As we get older we loose volume in our faces both beneath our eyes and in our cheeks, giving the face a more hollow appearance. Modern day fillers strive to be able to replace this lost volume and using our own fat taken from a different area of the body is one of the options that we have to return the face to a more youthful appearance.
The main problem with fat grafting/transplant has always been how to make fat cells survive. By simply injecting fat cells with a needle leads to very low fat cell survival. However, by careful harvesting, cleaning the cells before transplanting and using a special technique of injection it leads to a significant fat cell survival, as high as 50%.
Fat grafting is very successful in replacing lost fat and filling out deeper folds and wrinkles. It can also be used to reshape certain areas of the face to improve facial balance. Very mobile areas of the face, such as the upper lip area and lips themselves are poor recipients of grafted fat. This is because during the early post-operative period fat cells have to attach themselves to surrounding tissues and establish blood supply. In very mobile areas the fat survival can be as low as 20%. However, in most areas of the face it is possible to achieve as much as 50% take, meaning that half of the injected fat will survive permanently.
The fat for transplant is removed by liposuction usually from the lower part of the abdominal wall via a small incision in the umbilicus, and occasionally from the thigh area. The amount of fat harvested can be variable between individuals its removal should have very little effect on the donor site. Sometimes there might be some slight lumpiness of the skin following fat harvest.
The fat removed is then processed by cleaning it and it is then ready for transplant. The injection is carried out with special blunt needles through several small punctures. These heal without scarring. By making multiple and layered channels the fat cells are then deposited under the skin until a desired effect is obtained.
Because only about 50% of the fat is likely to survive, usually we place more that is needed in anticipation of subsequent fat absorption. The fat will settle over the first 6-8 weeks following the surgery and usually by 2-3 months there will be little further change.
Fat transfer can be undertaken as a surgical procedure on its own and is often used for facial reconstruction as well as cosmetic procedures. More commonly in facial rejuvenation it is undertaken as an ancillary procedure to other rejuvaenation procedures such as facelifting, to improve the final outcome.
Risks and Complications
As with all surgical procedures there may be complications and before considering this surgery you should be aware of these. They are uncommon.
- Infection: This is very unusual as, in most cases, antibiotics are used during surgery to prevent this complication.
- Bleeding: Again, this is very rare, as blunt needles are used to transplant the fat and risk of injury to blood vessels is extremely low.
- Skin irregularity: This can occur if, for some reason, fat absorption is excessive in one particular area. It can easily be corrected by further fat injections.
- Numbness: This is temporary and may last from a few days to several weeks.
- Fat absorption: In some areas fat absorption is unpredictable and may be excessive. It can be corrected by further injections.
- Asymmetry: This is a feature of all faces and may be temporarily exaggerated during the early post-operative period due to swelling. It usually corrects itself as the swelling subsides.
- Persistent swelling: Very rarely swelling may persist for a very long time, especially in areas such as cheeks and under eyes. It is unusual for it to be permanent.