Facial fat grafting is another procedure that plastic surgeons use for soft tissue augmentation. In some ways, it is similar to treatment with an injectable filler. Also known as autologous fat transplantation or micro-lipoinjection, the procedure involves the extraction of fat cells from your abdomen, thighs, buttocks or elsewhere, followed by re-injection beneath the facial skin.
Unlike injectable collagen, allergic reaction is not a factor for fat because the filler is harvested from your own body. There is however, a small risk of infection and other infrequent complications.
Dr. Howrigan may recommend fat grafting to fill in areas of the face that have lost volume over time. Some common indications include:
There are alternatives to fat grafting that may be more appropriate in specific cases. With all of the popular wrinkle fillers on the market, your plastic surgeon has many choices to provide the results that meet your cosmetic goals and expectations. In Boston, Dr. Howrigan often uses Juvederm or Restylane as viable alternatives to fat grafting.
Both the donor and recipient sites are numbed with local anesthesia. Sedation can be used as well. If you elect to use sedation, be sure to arrange for a ride home after your treatment.
After cleansing and treatment with local anesthesia, fat is withdrawn using a syringe with a large-bore needle or a liposuction cannula. The fat is then prepared and injected into the recipient site with a needle.
Sometimes an adhesive bandage is applied over the injection site. Slight over-filling may be necessary to allow for fat absorption that occurs. When fat is used to augment the cheeks, this over-correction may cause the face to appear abnormally full at first.
While some treatments require a brief recovery period, many patients resume normal activity right away. Expect some swelling, bruising or redness in both the donor and recipient sites. The severity of these symptoms depends upon the size and location of the treated area.
Stay out of the sun until redness and bruising subside - usually about 48 hours. In the meantime, you may use makeup with sunblock protection to help conceal your condition. In some cases, swelling and puffiness in the recipient site lasts several weeks, especially if a large area was filled.
Depending on the area injected and other factors, results may last from one to several years. Additional fat injections may be used to "maintain" the results. Fat grafting may be used in conjunction with a face lift to enhance results. Therefore, additional fat injections may be necessary. Dr. Howrigan will advise you on how to maintain your results with repeat treatments.
As we age, the face undergoes volume loss. Deflation or loss of volume can be seen around the mouth, at the cheeks, and at the temples. Fat grafting can be used to restore volume and to fill depressions or lines, giving a fresher and improved appearance. When there is significant laxity of the skin and a facelift is indicated, fat grafting is frequently used in conjunction with the facelift to give optimal results. As a soft tissue filler, fat has a natural appearance and feel. Dr. Howrigan has been using this technique for over 15 years in her plastic surgical practice.
In consultation, each patient is evaluated and treated individually. Dr. Howrigan will discuss areas which can be treated with fat grafting. She will discuss what can be expected during the procedure itself, during the recovery, and the effects of fat grafting.
Most commonly, the fat is harvested from the abdomen or thigh area. A small cannula or hollow tube is inserted through the skin to aspirate or collect the fat. Low pressure is used in the harvest in order to carefully collect cells for the transfer. This harvesting is one aspect of the technique which contributes to the transfer of living cells and to a successful result. The amount of fat harvested usually ranges from 40-90 cc (approximately 1-3 ounces). The fat is then centrifuged to remove the fluid. Fatty oils are removed as well, leaving the compacted healthy fat cells.
Dr. Howrigan will mark the areas to be treated with fat grafting. These facial areas are numbed with local anesthesia. The fat is then injected using microdroplet technique to maintain maximal fat survival. Fat cells require a “blood supply” to take. When small droplets of fat cells are injected, these fat cells are in close contact with healthy tissues and their abundant blood supply. Also, when the microdroplet technique is utilized, the surrounding soft tissues support and hold the fat and there is no shift in the fat injected. If large amounts of fat are injected in one area, the fat cells will not be able to establish a blood supply and the fat will be virtually completely resorbed. If the procedure is carried out in the office, premedication will be given prior to the procedure. If the fat grafting is carried out in conjunction with other surgical procedures in the operating room, either IV sedation or general anesthesia will be administered.
Usually, the volume that is present after 3 months will remain long term. It is important to understand that not all of the fat that is injected will “take.” In most areas, take of the fat cells is in the 30-40% range. Taking this into account, Dr. Howrigan will slightly overcorrect the areas to be treated. Patients can expect swelling and some bruising after the procedure. By 10-14 days, much of the swelling has resolved and most patients feel comfortable resuming their social and work lives. There will be some volume loss as the cells which do not “take” are resorbed by the body. This process generally stabilizes at 3 months’ time. The amount of “take” is variable and cannot be predicted. Therefore, additional fat grafting sessions may be indicated to give optimal results. Undercorrection is easier to treat than overcorrection, as it is very difficult to remove fat when there is too much. Complications are rare but may include prolonged swelling, bleeding, infection, and injury to deeper structures. Most patients experienced long-lasting improvement in the areas treated with fat grafting.