Fat Transfer – All You Need To Know About This Component of the Modern Approach to Facial Rejuvenation
What is Fat Transfer?
Fat Transfer is also commonly known as Fat Injections and Fat Grafting. All three terms describe the same procedure. The process involves removing living fat tissue from one part of the body and using it to treat another part of the body.
What is it Used to Treat and Who are the Candidates for the Procedure?
In our practice, we use it to treat:
Changes of the Aging Face. With time, our face looses fat and hence looses volume. This makes the face look tired, older, and less healthy. Fat transfer is used to restore the youthful contours and shape by eliminating the hollows and depressions, which make the face, look older, tired and less healthy. The patients range in age from late 30s to 80’s.
An example of periorbital fat transfer. Note the presence of bags and a long distance between her upper eyelid and cheek. This makes the eyes look tired and aged. The fat transfer blends the transition between the eyelid and cheek. On the side view, note how flat her midface and cheek looked pre-procedure. The soft gentle contour creates and healthier and more youthful look.
Fat transfer to soften the hollows under the eyes and decrease the flattening of the cheeks. A 15% Jessners/TCA chemical peel was also performed to revitalize the skin.
Fat Transfer, Upper and Lower Blepharoplasty
Genetic Volume Loss in Younger Patients. Younger patients (early 20s-30s) can also have volume loss patterns that make them look tired around the eyes or in other cases they simply want to have an enhanced aesthetic result by added fat to create fuller cheeks and maximize overall facial balance and attractiveness. In these cases, it is not due to aging, but related to genetics. Patients, who suffer from this pattern, note that their eyes look tired (even when they are not) or they lack full youth full cheeks which makes there faces look narrow or flat.
Corrective. In these cases it is used to correct problems that have occurred as a result of previous cosmetic surgery, trauma, or natural asymmetry.
What is Facial Volume Loss?
look as good as I feel”
Each and every individual, without exception, is losing facial fat. Facial fat is one of the key elements that maintains a youthful, healthy, and vibrant appearance. This process starts becoming noticeable by the time we are in our mid thirties and progressively continues with each year. To visualize the change, all it takes is to compare photographs of yourself throughout the various decades. The pattern of loss is consistent with everyone and has nothing to do with your body weight. The end result of these changes, are a face that appears more gaunt, tired, and aged.
Full Face Fat Transfer and Lower Eyelid Skin Pinch. Note the rejuvenated and fresh appearance following these results. The hollowed temples, lower eyelids and cheeks have been refilled leaving her looking natural and healthy.
Where in the Face does Volume Loss Occur?
The simple answer is everywhere throughout the face. Specifically, you can see it around the eyes, the cheeks, jawline, and mouth. To see more examples, please see the before and after gallery.
Dr. Karam’s wife! 3 years following full face fat transfer. The results represent the lasting and continued rejuvenation effect of fat transfer.
Why Does Fat Transfer Work So Well?
Fat transfer works so well because it is the most natural replacement for facial fat loss. One of the oldest dictums in plastic surgery is “replace like with like.” Since, fat is what is lost over time, restoring that lost volume with your own fat gives you the most natural rejuvenation results. Finally, the fat cells have an abundance of stem cells. Stem cells have been associated with long-term rejuvenation effects, such as skin clarity, improved skin tone, texture and even reduction in pore size.
Where is the Procedure Preformed and What Type of Anesthesia is Used?
In our practice, the majority of our fat grafting cases are preformed comfortably using local anesthesia in the office. This means you are awake (lightly sedated), but do not feel any discomfort or pain. Most of our patients prefer this as opposed to general anesthesia. We also do it under general anesthesia in an accredited and certified outpatient surgery center for those who prefer to be completely under or more heavily sedated. The choice is ultimately up to our patients. It just so happens that most choose to do it under local anesthesia for reasons that range from quicker recovery, less cost, and less potential risks.
How Long Does the Fat Last?
The results are permanent. Since it is a living graft it achieves a blood supply in the same way that a skin graft or hair graft would. Once that process of neovascularization (new blood supply) has been established, the fat grafts not only survive in their new environment but they thrive. This process can take several months to occur. The general rule of thumb is that whatever you have by 2-3 months is your lowest point. It will not get less, but you might see an increase in fullness over the following year as the fat grafts make the transition from survival to returning to their biological natural ways of storing fat.
If I Need a Touch Up or Would Like More Fat, When Can This Be Preformed?
