As we age our dermis of our face thins and we get a sunken look. Regenerative fat grafting provides volume and nutrients to the face.

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What are Fat Transfers?

The terms Fat Transfer, Fat Injections, Autologous Fat Transfer, and Fat Grafting all refer to the process of taking fat from an unwanted area (or areas) of your body and re-injecting purified adipose fat tissues into another area (or areas) of your body. The goal of any fat transfer procedure is to add fullness to the area which receives the fat grafts. Fat injections are commonly made to the face, lips, buttocks or hands. With the face, fat can be transferred to the cheeks, nasolabial folds, jawline, and the lower eye area.

illustration of the  3 components of fat transfer

The 3 components of Fat Transfer are:

  1. extraction of fat with liposuction
  2. processing and centrifugation of fat
  3. re-injection of fat

What concerns does a facial fat transfer address?

My face looks thin and sags--how do I get a youthful, glowing look?

a Maryland patient

Fat transferred from other areas of your body to your face will not only give some lifting to the general facial structure, but also improve the look of your skin. Patients seeking a fat transfer for facial rejuvenation often present these symptoms:

  • fine lines and wrinkles
  • crows feet
  • under eye bags or dark circles
  • worry and/or frown lines
  • 'sunken' cheeks
  • tired look

As we age, the dermis under our skin thins out, which can leave the face looking thin and has the effect of making the skin look like it sags. This happens to women of all body types: small frame, medium frame, large frame. A facial fat transfer adds adds fat to the area beneath the skin, and has the effect of 'filling out the face' to a more youthful state.

In addition to filling out wrinkles in the face, highly purified fat injections also enhance the blood circulation in the tissues. This is because there is a population of adipose stem cells in the fat cells that are re-injected. Even with only minimal manipulation, such as centrifugation, a small plug of Adipose Stem Cells (ASC's) are collected in high density fat grafting. Thus, a small number of Adipose Stem Cells (ASC's) are reinjected into your face with high density fat processing techniques!

How are Fat Transfers performed?

Fat injections can be done under local or IV sedation anesthesia. Using thin cannulas, fat is harvested from the hip, inner or outer thigh, lower back, or lower abdomen. These areas are called the 'donor sites'. The fat is then decanted and processed in a special centrifuge, and is then injected into the desired facial area. The area where the fat is re-injected is called the 'recipient site'. When performed properly, a large percentage of the fat transfer will 'take' and the face will fill out to look more youthful.

small cannulaIn order to get the best fat graft, I believe that slender cannulas with small holes should be used for the fat extraction. This is further discussed in my blog post here. In addition, I believe that proper processing and re-injection methods should be used.

Fat grafting has been performed for over 100 years by Plastic Surgeons. During the past two decades the Fat Transfer procedure has evolved greatly. More recently, plastic surgeons have refined the processing component of the procedure to yield a high density fat pellet, which is combined with purified fat. This technique is referred to as 'High Density Fat Grafting.' To reiterate, High Density Fat Grafting is performed using certain fat extraction, centrifugation, and re-injection parameters. The true beauty of high density fat grafting is that it contains a small plug of Adipose Stem Cells.

High Density Fat Grafting vs. Cell Enhanced Fat Grafting

High density fat grafting is not the same as Cell Enhanced Fat Grafting, where collagenase is used with centrifugation to increase the population of Adipose Stem Cells. Cell Enhanced Fat Grafting goes a step beyond typical high density fat transfer techniques, and requires IRB (Institutional Review Board) or FDA (Food and Drug Administration) oversight. Nevertheless, there *are* small ASC populations in high density fat grafts and they can have a positive effect on the skin. Adipose Stem Cells are truly the new Fountain of Youth, and this is an exciting new field of Plastic Surgery!

What areas of the face benefit from fat injections?

Fat injections are commonly used to rejuvenate nearly all areas of the face. Fat injections are best used to fill in bags under the eyes, fill out the cheeks and chin areas to lift facial structure, or as an all purpose filler.

As we continue to understand the aging process better, we have come to appreciate that in some patients, rather than dissecting tissues and surgically lifting, adding soft tissue volume such as fat will make the face look younger. We find ourselves using fat injections as an integral part of face lift surgery. In my own practice, I am increasingly doing less surgical dissection and more fat grafting in the facial areas.

Do fat injections last?

When a fat transfer is performed properly, a large percentage of the injected fat cells do indeed survive and are permanent.

- Dr. Rodriguez

Some patients think that fat injections "do not last." However, this is not the case. When a fat transfer is performed properly, a large percentage of the injected fat cells do indeed survive and are permanent. However, since some fat cells are lost in the immediate post op period, we tend to 'over-correct,' or inject more than we need to. After the majority of the swelling is gone, approximately two weeks later, you will have a very good idea of what the final result will be.

How are fat injections different from injectible fillers like Juvederm?

