Which areas of the face does fat transfer work best? Does fat transfer work well to diminish marionette lines? (photo)

The finer lines are better treated with fillers or other modalities.  Fat grafting works well in the cheeks, the lower eyelid-cheek interface, and the nasolabial folds.Kenneth Hughes, MDLos Angeles, CA

Fat is generally used to rejuvenate the face by replacing lost volume. In most patients this is in the cheek, cheek-lid junction, temple and prejowl areas. It works similar to the "liquid facelift"

Fat grafting works well for deep areas that need a significant increase in volume. Fat is placed below the skin, therefore it does not work as well for finer lines, such as the wrinkles that are circled in the glabellar region. I agree with Dr.Glasgold that it's best used as a foundation. Filler, such as hyaluronic acid, does a better job for fine lines. Often times folds are the result of deflation in other areas of the face. One example would be the nasolabial fold. The nasolabial fold results from deflation and descent of the cheek tissues. The pronounced nasolabial fold is the result of the descent. Injecting filler into the nasolabial fold doesn't treat the cause of the fold. Restoring volume (fat or filler) of the cheek bone (malar) area helps volumize and re-elevate the cheek tissues. This can help the nasolabial fold appear less pronounced.Fat transfer is commonly paired with more invasive procedures. Many facelift patients have sagging facial tissues and facial deflation. Dramatic results can be obtained with a facelift, that re-elevates sagging facial tissues, and fat transfer to provide additional volume. Fat is commonly placed in the malar area and nasolabial fold. Fat can also be placed in other areas of the face at the time of a facelift. This may include the supraorbital rim, temporal area, tear trough, etc.Consultation with your surgeon will help determine which procedures will hope you obtain your goals. 

Fat transfer will work best when treating loss of volume in the face rather than lines.  Typically the best take is going to be around the eyes (both upper and lower) and in the cheek and buccal region.  Areas where there is a lot of movement such as the mouth can be successful but are more difficult to get predictable results. Treating the areas that you circled will usually result in an unsatisfied patient.  You can get an improvement but it is usually much less than desired.  These areas which are more lines will respond much better to injectable fillers particularly hyaluronic acid.  There are two other general rules for fat vs fillers:  Fat is for large volume replacement over significant parts of the face but the correction is not very precise (fat take is unpredictable).  Fillers are extremely predictable and precise and excellent for more isolated treatment areas.  When thinking about long term answers, it is much better to build a foundation of volume with fat which is very long lasting and then use fillers on top to get a more precise correction.

The technique of fat transfer to the face is very technique dependent.  Fat has to be placed as droplets in good vascularized tissue to ensure good fat take.  The mid-face is an excellent place to fat graft as well as the temple region.  The best way is to combine fat grafting with facelifting as fat restores the volume lost due to facial aging and the facelift will help to restore tissue to the correct anatomical position.  Filling in Marionette lines with just fat is not as effective as lifting and filling with lines with fat.  Adding volume helps to restore a youthful fullness to the face.  It also seems to have additional beneficial effects such as improving the quality of the skin with the stem cells that are in the fat graft. 

You raise a superb question! In my experience, fat transfer works the best to add generalized volume. That being said, I have found it to not be as good in treating small, specific areas such as fine lines. I find long-lasting fillers to be more successful. This is particularly true in the areas that you are showing in your pictures. I would make an appointment with a board-certified plastic surgeon, and if you make a decision to have a fat transfer in those areas, look at multiple before-and-after pictures of specific fine lines like nasolabial folds and lines that are treated with just fat. While there are many great advantages to fat transfer, it is not as precise as injecting fillers. The areas you have marked off would be PERFECT for a long-lasting filler such as Radiesse.I hope this helps.Best of luck,Mats Hagstrom, M.D.