Facial Fat Grafting

Conveniently located to serve the areas of Beverly Hills, CA

Plastic surgery is steadily improving and as more innovations appear, the more exciting the field becomes. A recent trend that has taken the industry by storm is the popularity of injectable treatments, and not just with synthetic products.
Fat grafting is a technique that makes the best of the unwanted fat in your body. The fatty bulges that line your abdomen, love handles or thighs don’t need to be thrown away after a liposuction procedure. Instead, the same fat can be transferred to the face to improve the facial contour or even enhance the buttocks.
The procedure is particularly appealing due to the fat’s natural elements. It’s your own fat from your body, just injected elsewhere. The result does not look overly augmented and poses no risk of rejection.

Before and After Photos

Rejuvenate

At first glance, the idea of a fat transfer may sound absurd. Why reuse fat when your primary goal is to remove it from your body? In addition, treatment with dermal fillers such as Juvederm® and Radiesse ® are fully capable of restoring volume to the face and other regions without the transfer process.

When you consider the appeal for fat grafting, however, the science behind its popularity is actually quite sound. Because the volume loss you experience is a direct result of fat dissipation, increasing volume with replacement fat is the most natural way to enhance your appearance. With fat transfer, you replace exactly what you lost with aging. You will look and feel as you always have, but with a subtle addition that rejuvenates your face and body completely.

If you’re interested in liposuction in one or more areas of your body, it’s worth considering whether the excess fat is usable in another region. Dr. Neavin can help you determine whether fat grafting would be beneficial for you.

What does Fat do?

Injectable treatment with dermal fillers does what their name implies: fill. It’s also what patients assume fat grafting does as well. Injecting fat back into the body is more versatile than what fillers can provide, however, and has the potential to sculpt the contours of your face. Moreover, higher volumes for facial remodeling using fat are more feasible than dermal fillers from both a safety standpoint and cost standpoint. This becomes obvious when one understands that fat transfer to the face often includes up to 60 cc, the equivalent of 60 syringes of Juvederm®.

Fillers Vs Fat: The Stem Cell Advantage

The most significant difference between fat transfers and dermal fillers is the amount injected, the skin changes associated with the introduction of stem cells within the fat, and the longevity. Fat is permanent. Normal volume additions with fat transfer include 40-60cc in the face, 10 cc per hand, and up to 600 cc per buttock. Because of the high unit amount as well as fat’s natural consistency, it’s possible to significantly alter the facial structure. For optimal results, it’s also feasible to use both fat grafting and dermal fillers at once since fillers tend to be more predictable in certain regions of the face. Dr. Neavin frequently uses PRP (platelet rich plasma) to enhance fat cell survival.

When injected into other areas of the body, like the breasts, the fat can reduce the appearance of lines, ripples or deep cleavage planes. For instance, if the breasts are asymmetrical, fat grafting can provide balance as opposed to receiving implants.

Significance

Although it’s perfectly reasonable to assume that fine lines and wrinkles age your appearance, the loss of volume to the upper and mid-face regions is what will mostly contribute to aging. Plastic surgery can only do so much to tighten the skin when the features around your eyes and cheeks have sunken. Likewise, fat transfer can only do so much when the skin is incredibly lax or wrinkled. Often, both skin resection with a facelift and laser resurfacing accompanies fat transfer to produce the most dramatic results.

The reintroduction of fat into the face is the key to looking younger naturally, not only replacing lost volume, but also molding the fat to an ideal shape. A youthful facial structure maintains the majority of fat in the upper third of the face. When you begin to lose fat in those areas (in combination with other factors), the face will appear aged as a result.

Restoring the natural architecture of the face involves adding fat to hollow areas. With the addition of fat, Dr. Neavin can construct the ideal facial shape that helps you look younger and feel refreshed.

