who ask me to delive a result that very few will notice.  My favorite compliment is when the patient's coworkers/family/friends tell them they look refreshed, happier or younger and never ask them if they have had anything done.There are downsides to fat grafting in the face.  Only about 1/2 to 2/3 of the transferred fat survives, which can make the results a little more unpredictable.  If your surgeon over corrects, then you can look over filled.  If too much fat is lost, then you still need filler to get your result.  I think the happiest patients use a combination of surgery and fat grafting.Seeing a plastic surgeon who is familiar with fillers, fat transfer and facelifts is really the best way to figure out which procedures will help you achieve your aesthetic goals.  Not everyone is a candidate for fat grafting or fillers.  In a patient with laxity of the skin, using fat/fillers will leave them looking heavy in the central face.  Many patients think that if you see a plastic surgeon, the answer will always be surgery.  This is not the case, but if you see someone who can only offer fillers, then the answer will always be non-surgical.  Hope that helps.Best,Dr. B

Thanks for your question.  I'd say that fat transfer alone has the limitation of variability of fat survival and I'd also point out that photos often show patients early in their recovery when facial swelling may add to the quality of the (temporary) outcome.  Make sure that you judge photos taken at least six months after the procedure.  The photos that you posted look good in part because of the use of makeup in both sets of after pictures and no makeup in the before photo.  I am a firm believer in adding facial fat grafting to nearly all facelift procedures that i perform having witnessed the long term value of volume restoration and the effects of stem cells contained in the fat providing long term rejuvenation of the skin and softening of even deep wrinkles.Finally, for many patients the simplicity of injection of fillers with the certainty of outcome warrants filler injection over fat harvest and grafting done alone.Best wishes,
Jon A Perlman MD FACS 

Certified, American Board of Plastic Surgery 

Extreme Makeover Surgeon ABC TV

Best of Los Angeles Award 2015, 2016 

Beverly Hills, Ca