Sculptra Vs. Fat Injections, What's Best for Cheek Augmentation?

Doctor Answers 12

Cheek Augmentation with Sculptra vs Fat Grafting

To perform fat grafting successfully and reproducibly a surgeon must employ careful preoperative planning, appropriate instrumentation and meticulous surgical technique.  It is not something you can 'rush through' or spend just a few minutes on during a larger surgical procedure.  The unfortunate reality is that not everyone who performs fat grafting is willing to put in the level of education, training, investment in instrumentation and operative effort required to produce aesthetically ideal results.

One must also have an aesthetic vision for ideal and youthful-appearing facial fullness.   Just like traditional facelift surgery can be overdone or performed incorrectly to produce an unnaturally tight, pulled, 'windswept' look, fat grafting can be overdone to produce an excessively full and even bizarre postoperative appearance.  Too much fat grafted into any area (or any fat placed where it doesn't belong) looks unnatural.  It's analogous to breast augmentation results: if the surgeons selects an appropriate implant volume and positions the implants correctly, the patient gets a beautiful, natural-appearing breast enhancement.  If the surgeons stuffs a pair of 500cc implants behind the breasts of an average-sized patient, then that patient ends up with a cartoonish 'boob job'.  I think many of the unfavorable results in fat grafting are from the overzealous placement of excessive amounts of fat, which may have been the inevitable response to the recent paradigm shift in aesthetic facial surgery: away from the 'wind tunnel look', and towards the restoration of soft tissue volume.

Here is one patient’s experience with fat grafting posted to RealSelf:

Fat is great when used JUDICIOUSLY and CONSERVATIVELY, but too much of a good thing becomes a nightmare and deeply regrettable. Make sure your surgeon listens, draws up precise operative plans beforehand and makes plenty of time for you and your concerns. Do NOT take it lightly.

I couldn’t agree more with this patient’s response to her experience with fat grafting.  Just like breast implants, or liposuction, or browlifts, too much of a good thing is not at all a good thing.  And cosmetic surgery (and this includes the preparation for surgery) of any kind without attention to detail and a focus on natural-appearing results will leave patients feeling disappointed at best and feeling disfigured at worst.  Now regarding whether or not fat grafting is a surgically sound concept…

For transferred fat to truly qualify as a 'graft' the following must happen: living tissue must be transferred to a new location, and that tissue must gain a blood supply at the new location which provides oxygen and nutrients which allow it to persist indefinitely as living tissue.  We know that with appropriate instrumentation and technique this is achievable, so one of the opinions expressed in this thread that "most of the cells from fat injection are dead " is simply untrue (and structural fat grafting, to be clear, does not involve 'injection' of fat).  MRI studies have shown that with appropriate technique grafted fat persists long-term as living, vascularized tissue in the recipient site.

It is also well-established that adult human fatty tissue contains stem cells that have the capacity to repair damaged or injured tissues, and stem cells can be concentrated during the fat harvesting process.  This effect has applications in both cosmetic and reconstructive surgery.  Fat grafting is now being used, for example, as a means to stimulate the repair of chronic, non-healing wounds.  Several centers have reported on fat grafting immediately below non-healing chronic wounds resulting from radiation therapy for cancer, with rapid improvement and eventual healing of wounds for which no other wound treatment was successful.  The development of stem cell therapies involving the harvesting and processing of viable human fatty tissue is one of the hottest topics in both clinical and experimental medicine today.

When performed correctly fat grafting actually has the capacity to heal, revitalize and rejuvenate the local tissues at the recipient site.  I have treated a number of patients with facial fat atrophy following overly aggressive 'non-invasive' rejuvenation treatments including Thermage, Fraxel and IPL.  Most of these patients report not only an aesthetically  pleasing and permanent improvement in facial soft tissue volume, but also an improvement in the quality and vitality of their facial skin.

I perform extensive facial fat grafting during most of my facial rejuvenation procedures, and it is the very first thing I do - before making any incisions to lift the brows, eyelids, face or neck.  Fat grafting allows me to obtain results that are simply not possible with conventional, subtractive surgical techniques alone.  Patients frequently return for grafting of additional areas after their initial experience with strucutral fat grafting.  To characterize it as the pointless and potentially harmful placement of non-viable tissue is an opinion only, and it is an opinion with which quite a number of plastic surgeons who successfully rejuvenate faces (and breasts and bodies) with fat grafting would vehemently disagree, myself included.

