Fat Transfer (a.k.a. Facial Fat Grafting, Fat Injection, Lipo-Sculpting)
Over the years, facial fat grafting has taken an important role in Dr. Fechner’s facial rejuvenation program. As a minimally invasive procedure, it is well positioned to boost facial appearance. In order to enhance ones face, comprehensive understanding of facial esthetics and age-related changes are paramount. In the past, an aging face was virtually always approached with a facelift. And although facelift procedures continue to be extremely valuable today, they rarely are used as stand-alone procedures to improve all aspects of aging.
In addition to an increase in laxity and droopiness, the face also undergoes significant volume loss over the years. In fact, this facial ‘deflation’ is commonly the first age-related change observed by young women and men in their 30’s and 40’s. Therefore, achieving a youthful and natural look commonly requires repositioning of the saggy tissues (i.e. facelift, neck lift, Finesse Lift®) and filling of deflated regions.
Sculpting Your Face for a Healthy Appearance
The goal of the successful rejuvenation program is a refreshed, healthy and normal appearance with added attractiveness. Therefore, volume sculpting requires a highly individualized approach utilizing the artistic vision. Because effective facial volume restoration does not change a person’s characteristics, it commonly leads to rather subtle but nonetheless important enhancements. Frequently, friends and even family members may not be able to tell why the person looks vibrant and youthful. This natural understated improvement is the understood goal of facial fat grafting.
Which Areas of the Face Are Treated By Fat Transfer?
There are few regions that Dr. Fechner has not treated by facial fat grafting. Again, the key lies in the planning and preparation stages. When meticulous analysis leads to an appropriate plan, fat sculpting will be most successful.
Most patients benefit from treatments of the mid-facial cheek region. Because the cheeks represent a rather large anatomic area, it is helpful to subdivide this region into sub-units: high cheek (a.k.a. malar eminence), low cheek (sub-malar region), central cheek and posterior cheek (towards the ears). Depending on the very specific desires and anatomy of the face, these regions can be enhanced separately or in conjunction.
The greater mouth area commonly benefits from enhancement with fat grafting. Early jowls can be softened by grafting fat into a region just in front of the jowl (a.k.a. pre-jowl sulcus). If prominent nasolabial and marionette lines are present, they may benefit from softening. Deflated lips can also be treated by fat injections.
The region under the eyes may be sunken leading to dark circles and hollowness, a condition a.k.a. tear-trough deformity or naso-jugal grooves. Although advanced lower blepharoplasty (eyelid lift) techniques are most commonly applied by Dr. Fechner for these problems, alternatively, fat transfer may be effectively employed. In addition, some people develop very deep upper eyelid sockets which may make the eyes appear sunken. Although proper eyelid definition is desirable, hollowness may be less attractive sometimes even leading to an unhealthy look. Careful injection of fat can fill in these sunken eyelid regions.
Youthful temples are soft and convex. As their fat padding vanishes, the temples become hollow leading to a slightly wasted look. Fat injections may soften these regions of temple volume loss.
Additional areas that have been successfully treated by Dr. Fechner include the chin, glabella (area between the eyebrows) and eyebrows. Even the earlobes can be treated if they appear deflated. Depressed scars may also benefit from fat grafting.
How and Where Is the Fat Harvested?
The most common regions of fat harvest are the thighs, hips or belly. The fat is harvested with a small liposuction cannula through tiny skin punctures created with a specific needle. Different from liposuction for body sculpting, rather small amounts of fat are necessary for facial treatments. When liposuction is performed for removal of unwanted fat, amounts in excess of 1000cc are commonly removed by the plastic surgeon using a powerful suction machine. In contrast, Dr. Fechner rarely removes more than 40cc for fat grafting procedures. These small amounts are carefully harvested using rather delicate aspiration pressures in order to protect the fat cells from unwanted damage. The pinhole skin openings do not require sutures and vanish within a few weeks.
How Will the Fat be injected into the Face?
After harvest, the fat will be purified by sterilely removing excess fluids. Using a blunt needle, the fat is then deposited in tiny amounts at the time in the previously determined and numbed facial regions. Using this micro-droplet technique is important for maximal fat survival as the fat cells require sufficient blood supply in order to “take”. Simply injecting large amounts of fat in one area will inadvertently lead to virtually complete absorption.
How Long Will the Fat Last?
The question of longevity is one of the most important questions to discuss before fat transfer. In general, whatever is there after 3 months, will probably be there long-term. First, it is important for every patient considering fat grafting to understand that not all the fat injected will result in volume enhancement. For instance, when Dr. Fechner places 10cc of fat into each cheek, this will not lead to a volume enhancement of 10cc. (By the way, 10cc of additional cheek volume would be too much for virtually every patient.) Dr. Fechner’s experience is that about 25-50% of long-term enhancement can be expected. Obviously, this relatively large range needs to be taken in consideration in the planning of every fat treatment. Placing more fat later is relatively easy; removing what is too much is much more difficult. Recent studies using 3-D imaging show that in average about 30% of fat survives in the cheeks. In addition, Dr. Fechner’s observation has been that certain facial regions retain a higher percentage of the fat (i.e. the upper and lower eyelid area) than others (i.e. nasolabial creases or lips). This knowledge helps significantly in planning of fat transfer procedures.
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Another interesting observation shared with other plastic surgeons is that the overall volume after fat grafting is rather dynamic before it reaches its final destiny. Initially, of course, there is puffiness beyond the desired level of enhancement. After about 10 days, patients feel comfortable easing back into their regular social and professional lives. Further healing leads to further subtle decrease in the overall volume gain. Sometimes, patients reach a point of optimal enhancement where their do not want further volume reduction which may be a sign that an additional treatment (or treatments) may be of value. A low point in volume correction is usually reached at about 3 to 4 months. Over the subsequent 6 month, subtle improvement may follow leading to an unexpected, late enhancement. The final result will be durable for years.