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Micro Fat Transfer

Fat Transfer is one of the most popular and common procedures we perform at Carmel Valley Facial Plastic Surgery. It is essentially the cornerstone of our facial rejuvenation program. The main reason for this is that it is extremely effective and the results are permanent. We perform this procedure alone or in conjunction with other facial rejuvenation procedures such as facelifts and eyelid surgery (blepharoplasty). The key to success is highly based on the surgeon’s experience and technical abilities. Dr. Karam is among the most experienced fat transfer surgeons in the country.

View fat transfer before and after photos..


The Problem: As we age, the layer of fat under our facial skin begins to thin. This causes the face to look deflated and drawn when compared to the full roundness of a younger face. Especially around the eyes, hollows and contour changes leave the face looking older and more tired. Volume loss is one of the earliest signs of aging. It starts to occur in the mid 30’s and continues to progress. Until recently, this component of facial aging was overlooked. We are now realizing what a major contribution volume makes to looking younger, healthier and more energetic.

Dr. Karam’s wife! 3 years following full face fat transfer. The results represent the lasting and continued rejuvenation effect of fat transfer.

Fat Transfer before and after photo

The Treatment: One of the old dictums in plastic surgery is “replace like with like.” When it comes to facial volume loss, micro fat transfer is the treatment of choice. A gentle liposuction technique is used to prepare the fat for transfer. Then the fat is then injected in the desired portion of the face, using a micro injection technique. This approach allows extremely small parcels of fat to be placed into multiple layers of the face. This maximizes potential survival and allows for optimal aesthetic outcome. In my practice this is done most commonly around the hollows and grooves of the lower eyelid region and cheeks. Another common area is around the mouth and jawline. It can also be done throughout the entire face giving the entire face a natural rejuvenation.

three months
three years

A photo of a woman who underwent fat transfer to correct her flat midface and lower lid region. Note the enhanced and youthful contour of her cheeks and most importantly the durability and persistence of the fat after 3 years.

Anesthesia: The procedure is most commonly performed under local anesthesia with a light oral sedation. Patients go home the same day with little discomfort and essentially no downtime. Bruising is variable.

Expected Outcomes: Generally, 40-60% of the transferred fat persists permanently. Although, the long-term efficacy of transferred fat has been documented in numerous studies results are extremely technique dependent. I encourage all my prospective patients to speak to past patients and ask them what their experience has been with the long-term results.

Fat Transfer before and after photo

Post operative Course: Other than a very small incision at the fat harvesting site, no incisions are made in the face. The most common post procedure issues are swelling and bruising. This is often minimal and often resolves in a few days. Patients usually return to normal activity within a week. The more regions of the face that are treated, the more time it takes for the swelling to settle.

Fat Transfer – All You Need To Know About This Component of the Modern Approach to Facial Rejuvenation


Sculptra is used to treat the same problems as mentioned above. It is not a true filler. It is a unique product that is actually works by stimulating collagen production in the deep layers of the skin. The results are similar to fat transfer hence the term “fat in a bottle.” The treatments are performed in the office setting. It takes 3 treatments spaced 4-6 weeks apart. The changes occur slowly, leaving friends and loved ones wondering what is responsible for this positive change. We also use Scultpra as part of our Liquid Facelift technique.

I often recommend this for patients who are very thin and don’t have enough body fat to allow for successful fat transfer. Or for patients who simply choose this approach over fat transfer once they’ve heard the pro’s and con’s for each treatment.

Restylane/Perlane and Juvederm

These are true fillers. They consist of Hyaluronic Acid, a natural product abundent in our body. Unlike fat transfer and sculptra, which are often used to treat broad areas of facial volume loss, these products are used to target specific discrete areas. For example, the nasolabial folds (cheek folds), lips, and corners of the mouth are common areas for treatment. More advanced uses of these products are for treatment of the hollows and grooves around the eyes. The results are excellent and last between 6-9 months, depending on the treatment site.

Picture Yourself with Juvederm®

Juvederm® Treatment Visualizer


Radiesse consists of Calcium Hydroxyappetite. This office-based fille is used to treat deep folds, grooves and hollows. The most common uses are to treat the nasolabial folds and to add cheek volume. The results last 6-9 months.