Importance

Fat Looks and Feels Natural – Because it is

The volume of fat grafting will depend on the area treated and individual desires. The buttock and breasts generally require far more volume than the face or hands for a visible improvement. The temples and cheeks require more fat than the area under the eyes. And whereas 50 cc of fat can often be enough to fill out an entire face, hundreds of cc are required to augment breasts or buttocks.

photo showing the superficial fat compartments of the face (superficial fat layer)

Each region of the face will require different volumes to achieve permanent results for two main reasons. First, the fat loss in a particular area may be greater than it is in another location. Second, the fat survival varies in different areas of the face. To understand these principles, areas such as the temples and lips require proportionately more volume than the cheeks, because the temples and lips aren’t as fat friendly as the cheeks. That is, these areas have very little to no fat in their native state. To enlarge areas that aren’t big fat reservoirs, more fat transfer will be required. Understanding necessary volumes are an important component to producing natural, long-lasting results.

Fat can be Used to Sculpt and Remodel

In the face, fat provides the ability to remodel and reshape, not just fill. The amount of volume injected with a fat transfer can include dozens of cc fat. Comparing this to the traditional one cc of each Restylane, the volume achieved with fat is significantly more than one would receive with injectable products. With such high volumes, fat can be viewed as a facial sculpting tool. Cheekbones and jawbones, the components of the basic face architecture, can effectively be altered.

The image below illustrates where volume resides in young, beautiful faces.  These areas tend to hollow with fat loss during the aging process and tissue descent. To restore youth, these areas must be filled again.

Idea

Youth is not just the absence of wrinkles. If we take a photograph of a 50-year-old man and woman with wrinkles then edit out the wrinkles, they would probably look like someone who looks good for 50, but not necessarily younger. What other changes take place in the face that impart an aged look? You may think of sagging skin, and you would be correct in your view that sagging skin isn’t youthful. But tight skin isn’t necessarily youthful, either. The image below highlights areas of the face that are full in youth.  Thus, these will be the target areas for volume enhancement.

Pulled skin over bone with the absence of sufficient fat underneath looks like a bad face lift. There are plenty of actors 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 – probably. Or, God has been very good to them.

Youthful faces are top heavy and 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. To properly restore the architecture one needs, volume addition is essential. Nothing is better than fat to replace lost fat.

Fat Grafting Technique

Fat transfer can be performed 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 suctioned out of the body and washed and prepared into syringes. 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 the less the fat cells are manipulated, the greater survival rate. This less-is-more strategy preserves the viability of fat cells. Fat is rinsed and strained and immediately prepared for injection to reduce cell 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 thin skin such as the eyes and lips, very small cannulas are used to minimize trauma and maximize take. In areas such as the buttock or breasts, cannulas will be larger because fat take in these regions are higher.

Description


deep fat compartments of the face (deep fat layer)

Strategic placement of fat with or without a facelift will return the face to its younger years in both men and women, avoiding the “done” look if the essential sub-units of the face are addressed in harmony. Unnatural or overdone looks are a result of an error in planning, which often stems from ignorance about beauty ideals or inexperience.

In younger faces that won’t necessarily benefit from rejuvenation, facial fat grafting can remodel the face into a more attractive form. In men, the temples, cheekbones, and jawbones are often volumized to create a square face, the masculine face 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. The image below shows common areas where injection of fat can restore more heart shaped facial architecture.

When done properly, fat grafting creates permanent, natural-looking results. Also, fat contains stem cells, which act on the tissues to restore texture, tone and color. Stem cells in fat can even remodel scars. Any given fat transfer can contain millions of stem cells.

Candidates

Fat grafting to the face often involves the use of 60 cc 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 (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 most noticeably 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 bruising 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 for 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 and involved process than fillers and you need to be prepared for the process to ensure the safest procedure and the best possible results.

Consultation

The average person who undergoes fat grafting does not request fat grafting initially, since most men and women are unfamiliar with this method of volume addition. Often, patients will complain that they think they look tired or older. However, pulling the skin tighter doesn’t necessarily improve their appearance or make them look younger. These individuals tend to make the best candidates for fat transfer.

