Question 1

What is facial fat transfer?

Accepted Answer

Facial fat transfer is a minimally invasive plastic surgery procedure that uses your own body fat, taken from the hips, thighs, abdomen, or neck, to add or restore volume to specific areas of the face.

Also known as facial fat grafting, fat injections, or lipofilling, the facial rejuvenation technique can restore volume to the cheeks and temples, plump thin lips, enhance blepharoplasty (eyelid surgery) results, and smooth deep nasolabial folds and marionette lines. It can also improve the appearance of pitted acne scars.

Fat transfer to the face is an outpatient procedure that involves extracting excess fat from one area of the body via a gentle liposuction technique, at times processing the fat cells with a centrifuge or filter, and then injecting the purified harvested fat into the treatment area, to plump, lift, smooth, and reduce volume loss. The most common method of fat transfer, known as microfat transfer, injects the fat in tiny droplets (often called “microdroplets”), explains Dr. Sam Naficy, a board-certified plastic surgeon in Bellevue, Washington.

When fat is further processed, filtered and refined, it becomes “nanofat” that can rejuvenate thin, crepey skin, improving areas like the tear troughs (or under-eye hollows) and the skin of the upper lip. Nanofat does not contain any intact fat cells—since they rupture during processing—so it can’t add volume; it’s used solely to improve the quality, tone, and texture of the skin.

Fat is one of the best sources of stem cells, so autologous ("from the same person") fat transfer provides additional facial rejuvenation and anti-aging benefits, thanks to its growth factors and their ability to stimulate collagen growth beyond the treatment area.

Since nanofat contains fat-derived stem cells, but no whole fat cells, it’s used purely for tissue regeneration. Some doctors complement nanofat or microfat injections with platelet-rich plasma (PRP) or platelet-rich fibrin (PRF) to boost their regenerative effects and, in the case of microfat, “improve the chances of graft survival,” per one recent study.

Question 2

Which areas of the face can fat transfer treat?

Accepted Answer

Fat injections can rejuvenate these areas of the face:

Temples
Forehead
Glabella (between the eyebrows)
Hollow upper eyelids
Under-eyes
Cheeks
Nasolabial folds
Marionette lines
Lips
Chin
Jawline

In addition to restoring lost volume and smoothing folds, lipofilling can improve the appearance of pitted scars or rejuvenate crepey skin.

Question 3

What are the pros and cons of facial fat transfer?

Accepted Answer

Pros

“Fat grafting allows for large-volume facial augmentation,” says Dr. Naficy. “When using the patient’s own fat, it is very easy to add 40, 50, or 60 mls of fat to multiple areas of the face. This is not feasible or realistic with fillers such as hyaluronic acid and, at the cost of ~$700-800 per ml of filler, would not be cost effective.”
Fat grafting is the longest-lasting treatment option to reverse volume loss or smooth facial wrinkles and folds. The fat that survives the transfer process is considered permanent.
The procedure uses your own fat (not synthetic dermal fillers), so there's very little chance of an allergic reaction.
Harvesting unwanted fat from other body areas via liposuction also has body contouring benefits.
The stem cells present in your fat can stimulate new collagen production, providing ongoing facial rejuvenation from the inside out. This “stem cell effect” is something that no synthetic filler can produce, notes Dr. Naficy.
Newer processing techniques that produce nanofat particles show even greater promise for rejuvenation, notes Dr. Dilip Madnani, a board-certified facial plastic surgeonin New York City.
A facial fat transfer procedure can enhance the results of other facial rejuvenation procedures, like a facelift and blepharoplasty (eyelid lift).
This form of augmentation and facial contouring has high patient satisfaction. A 2017 study found an 81% satisfaction rate among patients surveyed, and type: embedded-entry-inline id: Ks6V6ARYAktTMUTOEu3el of RealSelf members say it’s Worth It.

