Facial fat grafting plays an important role in Dr. Fechner’s facial rejuvenation program. As a minimally-invasive procedure, facial fat grafting can dramatically improve one’s facial appearance. For fat transfer to enhance the face, a comprehensive understanding of facial esthetics and age-related changes are paramount. In the past, an aging face was typically resolved with a facelift.
While facelift procedures continues to be extremely valuable for most patients concerned with significant aging changes, it is rare to have a facelift as a stand-alone procedure. Modern aesthetic technology combines both surgical and non-surgical procedures to achieve a younger, fresher facial appearance – including implementing natural fat transfer to maximize results.
Your facial structure and skin quality is unique to you. If you are considering cosmetic treatments for facial enhancement, it is important that you have access to the latest generation of treatments, including facial fat transfer procedures.
Dr. Fechner, as a double-board certified facial plastic surgeon, has dedicated his professional life to assisting his patients to restore a more attractive appearance through the latest developments in aesthetic technology. His delicate approach, surgical expertise, and compassionate manner have made him one of the most sought-after plastic surgeons serving the Boston area.
The goal of the successful facial rejuvenation is a refreshed, healthy and attractive appearance avoiding the unusual. Volume sculpting requires a highly-customized approach paired with genuine artistic vision. Because effective facial volume restoration does not change your facial characteristics, it creates a subtle but important enhancement. Frequently, friends and even family members may not be able to tell what has changed, and why you now look more vibrant and youthful. This natural and subtle improvement is the goal of facial fat grafting.
In addition to an increase in laxity and droopiness, the face can suffer a significant volume loss over the years. In fact, this facial ‘deflation’ is often the first age-related change observed by young women and men in their 30s and 40s. Achieving a youthful and natural look commonly requires repositioning of the saggy tissues (i.e. facelift, neck lift, Finesse Lift®) and filling deflated regions with a fat transfer procedure.
Most patients benefit from treatments of the mid-facial cheek region. As 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 one treatment.
The mouth area can benefit from enhancement with fat grafting. Early jowls can be softened by grafting fat into a region just in front of the jowl (called pre-jowl sulcus). If prominent nasolabial (smile lines) and marionette lines are making your face look older, these facial areas can benefit from softening with natural fat injections. Thinning lips can also be enhanced with fat injections.
The region under the eyes may appear sunken, or have dark circles and hollowness, a condition called, in medical terms, “tear-trough deformity” or “naso-jugal grooves.” While advanced lower blepharoplasty (eyelid lift) surgery is commonly used by Dr. Fechner to correct these problems, fat transfer may be appropriate for some patients.
Some patients have developed deep upper eyelid sockets leaving the eyes appearing sunken. Although proper eyelid definition is desirable, hollowness can produce an unhealthy, tired appearance. Careful injection of fat may be the appropriate method by which to improve a sunken appearance in the eye area.
Youthful temples are soft and convex. As their fat padding vanishes, the temples become hollow leading to a gaunt, older appearance. Fat injections can subtly soften 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 look saggy and have lost a plump, youthful firmness. Depressed scars can greatly benefit from fat grafting for many patients.
The most common regions from which to harvest fat are thighs, hips or belly. The fat is harvested with a small liposuction cannula through minor skin punctures created with a tiny 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 beyond a quantity of 1000 cc are commonly removed by the plastic surgeon using a more powerful suction machine. In contrast, Dr. Fechner rarely removes more than 40 cc for fat grafting procedures.
These small amounts are carefully harvested using rather delicate extraction pressures to protect the fat cells from damage. The pinhole skin openings require stitches (sutures) and will vanish within a few weeks.
After harvest, the fat is purified by removing excess fluids in a sterile process. Using a special needle, the fat is then deposited in tiny amounts in the previously determined and numbed facial areas. Using this micro-droplet technique is important for maximal fat survival as the fat cells require sufficient blood supply to become viable. Simply injecting large amounts of fat in one area will lead to virtually complete absorption, and is not a workable process.
The question of longevity is one of the most important questions to discuss prior to undergoing fat transfer. In general, the viable fat cells in place after three months will probably remain and flourish for the 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 10 cc of fat into each cheek, this will not lead to a volume enhancement of 10 cc. (By the way, 10 cc of additional cheek volume would be too much for virtually every patient.) Dr. Fechner’s experience is that about 25 to 50 percent of long-term enhancement can be expected.
The loss of fat cells is taken in consideration in planning a custom fat transfer treatment. Placing more fat later is relatively easy; removing too much is far more difficult.
Recent studies using 3-D imaging show that in average about 30 percent of fat survives in the cheek area. 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 is considered when planning a custom fat transfer procedure.
The overall volume after fat grafting is rather dynamic. Initially, of course, you may see 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 increase.
In some cases, the optimal enhancement will require additional treatment (or treatments). A low point in volume correction is usually reached at about three to four months. The final visible result, which is long-lasting, is achieved after about six months in most cases.
FRANK P. FECHNER MD. All Rights Reserved.
428 Shrewsbury Street, Worcester, MA 01604