There are two main concepts in facial aging: gravity and volume loss. Volume loss occurs in various parts of the face at different rates. This loss of volume occurs at all layers of the face, including skin, fat, muscle, and bone. Restoring volume to the face is one of the main strategies in facial rejuvenation. One way to accomplish this volume restoration is via facial fat transfer, also known as facial fat grafting.
What is facial fat transfer?
Fat transfer is a procedure in which fat is removed from one part of the body and inserted into another. Facial fat transfer is when the fat is transferred into the face. Fat is the body’s natural filler, and for many reasons, is an excellent volume expander and contouring agent. Fat transfer to face is one of many options used in treatment of the aging face.
What is the history of facial fat transfer?
Facial fat transfer surgery was first performed in the 1890’s, when a surgeon used fat to correct indentations under scars in the face. Shortly thereafter, another surgeon used fat transfer to restore volume to an area of the breast that had been partially removed. This surgery continued to be used for a variety of purposes, and when liposuction technology became available in the 1970’s, it became an increasingly popular procedure particularly for face contouring.
What are the areas for facial fat transfer?
The areas of the face that are typically treated with fat transfer are the areas that typically experience volume loss with aging. Some of the most commonly treated areas are discussed in detail below, although there are other aspects of the face that may benefit from this type of procedure as well.
The temples are located at each side of the forehead and get their name from the temporalis muscle. As we age, the temporalis loses muscle mass, in addition to temporalis fat pad atrophy, and the temples can appear depressed. Loss of temporalis muscle can also be associated with nutritional deficiencies, cancer, and other underlying diseases.
Tear troughs (under eyes)
Tear troughs are located underneath the lower eyelid, at the lid-cheek junction. Loss of volume in the tear troughs is due to the decrease in fat, weakening of muscle, and changes in the bones associated with aging. This process can make the eyes appear sunken in and may have a dark color appearance.
Malar eminence (upper cheeks)
The malar eminences (upper cheek area) are felt to be of great importance in defining youth. The youthful face is often felt to be an inverted triangle, with the apices being the malar eminences and the chin. Loss of volume in the malar eminence causes this triangle to reverse and to even change shape and look more like a square.
Nasolabial folds (“smile” or “laugh” lines)
The nasolabial folds are lines that extend from the bottom of each side of the nose to the corners of the mouth. They are often referred to as “smile” or “laugh” lines. Some people have more prominent nasolabial folds than others, and due to changes in the skin’s elasticity they can become more apparent with age.
As mentioned above, the chin is a part of the inverted triangular shape that makes a face youthful. As we age, due to changes in the facial bones, the chin can become deflated, giving a blunted appearance to this tip of the triangle. Some people are born with less prominent chins and find this aesthetically unpleasing.
The prejowl sulcus refers to the indentations that form on either side of the chin and in front of jowls. The prejowl sulcus can become more prominent as jowling increases with time.
Who is a good candidate for facial fat transfer?
This type of surgery can be used for people who demonstrate the typical signs of aging in the areas discussed above. The majority of people seeking fat transfer to face are women, but men have become increasingly interested in maintaining the youthful contours of the face. Additionally, young people with congenital facial abnormalities or hollowing of specific areas of the face, such as scars, or who desire more prominent contouring, may also benefit from facial fat transfer.
How is facial fat transfer done?
Facial fat transfer surgery is typically performed in the operating room preferably under deep sedation anesthesia. It is important to be familiar with the steps of this procedure to fully understand what the procedure entails and whether or not it is a good option for you. The steps of facial fat transfer are outlined below.
Determining donor site
Determination of the donor site is one of the first steps of facial fat transfer. Most commonly, the donor site for fat is in the abdomen. Fat is typically removed from the lower central part of the abdomen. For those who either do not have enough abdominal fat or do not wish to use the abdomen as the donor site, the thigh is an alternative option.
Removal of fat from donor site
Once the donor site has been identified and marked with a surgical marker, local anesthesia is injected to the area to decrease pain. Liposuction is performed and typically 40 to 60 mL of fat is removed. Once enough fat is removed the liposuction cannula is withdrawn. A small surgical bandage called a Steri Strip is placed over the small incisions to facilitate closure or a suture is used.
Processing of fat
After the fat has been removed, the fat needs to be separated from the other non-fat liquids and particles in fat tissue. This can be done by allowing gravity to separate the pure fat from liquid, or by placing the fat into a centrifuging device and spinning it until separation occurs. Once the liquid has been removed, the remaining pure fat is known as microfat. A portion of microfat may be additionally processed to obtain nanofat, which is rich in stem cells and much thinner in consistency.
Insertion of fat
The amount of fat and type of fat used for facial fat transfer are variable based on the degree of volume loss and the specific treatment location. Microfat is bulkier and typically used for areas such as the temples, nasolabial folds, chin and surrounding areas like the marionette lines and prejowl focus. Nanofat is used for more delicate areas of the face, such as tear troughs, wrinkles in the upper face, the nasolabial folds and marionette lines.