Cons

The three-step fat transfer procedure takes considerably longer than simply injecting dermal fillers.
It's typically more expensive than getting temporary injectable fillers, “although a multi-syringe filler injection can be equally expensive,” says Dr. Naficy.
Only a limited amount of fat can be grafted at any given time, and approximately 40–60% of transferred fat cells will not survive. This makes results unpredictable and potentially asymmetrical.
The final result can be very difficult to reverse, if you don’t like it.
Recovery from this cosmetic surgery takes at least a week and involves swelling, bruising, and soreness.
Depending on the extent of your procedure and your personal medical history, sedation or even general anesthesia may be recommended.
RealSelf reviewers who rated facial fat grafting Not Worth It cited undesirable results, including persistent lumps. Some also say that none of the transferred fat survived longer than a few months.

RealSelf Tip: BeautiFill is an FDA-cleared system for laser-assisted liposuction and fat grafting. While fat removed via traditional laser lipo generally isn’t viable for transfer, the BeautiFill system breaks up fat without liquifying it and gently extracts it, allowing surgeons to prepare it for transfer to other parts of the face or body. The extracted fat reportedly has a viability rate of over 95%.

Question 4

How much does facial fat transfer cost?

Accepted Answer

The cost of your facial fat grafting procedure will depend largely on your surgeon’s level of experience and expertise, their practice location, and the extent of your procedure (for example, how many areas are treated).

Cosmetic surgery isn’t covered by insurance, but most providers offer payment plans or accept third-party financing options, such as CareCredit.

See our complete guide to facial fat transfer costs

Question 5

Facial fat transfer before and after pictures

Accepted Answer

The facial fat transfer photos in our gallery have been shared by the surgeon who performed the procedure, with the patient's consent.

Question 6

How does facial fat transfer work?

Accepted Answer

A facial fat grafting procedure has three stages and can take up to two hours, depending on the volume of fat being transferred and other specifics of your procedure.

1. Liposuction to harvest the fat

You and your surgeon will choose the body areas where excess fat will be harvested and removed via liposuction.
You’ll be given local anesthesia with oral sedation (or general anesthesia, if your surgeon feels it’s warranted).
Your surgeon will make a small incision in the donor area and insert a cannula (a thin, hollow tube connected to a vacuum), to gently remove and collect the fat. “When harvesting fat for transfer, it is very important to be gentle in extracting the fat so that cells remain healthy and viable,” Dr. Naficy explains. “Standard liposuction techniques may damage a large portion of the fat cells.”

2. Purifying and preparing the fat

The fat cells will be spun in a centrifuge and filtered to remove impurities.
Purified fat will be transferred to smaller cannulas.

3. Injecting the fat

Once your face is numbed with local anesthesia, your surgeon will insert a tiny cannula into the area that’s being treated, passing it into the treatment area multiple times, “so that each tiny morsel of fat is adjacent to living tissue with a good blood supply,” Dr. Naficy notes.
Each pass deposits a small amount of fatty tissue, until the desired effect is achieved. “Most surgeons believe in a certain level of ‘over-correcting’ since not all the injected fat will survive,” says Dr. Naficy, but they must also be careful not to overfill the tissues which can reduce viability. Once the fat cells are positioned, they will have to establish a new blood supply in order to survive.

Related: Facial Fat Grafting: 10 Terms That Define the Procedure

Question 7

What is the recovery time for facial fat transfer?

Accepted Answer

Patients typically take 1 week of recovery time after facial fat grafting. You’ll be able to resume most activities within 3 to 5 days, but it usually takes a few more days to look “restaurant ready.”

In the first week after your procedure, you‘ll likely experience some swelling, bruising, inflammation, and soreness at the injection sites.

You can also expect your donor sites (where the lipo was performed) to be tender and swollen for a couple of days. Most people don’t need prescription pain medication to manage the discomfort, so your provider will probably recommend over-the-counter pain pills.

Swelling should subside within 2 weeks. Keeping your face elevated on pillows, especially while you sleep, can help reduce puffiness. Most surgeons don’t recommend icing, which can reduce fat survival.

Any injection-site bruising should also disappear within 2 weeks. Until then, it can be covered with makeup.

Use a gentle facial cleanser and avoid scrubbing your skin until all inflammation has resolved.

Question 8

When will you see facial fat transfer results?