Solid fat/fascia and fat dermis grafts are another means by which facial soft tissue volume may be significantly and permanently enhanced.  As with fat grafting, survival of the grafted tissue is variable and some of the graft material is reabsorbed.  As with fat grafting, potential complications such as infection and cyst formation are possible.  And as with fat grafting, appropriate preoperative planning and surgical technique are required in order to obtain ideal and lasting results.  In my opinion structural fat grafting is more versatile, as fat can be easily and rapidly added to any tissue plane (level); and it has the added benefit of the ‘stem cell effect’ which is difficult to quantify but unquestionably present in many cases.

Both structural fat grafting and fascia-fat (or dermis-fat) grafting can be competently performed (or not) by Board-certified plastic surgeons.  Neither should be trademarked or considered proprietary.

As with any surgical procedure take time researching your plastic surgeon. Schedule several consultation, view many photos from many patients, each from multiple perspectives (start by looking at photos on this website) and speak to former patients of any plastic surgeon you are considering.Treatment of facial aging changes with fat grafting must  be carefully individualized to match each patient's aesthetic needs and desires.  I always examine and assess how each aesthetic area or 'unit' of the face contributes to an individual's overall appearance: the brows and eyelids, the cheeks or 'midface', the lower face and chin, and the neck. An individualized surgical plan is then developed which addresses each patient's specific concerns and needs.

Therefore, the price of a facial fat grafting will depend on exactly what each person needs and the time required to perform surgery. To select a plastic surgeon, take your time researching , visiting websites, view many, many before and after photos and speak to former patients.

Beware of doctors who discount their fees. Discounting the value of professional services, especially surgery, is not good marketing - it is a sign of desperation. The best plastic surgeons are still busy in this contracting economy, and they are not discounting their fees. At the same time, the most expensive surgeon is not necessarily the most talented, so as a consumer you still have to research this carefully. There is much more to consider than just the price in dollars that you pay: is your surgeon actually listening to you, do they truly understand the appearance that you hope to achieve, do you feel that he or she will be easily available and attentive once the surgery has been performed. If you don't have a good feeling, don't stick around to 'save money', go somewhere else.

Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 120 reviews

Both seem to work pretty well.

I quite often use both Sculptra and fat grafting as very effective ways to augment the cheeks.

Sculptra has been approved by the FDA for HIV lipodystrophy only at this time, although some plastic surgeons are using it off label for general cosmetic use. I find that most patients see a nice improvement after 1-2 treatments, and have some patients who have undergone more than the recommended 3 treatments.

Fat grafting is usually my first option (I am a surgeon, after all) and appears to give permanent or semi-permanent results for the fat that stays. Because fat grafting is actual surgery, however, some patients choose Sculptra instead to avoid the OR.

Bottom line: both approaches seem to work well for cheek augmentation, and the patient and doctor should decide together which is the right approach for you.

Anthony Youn, MD, FACS
Detroit Plastic Surgeon
4.8 out of 5 stars 62 reviews

LiveFill preferable either to fat injection or Sculptra

LiveFill involves the transfer of strips of the patient's own tissues, placed directly into the cheeks to increase fullness.

Fat injection is a nice technique, but aspiration of the fat through a canula and injection of the fat through a needle disrupts cell membranes and results in the death of most of the injected fat. This has been shown in study after study.

Our research shows LiveFill is alive at the time of transplantation and therefore the survival rate is higher than that of fat injections; that's why we prefer LiveFill.

Sculptra seems to work well for its FDA indicated use, lipoatrophy deep in the face in AIDS patients. We have seen many cases of lumpiness, in many cases permanent (over 3 years after the time of injection), especially when it is used for the tear trough or undereye area.

Sculptra is made of a reactive material, probably accounting for the difficulties we have seen when it is injected superficially.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 178 reviews

Fat Grafting > Juvederm Voluma > Radiesse > Sculptra

We currently use 4 methos for cheek enhancement:

  • SCULPTRA (injectable poly-L-lactic acid)
  • RADIESSE (calcium hydroxiapatite in a elastic gel matrix)
  • AUTOLOGOUS FAT (transfer of your own fat cells)
  • Highly cross-linked hyaluronic acid gels (ultra-reticulated): JUVEDERM VOLUMA or RESTYLANE SUB-Q

To tell you the truth, FAT GRAFTING is my first option; however I can understand that it's no "easy" for patient; it requires a steady and long time to perform the surgical process (comparing with fillers) and in many cases a 2-3 weeks swelling postop. time.

SCULPTRA needs 2 or 3 different sessions to be aplied, and in our hands in many cases can be noticed small irregularities at the end.

RADIESSE is a fantastic option; applied painless in 15 min. In our experience in 12-15 month needs a touch up.

