Fat Grafting is One of the Most Exciting Fields in Plastic Surgery
Fat grafting is a technique where fat is removed from an unwanted area such as the abdomen or lower back and injected into an area where fat is desired.
The most common areas where fat is injected include the face, the buttock, and the breasts. Many patients that come in for liposuction have lost their cheeks, lips, or developed flattened butts. This is the perfect time to discuss fat grafting because there will be a large amount of fat that can potentially be wasted. There really is no additional downtime for the addition of fat grafting to the body. For the face, there will be swelling.
It Looks and Feels Natural
It makes sense that if you lose fat in your face, buttock, or breast, replacement of that lost fat should look and feel natural.
Because it is! Fat is the perfect filler for areas of fat loss.
Fat can be used to sculpt and remodel
In the face, fat provides one the ability to remodel, not just fill. The amount of volume injected with a fat transfer can include over 60 cc of fat. Comparing this to the traditional 1 cc of each Restylane, that is 60 x the volume one would receive with injectable products. With such high volumes, fat can be viewed as a sculpting tool. Cheek bones and jaw bones, the basic face architecture can be altered. For the breasts, areas of rippling, deep cleavage planes, or other imperfections in shape and size can me modified. These kinds of precise improvements cannot be achieved with silicone.
Unlike traditional silicone or saline breast implants, fat can used to sculpt the shape of the breasts to the patient’s individual needs or desires. One breast is usually larger than the other, or shaped slightly differently. Structural fat can be placed exactly where it is needed to make the breasts more symmetrical. It can be used to fill in lumpectomy defects, scars and congenital malformations (tuberous breasts). It can be used to enhance the cleavage, fill out empty sacs left by weight loss or breast-feeding, or to hide the edges of visible artificial implants.
Idea Behind Facial Remodeling
Youth is not just the absence of wrinkles. If we take a photograph of a 50 year old man and woman with wrinkles then photo shop out the wrinkles, they would probably look like someone who “looks good” for 50. So what other changes take place in the face other than wrinkles that impart an aged look? You may think saggy skin, and you would be correct in that saggy skin isn’t youthful. But tight skin isn’t necessarily youthful, either. Pulled skin over bone in absence of fat looks like a bad face lift. There are plenty of actor and actresses that fit this description. Yet, there are many men and women on the big screen that appear to have not aged at all, or have aged very little compared to their peers. The reason why is because their facial architecture has been restored.
Youthful faces are top heavy. Heart shaped. Pulling skin and the fat beneath the skin certainly helps, but one is still pulling a deficient amount of tissue. When we age, we lose fat in our face. It just doesn’t sag. Thus, to properly restore the architecture one needs volume addition. And nothing is better than fat to replace lost fat.
Fat Grafting Technique
The procedure can be done under local anesthesia or general anesthesia (where one is put to sleep). The area where fat is to be harvested is injected with a mixture of saline (salt water), epinephrine to reduce bleeding and bruising, and lidocaine to anesthetize the area. With small cannulas, fat is then suctioned and washed and processed with centrifuge. The processing technique is a critical step in the procedure because in many ways it will determine the longevity or survival of the fat cells to be injected.
Dr. Neavin has found that slow RPMs with centrifuge under 2 minutes is adequate to separate the fat cells from fluid while being gentle enough to preserve the viability of fat cells. In some cases of high volume fat grafting such as the buttock or breast, fat will be rinsed and strained. In both preparations, fat is immediately placed back into the body for filling with very little exposure outside the body. Attention to preparation cannot be stressed enough, since technique alone can determine long term results.
Once the fat is prepared, it is injected immediately into the body with cannulas. Depending on the area of injection, cannulas will range in size. For fine areas with think skin such as the eyes and lips, very small
Facial Fat Grafting Before & After Gallery
Description of the procedure
Fat grafting also called fat transfer, is a surgical procedure that incorporates the removal of fat from an unwanted area of the body, and injected into an area where fat (or volume) is desired. Most commonly, these areas include the face, breasts, or buttock. For the purpose of this section, fat grafting will refer to facial fat grafting.
The idea of fat grafting is to fill in areas of depression that typically occur from the aging process, to highlight certain areas of the face (such as the cheeks, or lips), or to sculpt or remodel the face by building out the architecture. The strategy for fat transfer is adjusted to the goal of the surgery, naturally.
To understand why fat grafting rejuvenates the face, it is important to understand the features of an aged face. Faces start off as a ball of fat from birth. With age, fat is lost globally in the face, from the forehead, temples, lips, cheeks, and around the eyes. In addition to fat loss, tissue descends. This combination will alter a top heavy face found in youth to a bottom heavy face. While lifting tissue that has dropped can restore a younger-looking face, lifting alone without the addition of fat can often look artificial and “pulled”.
Strategic placement of fat wit or without a facelift will return the face to younger years in both men and women while avoiding the “done look” if the essential subunits of the face are addressed in harmony. Unnatural or “overdone” looks are a result of an error in planning, which often stems from ignorance of beauty ideals or inexperience.
In younger faces that won’t necessarily benefit from rejuvenation, facial fat grafting can remodel the face into a more pretty or handsome form. In men, often the temples, cheekbones, and jawbones are volumized to create a square face, the kind of shape you often see in Hollywood. Brad Pitt, George Clooney, and Ryan Gosling epitomize this look.
In younger women, the temples, cheekbones, lips, and mid face are often grafted in combination to create a more heart shaped face with stronger feminine features.