Accepted Answer

You’ll see your final results from facial fat transfer about 9 months after your procedure.

“In the first three months, 40–60% of the fat cells will die off,” explains Seattle oculoplastic surgeon Dr. A.J. Amadi. “Most surgeons overfill, in anticipation of this fat loss—so in the first two to four months, the face will seem overfilled or puffy in the areas that were injected. At three to four months, the volume will be in its lowest state, and from four to nine months, the fat cells that have survived will start to plump up.”

“Many surgeons believe that stem cells play a role in the later phases of increase in facial volume following fat grafting,” according to Dr. Naficy. “A large number of the mature fat cells may not survive the initial fat transfer, but that’s when the stem cells ‘wake up’ and start transforming into new fat cells.”

Some patients end up with minimal results because some (or all) of the transferred fat cells don't survive. In general, the older you are, the less fat will survive, but smokers tend to have worse outcomes. Any form of nicotine inhibits circulation, which makes it difficult for the transferred fat to establish a new blood supply.

See facial fat transfer before and after photos

Question 9

How successful is facial fat transfer?

Accepted Answer

About 20% of patients have a touch-up facial fat grafting procedure to improve on their initial results. “We explain to patients ahead of time that we will reevaluate and consider a touch-up, six to nine months after the initial procedure,” says Dr. Madnani.

As we mentioned above, a growing number of providers harvest and process fat for transfer via a system called BeautiFill, which boasts a fat transfer viability rate of 95%. This method is said to offer a significant advantage of making results more predictable, so it may be worth seeking out a provider who offers it.

Question 10

How long does facial fat transfer last?

Accepted Answer

The results you see 9 to 10 months after your procedure are considered permanent. However, any weight change—loss or gain—can shrink or grow those transferred fat cells, changing the proportions and appearance of your face.

The treated area will also continue to lose volume over time, due to the normal aging process.

As we’ve mentioned above, the biggest drawback of fat grafting is that it’s impossible to predict how much of the transferred fat will reabsorb and how much will remain permanently in the injected area.

In the rare instance that your final result leaves you with more volume than you wanted, the outcome can be very difficult to reverse. While hyaluronic acid-based dermal fillers can be dissolved with the help of an enzyme, precise fat removal is far trickier.

“Injections with steroids might help, and some have advocated micro liposuction to remove excess fat. Sometimes fat can be directly excised [removed manually], in cases of specific lumps or bumps,” explains Dr. Amadi.

On the other hand, “It should be comforting to note that most patients lose fat as they age and that any excess of fat would reduce over time,” says Dr. Naficy.

If your provider suggests reducing excess fat with Kybella, especially under the eyes, find another provider. Kybella is only FDA-approved to treat submental fat (under the chin), and there are a host of potential complications if it's used elsewhere in the face. There's also the risk that it could dissolve too much fat, leaving you with irregular contours and hollows.

To avoid “buyer’s remorse,” some doctors suggest that patients try a filler like Restylane or Juvéderm to preview the results before committing to a fat transfer procedure, but others recommend against this. “There are some downsides to injecting fillers prior to fat grafting in that ideally, fat should be injected on a ‘clean canvas,’ and presence of fillers can at times interfere with survival of grafted fat,” cautions Dr. Naficy.

Another way to test-run volume gains is by injecting saline into the desired treatment areas. “I’ve done this a few times for potential fat-transfer patients who don't want to waste time with injectable fillers,” says Dr. Madnani. “The saline injections last a few hours to days and immediately show what added volume to areas of concern will look like.”

Question 11

What are the risks and side effects of facial fat transfer?

Accepted Answer

Facial fat grafting is a relatively low-risk cosmetic procedure. “Fat transfer to the face carries different risks than large-volume fat transfer to the buttocks or other body sites,” explains Dr. Madnani. “Facial fat transfer uses smaller volumes and smaller cannulas, so the risks are generally lower.”

As with any surgical procedure, infections and unsatisfactory outcomes are always possible. As we mentioned earlier, some patients have a low survival rate for transferred fat, which can create asymmetry.