JUVEDERM VOLUMA & RESTYLANE SUB-Q really  are fantastic filler for cheeks. They are compossed of highly concentrated and crosslinked hyaluronic acid gels, easy to apply and with excellent results in cheek and chin enhancement. They have another characteristic that other fillers don't have: if result is not the desired one, it can be removed (60-70%). And they are the cheapest option. Currently they are not FDA approved, but sure they will be approved in a very near future. In Europe (and Canada) we use them (EMA approved) since 2004 with excellent and long-lasting (2 years) results.


Good luck with your decission!

Enrique Etxeberria, MD
Spain Plastic Surgeon
5.0 out of 5 stars 7 reviews

Sculptra or Fat Injections, Which is Better for Cheek Augmentation

Hi A,

I find that Sculptra is much more predictable than fat injection facial augmentation.  When fat transfer is performed, the area being treated needs to be over corrected because only a certain variable percentage of fat survives.  If too much fat survives, that is a problem because it is permanent and difficult to remove.  Also if the patient should gain weight, they can be surprised by the way the implanted fat can grow in the face as well.  If too little fat survives then a second and or third fat transfer needs to be performed.  When used properly Sculptra is predictable and gives a most natural volumetric improvement.  Most importantly choose your injecting physician most carefully.  Good luck and be well.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

Cheek Augmentation, Cheek Enhancement, Cheek Fillers

Neither. Fat transfer still has to high a level of scar formation and absorption to make it acceptable for this use in my opinion and sculptra will last up to 2 years but does not the ability to create the natural curvature of an aesthetic cheek. I prefer to use Radieese or Perlane which I believe give superior results.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 25 reviews

Radiesse is my Favorite for Cheek Augmentation

Although fat and Sculptra are both useful for cheek augmentation, I find Radiesse is a much better product.  I perform many cheek augmentations daily, and with Radiesse I can shape and "re-inflate" sagging and flattened cheeks in just 10 minutes, painlessly.  And the results are seen immediately.  Sculptra usually takes 3 appointments and the results are seen weeks and months after each treatment, not immediately.  The injection technique for Sculptra is also more cumbersome, requiring more needle sticks and therefore more risk for bruising.  Fat augmentation might last longer but is unpredictable in how much of it will "take" so that it can occasionally appear lumpy.  It is also unpredictable in how long it will last, it could last years or just weeks.

Lorrie Klein, MD
Laguna Niguel Dermatologic Surgeon
4.9 out of 5 stars 216 reviews

Choosing between Sculptra and fat injections for cheek augmentation


there are many factors to consider when choosing between Sculptra and fat injections. Fat injections typically do not require multiple sessions like Sculptra. Also keep in mind that whenever fat is moved to another part of the body approximately 20% of that fat will melt away. For this reason, extra fat is always injected into these areas. When fat is injected to these regions the patient may expect a prolonged period of swelling and recovery. Sculptra works very differently. After Sculptra is injected into the hollow areas within the tissue this chemical will attract water. As the water moves to these impressions the Sculptra will swell and improve the deformity slowly. Approximately 6-12 months later the process may be repeated until the desired result has been achieved.

Pat Pazmino, MD, FACS
Miami Plastic Surgeon
4.7 out of 5 stars 108 reviews

Sculptra new gold standard for cheek augmentation

Scultpra has increasingly replaced fat transfer as the prefered way to bring about natural cheek augmentation. Made of poly L lactic acid, Sculptra stimulates collagen production that can last 2 to 2 1/2 years after series of 3 injections 6 weeks apart. Fat transfer may be complicated by inconsistent longevity and greater challenge to maintain symmetry.

William Ting, MD
Bay Area Dermatologic Surgeon
4.8 out of 5 stars 12 reviews

Much differing opinions on Sculptra vs. fat injection for cheek augmentation

As I would suspect there is much differing opinions on the comparison between sculptra and fat transfer for cheek augmentation. I try a more simple explanation. Sculptra is not a filler but an enhancer or collagen stimulator. It requires 3 to 6 injection treatments every 3 to 4 weeks to see any improvement. Thus, the cost, time of achieving some slight to moderate improvement are the negatives. Also reproducibility of results seems limited, in other words, one patients' results are terrific while many are not.

For fat transfer, it is usally one to 2 procedures. You must overcorrect the areas due to fat resorption. There is a healing time. And the cost per treatment are higher. But Fat seems to be a better lasting route.

But to throw another injection filler into the mix,not to confuse you even more. I would recommend ArteFill (PMMA) injections. These semi permanent fillers are faster to achieve results and slightly less $.

Hope that helps a bit.

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 174 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.