Why don't more surgeons do fat-fascia grafts to correct volume loss in the face, given the reabsorption rate of injected fat?

Question

Why don't more surgeons use intact fat-fascia grafts to correct volume loss in the face? (I know that Dr. Moelleken trademarked the name LiveFIll for fat-fascia grafts; why don't others do these grafts?) Won't the survival of an intact fat-fascia graft be higher than fat that has been extracted, washed, centrifuged, and injected? Yes more surgical procedures are involved both at donor and recipient sites, but that can't be the main reason, when patients are undergoing surgical facelifts.

Brent Moelleken, MD · Answer

LiveFill grafts do not consist of dermis, only fat and fascia.  The dermal fat (fascial) grafts did not succeed because of the lack of pliability of the dermal layer and large clumpiness of the grafts that didn't allow sufficient time to revascularize before they died.  The blood supply didn't have enough time to revascularize the grafts before they died due to a poor surface area to volume ratio.  LiveFill overcame the surface area problem and the lack of pliability problem of dermal fat grafts.  It isn't rocket science, it's just biology.  All surgeons learned that you don't put a really thick skin graft on a wound because it won't survive, but surgeons forget that the same principles apply for tissues below the surface, and wonder why a fist- sized fat injection graft doesn't survive.

Barry L. Eppley, MD, DMD · Answer

While it is true that dermal-fat grafts can have better survival than injected fat grafts, they do require a donor site harvest and a resultant scar. This is an aesthetic issue that larger than the dermal-fat grafts becomes not to mention the need for an incision to place the graft.

Steven Wallach, MD · Answer

It's all about the comfort factor and what works for a given surgeon. I think that most have more experience using fat grafting.   I have used fascia for lip augmentation and rhinoplasty.

Val Lambros, MD, FACS (retired) · Answer

fascia has almost no volume, it is very thin and you need to make big dissections to get it out. The addition of fascia has not shown to be better in longevity.  If something really works, everyone does it.

Why don't more surgeons do fat-fascia grafts to correct volume loss in the face, given the reabsorption rate of injected fat?

Answers (4)

Answer: Fat-fascia grafts

Answer: Fat-fascia grafts

Recommended reading

Everything you need to know about Facial Fat Transfer

Our mission is to create a world where every investment in modern beauty is Worth It.

Why don't more surgeons do fat-fascia grafts to correct volume loss in the face, given the reabsorption rate of injected fat?

Answers (4)

Answer: Fat-fascia grafts

Answer: Fat-fascia grafts

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Recommended reading

Everything you need to know about Facial Fat Transfer

Our mission is to create a world where every investment in modern beauty is Worth It.