How long does facial fat transfer last?
Is facial fat transfer permanent? The results of the procedure can last several years and in some cases be permanent. It is important to note that a portion of fat cells that are initially injected into the treatment area will die within the first few months of the procedure, so final results are expected to be seen in 6 to 12 months. While the fat that remains after this period of time is considered permanently transplanted, it does not stop the aging process. As such, additional fat transfer surgery or other aging face procedures may be needed to augment the results.
How to prepare for the fat transfer?
Once you have decided to undergo facial fat transfer surgery, there are a few steps you will need to take to prepare for your procedure. These steps include:
- Stop certain medications that can thin the blood, such as aspirin, NSAIDs (i.e. ibuprofen, naproxen), warfarin (Coumadin), and vitamin E
- Choose an escort who can accompany you home after the surgery
- Do not eat or drink anything after midnight prior to the facial fat transfer
What to expect on the day of the procedure?
On the day of your facial fat transfer surgery, you will meet with Dr. Linkov and an anesthesiologist who will go over your medical history and make sure it is safe for you to receive deep sedation anesthesia. Dr. Linkov will mark the donor sites and recipient sites with a surgical pen and review these markings prior to starting the procedure. Once you have received anesthesia, Dr. Linkov will begin the fat transfer to face. This procedure typically takes about 2 to 3 hours.
What is the recovery from facial fat transfer?
Bruising and swelling are common and expected after facial fat transfer. Swelling typically improves in the first 1 to 2 weeks after the procedure, though it can take a couple of months to fully resolve. Keeping the head elevated and using a cool compress can help reduce swelling. There is typically minimal pain at the face recipient sites and only mild discomfort at the donor site. People can typically return to work after 5-7 days and resume regular exercise at least 1 week after the procedure. Final results are expected in 6 to 12 months after facial fat transfer.
What are the complications from fat transfer?
Facial fat transfer surgery is a relatively well tolerated procedure. There are, however, some complications that may arise and are typically located in the treatment areas of the face. These complications include:
- Lump formation – a focal, round collection of excess fat. Lumps can be treated with steroids or surgically removed.
- Bulge formation – a wider, oval-shaped collection of excess fat. Bulges can be treated with steroids or surgically removed.
- Overcorrection – generalized excessive fat in the treatment area. Overcorrection should be assessed 6 months after the procedure after all swelling has resolved. Overcorrection can be treated with microliposuction or surgical removal.
- Undercorrection – not enough fat was transferred to the treatment area. Undercorrection can be treated with additional facial fat transfer.
- Dimpling – a dimple may form at the treatment site where the fat was injected. Dimpling is treated by making a small incision under the skin at the site (subcision).
- Vascular occlusion – fat can enter a blood vessel. If fat is injected into a blood vessel it can block the artery and cause skin damage and more rarely vision changes.
What are the contraindications for fat transfer?
There are some people who may not be candidates for facial fat transfer. While not an absolute contraindication, people who have received liposuction many times in the past may not have enough stable donor fat to use for this procedure. People under the age of 40 may not be appropriate for facial fat transfer due to possibility of abnormal appearance of treatment sites later in life. People who do not have enough donor fat are also not good candidates. Further, people who are unable to receive deep sedation anesthesia due to underlying medical issues may not be able to undergo facial fat transfer.
What is the difference between facial fat transfer and fillers?
Fat transfer can be thought of as a type of natural, biologic filler. Synthetic fillers are typically made of hyaluronic acid, which is a gel-like sugar molecule. Facial fat transfer results can last years and sometimes be permanent, while synthetic filler results usually last from 6 months to 2 years. This surgery typically requires use of deep sedation anesthesia, while synthetic fillers are performed under local anesthesia with minimal downtime. Vascular occlusion risk is higher in fat transfer procedures than it is with hyaluronic acid filler.
Are patients satisfied after facial fat transfer?
People are generally very satisfied after facial fat transfer surgery, feeling as if they look much more youthful and rejuvenated. With a minimal recovery period and lack of major risks and complications, people are very happy to resume their regular activities shortly after facial fat transfer surgery.
How much is facial fat transfer?
Facial fat transfer surgery cost will vary based on type and number of areas to be treated, whether or not it is combined with another procedure or surgery, and the location of the surgeon. The cost of facial fat transfer in NYC ranges from about $5000 to $10,000.
Who is the best facial fat transfer surgeon in NYC?
Dr. Linkov is a board-certified facial plastic surgeon in NYC with extensive experience in many aging face procedures, including facial fat transfer surgery. Trained in plastic surgery specifically for the head and neck, Dr. Linkov is exquisitely familiar with the delicate anatomy of the facial structures and practices with extreme attention to detail to ensure the most natural appearing results.