The purpose of the consultation is for Dr. Neavin to make the appropriate diagnosis and develop the proper treatment plan to meet expectations with the least invasive method. This may include a 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 the ways to achieve a person’s goals, ranging from temporary solutions such as fillers to permanent results with fat, Sculptra or Bellafill.

Surgery Details

Fat grafting requires both the harvesting of fat and the injection of fat. At any point of that process, fat cells can be injured or killed, resulting in poor results. This reality makes technique and experience paramount to a successful fat grafting process.

Factors that impact cell survival and activity include:

– Area of the harvest
– Infiltration used in the harvest
– Size of the harvesting syringe (or power of suction machine)
– Amount of negative pressure generated in the syringe used for harvesting
– Size and type of harvesting cannula
– Process of separating fat from oils
– Time lapse from harvest to injection
– Depth and speed of injection
– Cannula size used for injection
– 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 cc or more may be injected into the face with the average volume hovering around 48 cc.

Fat grafting can be performed under general anesthesia with the patient asleep or local anesthesia with or without some sedation. Both the harvest and donor site must be properly anesthetized. The procedure is a same day procedure meaning that patients will go home shortly after surgery. If multiple procedures are performed with the fat transfer and the combination of procedures exceeds a specific time frame, patients may be advised to spend the night at a recovery facility under the care of medical providers.

Recovery

Surprisingly, fat grafting causes little 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. Eighty-five percent of swelling will dissipate within two weeks. Residual swelling may persist a bit longer.

Results

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. This means fluctuations in weight will not generate unnatural facial changes.

In very gaunt faces, more than one grafting session may be performed to achieve optimal results. Not every fat cell will survive the harvest and injection, so slight over-correction 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. He also spent a 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.

Scars

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 they will be hidden by underwear.

Please visit the FAQ page for more information on facial fat grafting.

Schedule

To schedule your appointment, please call the office at 310-858-8811 or text 323-975-1287. You can also visit our 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.

FAQ


What is fat grafting (or fat transfer)?

Fat grafting is a process in which fat is taken from one part of the body and transferred to another. Common uses for fat grafting are in facial rejuvenation or buttock augmentation.


Where is the fat taken from?

The removal of fat is called harvesting. The site where the fat is harvested is called the donor site. While fat is distributed all over the body, there are certain areas that make better donor sites than others. The love handles and abdomen are generally the sites most often used. Fat here is usually abundant, even in men and women who are thin. The fat in this area also tends to be the hardiest, and it is thought that “tough” fat in this area may translate into better incorporation and longevity in the transfer process.


How is the fat taken (harvested)?

Fat is aspirated through a very small incision placed in an area that is hidden easily such as the hip or inside the belly button. From this incision, a small cannula is tunneled under the skin and moved back and forth. The cannula breaks up the fat. Attached to the end of the cannula is a syringe that serves as a collection tube. The syringe generates negative pressure and acts like a mini vacuum.


Does taking fat leave a dent or divot?

For facial fat grafting and other low volume areas it shouldn’t. The amount of fat needed for transfer is relatively small. Considering that liposuction of the love handles can range up to 600 cc of fat, the 30 to 80 cc of fat harvested for grafting is almost inconsequential when it comes to making a visible difference at the donor site. When we graft areas like the buttock or breast, we take fat from multiple sites and in high volumes as part of a liposuction procedure. Thus, in those cases we expect (and want) there to be visible fat depletion at donor sites.


How much fat is harvested for grafting?

The amount of fat harvested ultimately depends on how much fat is needed. How much fat one needs to correct an area of deficiency, of course, depends on the area one is correcting. Grafting can range from a few cc’s to hundreds off cc’s. As a rule, the face will often receive between 20 cc and 80 cc of fat. Buttock augmentation ( also known as the Brazillian butt lift) generally receives anywhere between 100 and 500 cc of fat. The breast may receive anywhere between 10 cc to correct rippling to several hundred cc for augmentation.


How much fat survives the transfer process?

