Why do doctors perform the facial fat transfer procedure?

Question

After seeing so many negative results and reviews on this procedure, especially to the tear trough and lower lids, why are surgeons still offering this? Why cause trauma to patients knowing what the most likely outcome will be? There is so many negative reviews it seems there is more negative then good.. I am curious why this is still being offered knowing how difficult it is to remove and how most patients are dissatisfied with the results.

George Bitar, MD · Answer

Fat grafting to the face is performed to fill lines and add volume the face. It's a more long-lasting solution compared to fillers. Fillers, on average, last for 6-12 months. Fat can last for much longer and can be very effective to fill hallows caused by aging or volume depletion. I understand your fears based on negative reviews. If you're more comfortable, start with fillers to see if you like the look.

Patrick Flaharty, MD FAACS · Answer

Facial fat transfer has grown in popularity over the years as the technique has become more sophisticated and predictable. That said, it still has its challenges including undercorrection with loss of fat and the potential for contour irregularities, especially under the eyes. Lower eyelids in particular are very technique dependent, but with good technique you can avoid problems and achieve excellent results. We routinely perform full face fat augmentation including the lower eyelids as part of our facial rejuvenation procedures (with face lifts, brow lifts, blepharoplasty, and laser resurfacing) with excellent results. Restoring lost volume can make patients look younger and healthier and is the reason facial fillers are so popular. The key to successful fat grafting is good technique which comes with experience.

Mats Hagstrom, MD (license on probation) · Answer

Unbiased information about cosmetic surgery is very difficult to obtain for lay people.

Most people rely on the Internet as their go to source for information including cosmetic surgery information.  in reality most information available to the consumer is highly biased and is primarily aimed at promotion.

Facial volume restoration can give a spectacular results and doing it with grafted fat can offer a permanent solution which compared to doing fillers every 4 to 6 months for the rest of your life can seem very appealing.

Lots of patients who have undesirable outcomes are desperate for ways to improve the results and often feel lost.  these represent a high percentage of people posting on real self.

Patients happy with the results have no need to post about their experience. They simply appreciate the outcome and go on with life.

Personally I believe most patients are wise to stay away from fat transfer especially in tricky areas around the eyes.

To do this procedure well requires mastering the procedure and that means tackling a long steep learning curve.

Eventually some providers do that and have the skill and experience to deliver consistent quality results with this procedure.

In cosmetic surgery most providers want to take advantage of all the various opportunities to do surgery and generate income.

For that reason the majority of plastic surgeons do not specialize but rather are “general” plastic surgeons.

Some plastic surgeons do more of some -procedures than others.  Facial fat transfer isn’t a bad procedure. It’s a difficult one to master.

Being part of the experience during physicians early part of the learning curve may not be the best choice.

Obviously surgeons have to learn somehow and somebody has to be a surgeon‘s first patient.

The key is for patients to be well-informed and make good decisions as well as being highly selective of who they go to for their procedures.

In the hands of a skilled and experienced provider there’s nothing wrong with doing even the most difficult or complex procedures if they’re indicated.

Most of the bad work was done by people collect skill and experience.

Being board-certified with a general overall good standing in the community is in sufficient to have mastered Liposuction or fat transfer procedures.

Delivering consistent quality results with both Liposuction and a fat transfer it’s far more difficult than most people believe.

Most patients are naïve when it comes to choosing a provider.

Many patients don’t even bother interviewing more than one plastic surgeon.

The fact that people trust doctors is a nice testament but patients need to serve as their own advocates when it comes to cosmetic surgery.

If patients take the correct measures to find the correct providers then patient satisfaction with cosmetic surgery is generally excellent.

All that said I believe patients in general do better sticking with fillers when it comes to face volume restoration.

Grafting fat it’s less predictable imprecise and unforgiving in relationship to fillers.

This is especially true around the ice where the amount of host tissue to support the graft is very thin and changes quickly in different areas.

Grafting fat is good for diffuse overall volume but not as good when it comes to adding very precise amounts of volume in small areas.

There is a higher demand for long lasting volume enhancing results so the desire for facial fat transfer isn’t gonna go away.

There are lots of people who want facial volume restoration but are not willing to have fillers several times a year for the rest of their life.

For those interested in having cosmetic surgery I have some general recommendations to make the overall experience a better one.

If people follow these recommendations they will be better off than if they don’t.

1. I recommend patients avoid traveling long distances for elective surgical procedures. There are of course instances where there is a lack of local talent and traveling to some degree is inevitable. If traveling for the procedure patients should be ready to travel to have the consultation, post operative appointments and follow up should there be issues or complications.
Patients sometimes do not appreciate the importance of in person consultations, that complications do happen or the number of people who have issues with their results or need revisions.

2. Schedule multiple consultations with different providers in your area who seem to have a good reputation for the procedure you’re interested in. Starting with at least five consultations seems like a reasonable number to me.

3. Whenever possible schedule in person consultations.  
4. During in person consultations ask each plastic surgeon to show all of their before and after pictures for the procedure you’re interested in.

The goal is not to see the best results of their career but to get an idea of what average results look like and get some type of confirmation of how many of these procedures that provider has performed.

Ask to see results that were not as good as the doctor would’ve hoped for and talk about the differences in outcomes.

Honest and experienced providers should have no problems presenting this type of information.

A highly experienced plastic surgeon should have hundreds of before and after pictures for the procedure you’re interested in. At a minimum at least 20+.

5. Read all the reviews on various physician review websites paying close attention and avoiding providers with any significant number of justified negative reviews.  Providers with an abundance of reviews often have aggressive marketing campaigns.

The plastic surgeons I respect most all have the single variable of not having justified negative reviews on their online profiles. 
In my opinion justified negative reviews are far more telling than an abundance of positive reviews.

6. Avoid scheduling for surgery or making a deposit on the day of the consultation.  Give yourself some time to think about the decision and make sure you finished all scheduled consultations before committing to having surgery that will permanently and irreversibly change your body.

When in doubt slow down and schedule more consultations.

Choosing the right plastic surgeon is the single most important variable to having a positive experience.

7. Don’t go chasing after technology or names of certain equipment. Instead focus all your efforts on finding the most experienced and talented board-certified plastic surgeon.

Best,

Mats Hagstrom, MD

Robert T. Buchanan, MD (retired) · Answer

The problem with fat grafting is the same as it is with filler injection, a large number of the practitioners doing the procedure are not really experts. When done by a plastic surgeon who understands grafting it is a reliable procedure that obtains excellent results with with 75-85% take. Unfortunately, a great many people doing fat grafting do it like they were injecting a filler. This will result in a significant decrease in the amount of fat that lives and, thus, a poor result. That is why you need to make sure that, if you are considering fat grafting, or any filler, you need to see a true expert.

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