Addressing Facial Volume Loss

Each and every individual, without exception, is losing facial fat. This fat is one of the key elements that help you maintain a youthful, healthy, and vibrant appearance, and its gradual loss generally starts becoming noticeable by the time we are in our mid-thirties, continuing progressively with each year. 

To visualize this 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, and the end result of these changes will be a face that appears more gaunt, tired, and aged.

This procedure is frequently performed on its own, but can also be utilized as a part of the comprehensive Vertical Restore procedure. If you’re ready to learn more about how the fat transfer technique can enable you to turn back the clock and restore this lost volume, simply reach out and set up your consultation with a member of Dr. Karam’s team.

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Ideal Candidates for the Fat Transfer Procedure

With time, our face loses fat and therefore loses volume, leading us to look tired, older, and less healthy. Fat transfer to the face is used to restore your youthful contours and facial shape by eliminating these problematic hollows and depressions. Our fat transfer patients typically range in age from their late 30s to their 80s.

Younger patients (those in their early 20s or 30s) can also experience volume loss patterns that make them look tired around the eyes. Some patients may simply want to experience an enhanced aesthetic result by adding fat to create fuller cheeks to maximize their overall sense of facial balance and attractiveness. In these cases, the issues aren’t caused by aging but are related to genetics. Patients who suffer from this pattern, note that their eyes look tired even when they are not, or that they lack full and youthful cheeks, causing the face to look narrow or flat.

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Our Impressive Results

This patient underwent a full facial rejuvenation procedure, including the Vertical Restore operation, full fat transfer to the face, and rhinoplasty.

Where Does Facial Volume Loss Occur?

The simple answer is that facial volume loss occurs everywhere throughout the face, most specifically around the eyes, cheeks, jawline, and mouth. The presence of bags and a long distance between her upper eyelid and cheek can make the eyes look tired and aged.

Fat transfer blends the transition between the eyelid and cheek, creating a soft and gentle contour that results in a healthier and more youthful look.

before procedure photo

Fat transfer with upper and lower blepharoplasty.

After procedure photo

An example of orbital fat transfer.

Why Does Facial Fat Transfer Work So Well?

Our facial fat transfer procedure 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 facial fat is lost over time, restoring that lost volume with your body’s own fat gives you the most natural rejuvenation results. Finally, the fat cells have an abundance of stem cells, which 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 Performed and What Type of Anesthesia Is Used?

At our practice, the majority of our fat grafting cases are performed comfortably in our office, using local anesthesia. This means you’ll be awake, though lightly sedated, and will not feel any discomfort or pain. Most of our patients prefer this as opposed to general anesthesia.

We can also perform this procedure 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.

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How Long Does Fat Transfer Last?

The results will be permanent. Since fat transfer is what we call 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 will fully thrive in their new environment. 

This process can take several months to occur. The general rule of thumb is that whatever you have in two to three months will be your lowest point. Your results will not dissipate, 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 biologically natural ways of storing fat.

If I Need a Touch-Up or Would Like More Fat, When Can This Be Performed?

The need for a touch-up is actually very rare in our practice, as the majority of our patients enjoy their ideal results after just 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 to wait one year. This is because there are cases in which the fat looks like it did not take to the desired level, but after one 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 after three to six months, the fat begins to really thrive. By one year to a year and a half after the transfer, the final results will be established. Patients always note that their results look better at one year than at the three-month mark. However, each case is looked at individually, and in some cases, a touch-up can be performed earlier.

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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. Our fat transfer in San Diego 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.

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What Makes Our Practice Uniquely Successful?

Our results are driven by my passion for volume restoration, alongside my belief that fat transfer is one of the most effective methods for the replacement of lost facial volume.

Our practice ranks among those who perform the highest volume of fat transfer procedures in the country and enjoys a very high level of success with consistently excellent patient satisfaction, in addition to an extremely low rate of complications. Patients come to us from all over the United States and the world for this procedure. 

My experience with fat transfer started in 2004 and has increased to very high volumes in the years since. To perform fat transfer well, a surgeon must have a keen understanding of the three-dimensional changes that occur as a result of aging, in addition to a deep well of understanding in terms of what the "normal" youthful facial contours should look like. This takes a lot of study in addition to years spent staring at a wide variety of faces throughout the population. After a while, Dr. Karam was able to attain a sense of patterns, learning how much and where the fat should go to re-establish those youthful facial contours. 

Since the process of fat injection is closer to sculpting than surgery, it is absolutely critical that Dr. Karam brings an artistic eye to the table. Technical skills enable him to 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 view a number of before and after photos, so you can ensure that your surgeon is capable of creating a look that you’ll be satisfied with.

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What Should You Ask Your Potential San Diego Surgeon?

Since this is a permanent procedure, it pays to do your homework. Dr. Karam has years of experience in the area of facial plastic surgery and arguably offers the best results in facial fat transfer San Diego has to offer. Ask to see a least 20 outcomes that resemble the correction you are looking for, and request to speak with at least five patients that were treated in the last month, as well as five patients that have been treated over a year ago. You’ll also want to ask your potential practitioner how long they have been performing the procedure, and how many of these procedures they perform per week. It can also help to understand how often they have complications that require a touch-up or retreatment.

A Happy Patient's Testimonial

Dear Dr. Karam,

I just wanted to put pen to paper and say a thousand "thank yous" for the most wonderful, natural appearance you produced by your very skillful facelift. 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 San Diego, California. It certainly paid by doing my homework and research, and I know without a doubt that I could not have made a better choice. You are a real artist, with a gift for making your patients feel relaxed and assured, coupled with first-class results. Also, it was a real pleasure to have met all the lovely women who work with you, it takes away a lot of fear when you are greeted by such a warm and caring staff.

Thank you, once again, for all your kindness and understanding in easing my fears.

- Kathy B. (Facelift and Fat Transfer from the United Kingdom)

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