The need for a touch up is actually very rare in our practice. The majority of our patients get what they need after one treatment. However, if a touch up is needed or if more fat is required to get the desired result, the general rule of thumb is we wait 1 year. This is because there are cases in which the fat looks like it did not take to the desired level, but after 1 year we see the results have actually been enhanced. This is thought to be due to the fact that once the blood supply is firmly established by 3-6 months; the fat begins to really thrive. By 1 to 1.5 years after the transfer, the final results are finally established. Patients always note that their results look better at 1 year than at the 3-month mark. However, each case is looked at individually, and in some cases, a touch up can be preformed earlier.
What are the Potential Complications?
The main complications are contour irregularities (lumps and bumps), poor cosmetic distribution, and poor fat take. All of these potential complications can be significantly minimized in the hands of an experienced fat grafting surgeon. Fat Transfer is one of those procedures in which an extremely high level of judgment, knowledge, excellent technique, experience and artistry are required to get natural and enhancing results that last. Unfortunately, most of the bad press that fat transfer has received is from surgeons that dabble in this procedure. As a result, they lack the experience and knowledge to achieve consistent and excellent results. This is most analogous to Rhinoplasty in which a very unique set of skills and knowledge is required. And this is uncommon.
What Makes our Practice Unique and Successful?
My passion for volume restoration and belief that fat transfer is one of the best options available to replace lost facial volume is the inspiration that drives our results. Our practice, which is among the highest volume fat transfer practices in the country, enjoys a very high level of success and high patient satisfaction and an extremely low complication rate. Patients come from all over the US and the world for this procedure. My experience with fat transfer started in 2004 and has picked up to very high volumes since 2006. To perform fat transfer well, the surgeon needs to have a very good understanding of the 3-dimentional changes that occur as a result of aging as well as knowledge of what the “normal” youthful facial contours should look like. This takes a lot of study and starring at a wide variety of faces throughout the population. After awhile, you get a sense of patterns and how much and where the fat should go to re-establish the youthful facial contours. Since, the process of fat injection is closer to sculpting than surgery, it is absolutely critical the treating surgeon has that sense and knowledge. The technical skills maximize fat survival and minimize complications, but the beauty and elegance of the results are purely artistic. When picking a surgeon, a picture is worth a thousand words. It is important to see many before and after photos. This ensures that the surgeon is capable of creating a look that you are comfortable with.
What should you ask your potential surgeon?
How long they have been doing this?
How many of these procedures they perform per week?
How often do they have a complication that requires a touch up or treatment?
Ask to see a least 20 outcomes that resemble the correction you are looking for.
Ask to speak to a least 5 patients that were treated in the last month and 5 patients that have been treated over 1 year ago.
Since, this is a permanent procedure, it pays to do your homework.
What is the Recovery Like and How Long Does it Take to Recover?
Swelling and occasional bruising are the basic characteristics of the healing phase. The swelling is the worse on days 2-4 and then it begins to settle thereafter. After day 5, the rate of swelling resolution speeds up. In some cases, patients are good enough to go out without minimal post operative swelling by 1 week. However, the majority of patients need a bit more time. Typically between 1-2 weeks the majority of the swelling and potential bruising has resolved. Things do continue to evolve in a positive way over a 4-6 week period. Typically by 6-8 weeks, things are stable. Most patients will take 4-5 days off work to recover. Although, depending on the job, others feel comfortable returning before this period.
Just wanted to put pen to paper and say a thousand ‘Thank you’s’ for the most wonderful, natural appearance you produced by your very skillful face lift. To say I am delighted would be an understatement.
No-one has noticed; they just think I look so well after a lovely holiday in California. It certainly paid by doing my homework and research; and I know without a doubt I could not have made a better choice. You are a real artist; with a gift of making your patients feel relaxed and assured; coupled with first class results. Also a real pleasure to have met all the lovely girls who work with you; takes away a lot of fear when you are greeted by warm, caring staff.
Thank you once again for all your kindness and understanding in easing my fears.
Kathy B. Facelift and Fat Transfer Patient from the United Kingdom
Dr. Karam, who is board certified by the American Board of Facial Plastic and Reconstructive Surgery and American Board of Otolaryngology, offers services in San Diego County including San Diego, Del Mar, Carlsbad, Carmel Valley, Encinitas, Rancho Bernardo and La Jolla in Southern California. If you are ready to schedule an appointment with Dr. Karam contact us today. 858.259.3223