InHealth: Fat or Fiction?

By Braun Graham, MD FACS
March 2021

How have fat injections to the face improved the results of facelift surgeries?

Facial aging is a combination of stretching and sagging of the facial tissues as well as loss of the youthful fat volume in the face. Surgically moving lax facial skin uphill without addressing the facial volume loss may create surgical results that appear pulled and unnatural. Adding fat to volume-depleted areas of the face during surgery restores the volume loss and results in a more refreshed, natural appearance.

How is fat added to the face?

Most middle-aged patients undergoing facelift surgery have some extra deposits of fat in the lower abdomen or hip areas that are useful sites to obtain fat for re-injection. The fat is harvested by gentle liposuction using a small instrument introduced through a puncture in the skin. The fat is processed and immediately re-injected into the face in micro-droplets that will survive without moving out of position.

How long do fat injections last?

Scientific studies demonstrate that approximately 70% of the fat cells that are injected survive. The 30% of cells that don’t survive gradually disappear over the first three months. The remaining fat cells survive for the lifetime of the patient.

Do facial fat injections have any other benefits?

Clinical observations have shown that the facial skin overlying the fat injection sites can slowly improve in appearance, texture and sometimes pore size. This secondary benefit is thought to be due to the presence of adult stem cells that reside with the fat that is injected. More lab studies are ongoing to prove this theory.

Who are the best candidates for fat transfer?

Individuals exhibiting moderate facial volume loss who have a pinch of excess fat in the hips, abdomen or thighs can be good candidates. Although it never occurs, most patients wish they could donate more fat in hopes of losing a garment size. Obviously, ultra-thin individuals rarely have adequate fat volume to allow successful harvesting of fat to augment the face.

How do fat injections compare to fillers?

As a rule, fat injections are ideal to volumize the deeper levels of the volume-depleted face. The fat can be injected in micro droplets at varying depths but are usually avoided at the most superficial levels of the skin. Fillers on the other hand, can be utilized to plump superficial depressions such as the nasolabial creases and marionette or “puppet lines” where they may have more “plumping power” than fat. Fillers are successful temporarily (six to twelve months), whereas living fat cells have the potential to be permanent. 

Dr. Braun H. Graham is President of the Sarasota Plastic Surgery Center. He is the former President of the Florida Society of Plastic Surgeons and the Past President of the Southeastern Society of Plastic and Reconstructive Surgeons.  Dr. Graham is certified by the American Board of Plastic Surgery and a member of the American Society of Aesthetic Plastic Surgeons.

Sarasota Plastic Surgery Center
2255 S Tamiami Trail
Sarasota, FL 34239
941.366.8897
sarasotaplasticsurgery.com