The procedure also carries these potential risks:

Hematoma (blood pooling under the skin)
Fat embolism (fat that blocks a blood vessel)
Scarring
Rarely, facial fat necrosis (fat cell death) or cyst formation, if the transferred fat fails to survive

According to a 2022 review of facial fat grafting complications reported between January 1965 and July 2021, “the overall general complication rate of facial fat grafting is assumed to be around 2%, [however] the real complication rate of facial fat grafting is unknown due to a lack of reporting and the absence of consensus on side effect definition and identification.”

The study offers these additional insights about risks and side effects.

If the area is overfilled, or if patients gain weight in the future, fat hypertrophy (overgrowth) can occur, leading to a bloated, uneven, or distorted look.
Minor side effects include prolonged swelling and redness, as well as acne reactivation.
Facial fat transfer can carry more severe risks, including neurological side effects stemming from accidental injection into a blood vessel. According to the previously mentioned study’s authors, “the highest rate of severe (vascular) complications occurred in cases of multisite injections and glabella treatment [between the brows], followed by the forehead and temporal area, which carried a medium-high risk.” However, this study also notes that vascular complications are very rare, occurring in roughly one in 5 million cases.

A separate 2022 review and meta-analysis of ophthalmic complications related to facial fat injections reports a “noticeable increase in the complications such as vascular compromise and blindness.” The researchers found forehead injections to be most commonly associated with such catastrophic complications. “It’s important to note,” says Dr. Sam Naficy, “that vision-related complications are very rare, and that they can also occur with facial filler injections.”

Doctors on RealSelf have mixed opinions on injecting fat into tear troughs and hollows in the eye area. Some urge patients to avoid fat transfer to the under-eye area completely. Others assert that if done properly, facial fat transfer below the eyes will produce favorable, long-lasting results with no complications. Other proponents of fat transfer will seldom perform a lower eyelid blepharoplasty without simultaneously performing fat transfer.

Risks associated with fat grafting under the eyes appear to be very low. A 2018 paper on combining fat grafting with lower blepharoplasty for tear trough correction found “no serious complications were reported during a period of 10 years” of performing the procedure.

Lips are another debatable area for fat grafting. Some doctors will very judiciously inject the lips with fat, while others find hyaluronic acid filler to be a more predictable choice for lip augmentation. “Because lips are constantly moving, survival of grafted fat into lips appears to be less than in other areas, but the results are natural and well-liked by patients while they last,” Dr. Naficy notes.

The bottom line: The results of this procedure can be very dependent on provider technique. Look for a doctor with specialized experience, who regularly performs facial fat grafting and has a photo gallery that includes long-term results.

Question 12

Facial fat transfer vs. dermal fillers

Accepted Answer

Fat injections perform a similar function as temporary dermal fillers because they can either be used to plump and contour the face, or to smooth wrinkles, creases, and folds.

While a fat transfer uses injected fat taken from your own body, most facial fillers are a synthetic gel, usually made of hyaluronic acid. “Filler is predictable, easy to perform, requires no downtime, and lasts about six months to a year or longer, depending on how much filler is placed,” says Dr. Madnani.

Fat transfer results are typically more long-lasting than temporary fillers, but the up-front cost can be higher, depending on how much filler would be required. And again, results of fat transfer are less predictable.

A provider who specializes in facial rejuvenation can advise you on whether you’re a good candidate for facial fat transfer or if dermal fillers would be a better choice. The best filler will depend on your specific situation, but these are some of the most highly rated options.

Renuva: This injectable fat precursor lays down an "adipose matrix" (derived from purified donor tissue, made of collagen, growth factors, and proteins) that acts as a sort of scaffold onto which natural fat cells can grow. Once injected, it’s gradually replaced by your own fat cells over a three-month period, reversing volume loss.
Juvéderm: There are multiple versions of this hyaluronic acid dermal filler, each formulated with a unique texture and density for different areas of the face.
Restylane: Another hyaluronic acid–based filler, Restylane temporarily adds volume to plump lips, lifts cheeks, smooths wrinkles, fills in scars and under-eye hollows, and rejuvenates aging hands.
The RHA Collection: RHA, or “Resilient Hyaluronic Acid,” is said to more closely mimic natural hyaluronic acid than competitor formulas. These fillers are FDA-approved for dynamic facial wrinkles and folds—the ones that develop in response to natural facial expressions.
Sculptra Aesthetic: Sculptra is made of poly-L-lactic acid (PLLA), which stimulates collagen production to restore lost volume through the midface, temples, and jawline while also smoothing cheek lines. Sculptra is not safe to use in the lips or around the eyes.