Fat grafting, when done properly, creates permanent, natural looking results. Also, fat contains stem cells. Any given fat transfer can contain up to millions of stem cells that when injected, act on the tissues to restore texture, tone, and color. Stem cells in fat can even remodel scars.
Am I a candidate?
Fat grafting to the face often involves the use of 60 ccs or more. To put this in perspective, this is about 60 syringes of Juvederm or Restylane. Another way to think of it, it’s like two shot glasses (at least in Australia. The standard shot glass in the United States is 44 cc). Even the thinnest, most fit people have enough fat for this procedure. And in fact, it is the thin, healthy person who often ages the worst in the face because fat loss is more pronounced in these individuals.
Poor candidates are men or women who want virtually no downtime. Fillers such as Restylane, Juvederm, Radiesse, Sculptra, and Bellafill often result in little to no brushing or swelling. This is not the case with fat grafting. Typical fat grafting sessions will generate swelling of the face that can last well over a week.
The exception to this rule is with nano fat grafting, which is a rather new technique that is used primarily to improve scars and rejuvenate skin, or, smaller sessions of fat grafting.
Other potentially poor candidates are men or women who do not want general anesthesia or have a difficult time with local anesthesia. Fat grafting is a more laborious process than fillers.
The average person who undergoes fat grafting does not request fat grafting. That is, most men and women are unfamiliar with this method of volume addition. Often, patients will complain that they think they look tired or simply “older.” However, pulling the skin doesn’t necessarily improve their appearance or make them look younger. This is precisely the perfect candidate for fat transfer.
The idea of the consultation is for Dr. Neavin to make the appropriate diagnosis and develop the proper treatment plan to both meet expectations with the least invasive method. This may include facelift, fat grafting, fillers, or any combination of the three.
It is often helpful for patients to bring in photos from 10 to 15 years ago, or, photos of people that they think have beautiful features. While it is almost never the goal to make someone look like another person, examples of specific facial characteristics are useful in determining a plan and setting reasonable expectations.
Dr. Neavin will review all of the ways to achieve a person’s goals ranging from temporary solutions such as fillers to permanent results with fat, Sculptra, or Bellafill.
Fat grafting requires both the harvest of fat and the injection of fat. From harvest to injection is preparation. Anywhere from harvest to injection, fat cells can be injured or killed resulting in poor results. Thus, technique and experience are paramount with fat grafting.
Factors that impact cell survival and activity include:
– the area of the harvest
– the infiltration used in the harvest
– the size of the harvesting syringe (or power of suction machine)
– the amount of negative pressure generated in the syringe used for harvesting
– the size and type of harvesting cannula
– the process of separation of fat from oils
– the time lapse from harvest to injection
– the depth of injection, the speed of injection
– the size of injection, cannula size used for injection
– and volume of injection
Small, often hidden or inconspicuous “stab” incisions are made in areas for fat harvest. After harvest (liposuction), the fat is washed and prepared for injection into the face. The most common sites for injection are the corner of the mouth or in the hairline. Thus, no visible scars on the face or head are created with this technique.
Microdroplets of fat with tiny cannulas are delivered in dozens of passes at multiple depths to ensure vascularization of the cells.
Volumes up to 60 ccs or more may be injected into the face with the average volume hovering around 48 ccs.
Fat grafting can be performed either under general anesthesia with the patient asleep or local anesthesia with or without some sedation. Both the harvest site and donor site must be properly anesthetized. The procedure is a same day procedure meaning that patients will go home the same day after surgery. If multiple procedures are performed along with fat transfer that exceeds a specific time frame, sometimes patients are advised to spend the night at recovery facility under the care of health care providers.
Surprisingly, fat grafting causes tiny facial pain. More discomfort is experienced in the donor site such as the hip or abdomen where the fat cells are harvested.
Bruising is rare, but swelling is common. Most of the swelling will subside within a week. 85 percent of swelling will dissipate by two weeks. Residual swelling may persist a bit longer.
The results from fat grafting are permanent. If one gains weight or loses weight, the fat cells will respond in their usual fashion as if the fat was always there from the start. Thus, fluctuations in weight will not generate unnatural looking facial changes.
In very gaunt faces, sometimes more than one grafting session is performed to achieve optimal results. Not every fat cell will survive the harvest and injection. Thus, slight overcorrection is performed to account for some fat loss within the first week. This is precisely why technique and experience are critical with this type of procedure. The results in skilled hands are night and day from poorly trained or inexperienced surgeons.
Dr. Neavin has trained under leaders in fat cell research such as Dr. Peter Rubin at the University of Pittsburgh and spent an additional year of post-graduate training under the pioneer of facial fat grafting, Richard Ellenbogen, where he performed hundreds of fat transfer cases.
Dr. Neavin lectures nationally on injections and instructs doctors from all over the world on aesthetic ideals and facial fillers.
Fat grafting often leaves no visible scars on the face. Injection points which are a millimeter or two in size include the corner of the mouth, within the hairline, or in the eyebrow. Harvest sites for fat require subtle stab incisions and are hidden inside the belly button or low on the hip so be hidden by underwear.
To schedule your appointment, please call the office at 310-858-8811. Or, if you have any additional questions visit the FAQ page, or call the office and ask to speak to Dr. Neavin directly. If you would like Dr. Neavin’s professional opinion about whether or not fat grafting is right for you, please send us an email and Dr. Neavin will get back to you within a couple of days if he is not traveling for work.