Fat Injections

Volume loss of the face is a KEY element of aging.  It is commonly seen in the upper, outer cheeks, junction of the nose and smile line (nasolabial fold), entire region around the mouth (peri-oral), marionette area and the space just in front of the jowls (pre-jowl hollow).   Hollowing of the temples can make the face appear skeletal.   Loss of central cheek tissue makes the lower eyelids appear long at the lid-cheek junction.  Early volume loss can be treated with fillers easily in the office (See Fillers).

Fat is also an excellent source of volume.

Fat harvested from the patients’ own body is “autologous”.  One advantage is that most people have a plentiful supply, so it is cost effective when several areas need fill.  The area where fat is to be taken is anesthetized with local anesthesia.  Fat is then removed via liposuction.  The fat is then centrifuged to get rid of liquids leaving the fat as pure as possible.

Next, the areas of the face are anesthetized not only for pain control but also to shrink the blood vessels and minimize bruising.  Fat is then carefully injected (or “transferred”) into the areas where volume is required with a very small cannula and multiple passes in many layers.  Bruising should be expected.

COMMENTARY ON FAT INJECTION (Dr. Anson)

Thanks to some pioneering photographic work by Val Lambros, MD, we have come to recognize that volume changes account for early aging which continues through life.  We now also know that the volume changes are due to both soft tissue and bone atrophy (loss).  Ultimately, the volume loss results in “deflation”.  Laxity of the skin envelope is due both to deflation and excess tissue; both need to be addressed depending on age and specific anatomy.

We commonly recommend fat injection in conjunction with a facelift.  While the facelift decreases the size of the “envelope”, the fat provides volume in the appropriate places.  Fat injection alone is commonly performed on the younger patient whose “envelope” is not yet excessive.  In the older patient with a large amount of skin, fat transfer is an adjunct to the facelift, not a replacement for it.  (See Facelift)  We have all seen examples of people who have had tight facelifts but still look “old” because of inadequate volume.

As a science, fat transfer is still in the early phases.  The amount of fat that “takes” is still variable in the best of hands.  In order for fat to “take”, the fat cells have to become incorporated into the surrounding tissue with a blood supply to nourish it.  One of the reasons fat works well as volume replacement if stem cells.  Fat is the most abundant and accessible source of stem cells.  These are specialized cells that have the ability to morph into a variety of cell lines.  This probably accounts for why some patients who have had fat injections have skin or scars that actually looks better years later.  However, we are still learning about the best ways to do this.  At present, this is a “good” technique; in the future, I expect it to become a “great” technique.

Can fat be overdone?  Absolutely!  Any volume enhancement, fillers or fat, can be overdone.  Injecting volume is like sculpting.  Judicious use of materials is required.