Question 13

Sources & studies

Accepted Answer

Vasavada A, Raggio BS. “Autologous Fat Grafting For Facial Rejuvenation.” 2023 Feb 14. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 32491783.

Schiraldi L, Sapino G, Meuli J, Maruccia M, Cherubino M, Raffoul W, di Summa PG. “Facial Fat Grafting (FFG): Worth the Risk? A Systematic Review of Complications and Critical Appraisal.” J Clin Med. 2022 Aug 11;11(16):4708. doi: 10.3390/jcm11164708. PMID: 36012947; PMCID: PMC9410081.

Mortada H, Seraj H, Alhamoud MA, Alghoribi RS, Alsuhaibani OS, Khoshhal MS, Neel OF. “Ophthalmic Complications Following Facial Autologous Fat Graft Injection: A Systematic Review and Meta-Analysis.” Aesthetic Plast Surg. 2022 Dec;46(6):3013-3035. doi: 10.1007/s00266-022-02924-5. Epub 2022 Jun 1. PMID: 35650299.

Faith H K Jeon, MBBS, MSc, Jajini Varghese, MBBS, MRCS, MPhil, PhD, Michelle Griffin, MBChB, MRes, MSc, MRCS, PhD, Afshin Mosahebi, MBBS, FRCS, FRCS(Plast), MBA, PhD, Peter E Butler, MD, FRCSI, FRCS, FRCS(Plast), Simon Withey, MBBS, MS, FRCS(Ed), FRCS(Eng), FRCS(Plast), Hugo Henderson, MA, MBBS, FRCS(Ophth), “Fat Hypertrophy as a Complication of Fat Transfer for Hemifacial Atrophy,” Aesthetic Surgery Journal, Volume 40, Issue 4, April 2020.

Kim J, Shin H, Lee M, Shin D, Kim S, Jo D, Kim C, Kim H, Choi H. Percutaneous Autologous Fat Injection Following 2-Layer Flap Lower Blepharoplasty for the Correction of Tear Trough Deformity. J Craniofac Surg. 2018 Jul.

Gornitsky, Jordan, et al. “A Systematic Review of the Effectiveness and Complications of Fat Grafting in the Facial Region.” JPRAS Open, Elsevier, 22 Dec. 2018.

Wang, GH, et al. “Facial Aesthetic Fat Graft Retention Rates after Filtration, Centrifugation, or Sedimentation Processing Techniques Measured Using Three-Dimensional Surface Imaging Devices.” Europe PMC, 31 Dec. 2018.

Groen, Jan-Willem, Krastev, Todor K., Hommes, Juliette, Wilschut, Janneke A., Ritt, Marco J. P. F., van der Hulst, Rene R. J. W. “Autologous Fat Transfer for Facial Rejuvenation: A Systematic Review on Technique, Efficacy, and Satisfaction.” Plastic and Reconstructive Surgery – Global Open, Dec 2017.

FACIAL FAT TRANSFER

Sam Naficy, MD, FACS

Jolene Edgar

BEFORE & AFTER PHOTOS

Sam Naficy, MD, FACS

Jolene Edgar

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Sam Naficy, MD, FACS

Jolene Edgar

BEFORE & AFTER PHOTOS

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Jolene Edgar

FACIAL FAT TRANSFER QUESTIONS

How to deal with uneven fat transfer to face? (Photo)

What procedures will help me achieve a more structured jawline and cheekbones? (Photo)

Would fat graft in the hollows of my eyelids be enough to solve the results of such an aggressive blepharoplasty? 9Photos)

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