It depends. Unfortunately, there is no hard and fast number that any one doctor can quote. There are so many variables at play, so the best one can do is come up with a range. The amount of fat that is retained after fat grafting generally ranges from 20 percent to 60 percent.


What factors determine fat “take” and survivability?

From harvest to injection, fat cells are vulnerable to death. For fat cells to survive a transfer, they must be collected and injected properly. The amount of pressure generated to aspirate fat must be great enough to collect the fat, but not so great that it damages the integrity of the cells. Collecting 100 cc of dead fat won’t help anyone, which is why technique is an important component of successful fat grafting procedures. Once fat is collected, it can be processed or not processed. Processing can range from using a centrifuge, to adding growth factors and stem cells, to simply allowing the fat to be strained. All of these may offer some advantages and disadvantages, but Dr. Neavin will select the optimal technique to provide you with the best possible results.
Once fat is collected, it must be injected relatively soon. If fat is collected in the beginning of a liposuction case and injected into the buttock at the end of the liposuction case, there may be some cell death depending on the time interval between harvest and injection. In addition, if the fat is going to sit around after a harvest, how is it preserved? Cooling fat offers some advantages to cell viability over room temperature.
How is the fat injected? The size of the injection cannula, syringe, and location of fat donor site all play roles in fat survivability. If the cannula is too small, the trauma from fat injection through a small opening can damage cells. If the cannula opening is too large, too much fat may be injected into any one area resulting in fat cell crowding. Since every single fat cell needs its own blood supply, crowded injections will result in cell death.
The array of variables when it comes to fat grafting makes it impossible to give straight percentages when it comes to fat “take”. The last factor one must consider is donor site. Areas that already have native fat (cheeks, breasts, buttocks) will inevitably have a higher fat cell survival than areas that don’t have much native fat (lips, temples). In areas that have little or no native fat, often over-correction is the rule. When one over-corrects, more fat is preferentially placed in anticipation of a larger percentage of cell death.


What are risks associated with fat grafting?

Harvest site risks include bruising, pain, contour deformity, and infection. Contour deformity is rare because the fat collected for grafting is from deep layers of fat. In thin people, more than one donor site is often used to reduce or eliminate a contour irregularity. Infection at the donor site is also exceptionally rare.
Risks associated with the recipient site include bruising, swelling, and infection. Because the face is very vascular, infections in this area are uncommon. Breast and buttock infections are also rare, but more common than face infections. Contour irregularities and hard lumps and bumps in experienced hands are very uncommon. If fat is injected through proper cannulas at the appropriate depth, the risk of any visible irregularities is almost unheard of. If they do occur, they can usually be corrected by experienced hands.
Does adding stem cells or growth factors help “take”?
More important than the addition of stem cells and growth factors, is technique of harvest and injection. Theoretically, it would make sense that the addition of growth factors (PRP) or stem cells would offer advantages in survival rates and longevity of results. However, there really isn’t any good evidence to support this idea. Stem cells and PRP might add time to the procedure (and cost), but at probably no added benefit to your results. Until more science is collected, stem cell addition to fat grafting mainly offers only theoretical advantages – assuming that the extra steps don’t interfere with cell viability, given the delicate nature of fat cells.


How long does fat grafting last?

Forever and never. Because not all cells live, the “take” varies. However, the fat that does survive will be permanent in most cases. If the fat cells integrate and become part of one’s body, as is the goal of fat transfer, then the results are long-lasting for those cells.


What is downtime for fat grafting?

Downtime for fat grafting is generally cosmetic in nature. It’s a surface operation. Fat is injected in the tissues below skin and above any major organ or vessel. Time needed off work is strictly related to how one feels about the swelling and bruising.
Facial fat grafting: Large amounts of swelling and possible bruising for up to seven days. Residual mild swelling for another week or two.
Breasts and buttock augmentation: Mild to moderate swelling for up to seven days.
Fat grafting is a versatile procedure that offers substantial benefit with minimal discomfort or downtime. To learn more about this procedure, contact Artisan of Beauty Plastic Surgery at 310‑858‑8811.