Compared to injectable facial fillers such as Juvederm, the fat transfer procedure is more involved because the fat has to first be harvested from another part of the body with Liposuction. However, unlike injectable fillers, fat transfers can be used in larger volumes to fill larger defects. And above all, fat injections are a natural type of surgical enhancement, and they contain a small population of regenerating adipose stem cells.

What are the pre-op requirements?

During your consultation, we'll discuss the liposuction areas as well as fat injection areas to determine the best surgical plan to achieve your goals. Be sure to listen to all of the pre-op instructions and get answers to any concerns you may have. Pre-op instructions will depend heavily on whether you elect to have the procedure under local or IV anesthesia.

At least half of my patients elect to do facial fat transfer under local anesthesia. This is comparable to going to the dentist, but you will feel some temporary discomfort during the liposuction part. The attraction to have the procedure done under local is that the total cost is less since we do not need the full OR staff, and no pre-operative testing is required.

For those patients having it done under IV anesthesia, you will need a pre-operative clearance from your physician two weeks before surgery. If you are healthy, this includes an H&P (physical) and a CBC blood test. You should stop smoking 4 weeks prior to the surgery for the best results. Smoking does adversely affect the way you heal!

What is post-op recovery like?

You will likely have some discomfort as well as some swelling during the immediate post op period. For a fat graft to be as successful as possible you'll need to avoid stressing the fat injection area(s) for three weeks. It takes up to 4 days for the blood vessels to grow ito the fat grafts and another 2 or 3 days for the blood vessels to strengthen. It takes 2 to 3 weeks for the extracellular matrix surrounding the fat graft to reach enough strength to withstand minor stresses.

Post op instructions for facial fat grafting include the following:

  • wear surgical tape on facial areas for 5 days
  • sleep on back with head elevated for the first week
  • no rubbing of the face for 2 weeks (only soft washing)
  • post op office visit at day 5
  • return to work after 1 week
  • exercise as tolerated after 2 weeks
  • follow up office visits at month 1 , month 4

What are the risks and possible complications with fat transfers?

As with any cosmetic surgery procedure there are risks and complications associated with fat transfers. Possible concerns include:

  • swelling
  • irregular contours or uneven results from liposuction
  • hematoma
  • seroma
  • skin necrosis
  • fat necrosis
  • less than expected results
  • asymmetry

How much does Facial Fat Transfer cost?

The total cost for a facial fat transfer ranges from $4500-$8200, depending on the area(s) to be injected, and the type of anesthesia used. In most cases, the procedure can be performed under local anesthesia. However, if you prefer to be sedated, for additional costs the procedure can be done under IV sedation with a Board Certified Anesthesiologist.

Total cost estimates are as follows:

Facial Fat GraftingLocal AnesthesiaIV Anesthesia
Two areas (ex: cheeks, under eyes) $4500-$5500 $5400-$6400
Three areas (ex: cheeks, under eyes, nasolabial folds) $5500-$6500 $7200-$8200

If the procedure is done in conjunction with another facial procedure, a professional discount is usually applied. Financing is available. Please call the office at 410-494-8100 for a consultation or Contact Us to discuss your individual needs.

Before and After Facial Fat Transfer Photos

before and after facial fat transferSee our gallery of Before and After Fat Transfer photos, all performed by me, a Board Certified Plastic Surgeon with over 20 years experience, here in Baltimore.

Please note that all of these patients have given their written consent to use the photos at our web site. We are very grateful to our patients for participating in patient education!

What other parts of the body are fat injections or fat transfers done?

fat grafting for breast reconstruction after lumpectomy and radiationFat transfers can also be used for the following purposes:

Where can I learn more about Adipose Stem Cells?

I am passionate about adipose stem cells, regenerative medicine, and fat grafting. As such, I am involved in clinical research, which I discuss frequently in my blog. I am a member of the ASPS Regenerative Medicine Task Force, founded in 2011, the group largely responsible for education and advancing the field of Adipose Stem Cells among Board Certified Plastic Surgeons.

mscrf and ifats logosWe recently received a Maryland Stem Cell Research Fund grant, in collaboration with Johns Hopkins University (JHU) and the University of Maryland School of Medicine, to study autologous adipose stem cells for the treatment of radiation damaged breasts (see coverage here and here).

I am also a member, and will serve as the 2016 President, of IFATS, the International Federation for Adipose Therapeutics and Science, a non-profit scientific society dedicated to adipose tissue research.

My research team and I have written extensively about the topic. Some of our most popular blog posts include:

Having your Facial Fat Transfer in Baltimore

Contact UsI performed my first case (micro fat grafting to the face) over 15 years ago to help a patient who was troubled by acne scarring on her face. I found that fat grafting used to fill the pits under the skin had a super bonus - it also left the skin looking rosier, softer, and just younger looking.

Since then, I've performed fat grafting to the face, hands, breast and buttocks for local patients as well as patients from all over the world.

My office and surgical center is only 30 miles from BWI airport and we're only 20 minutes from the downtown Amtrak train station. Give us a call at +1-410-494-8100 or Contact Us online to set up a consult. We're happy to schedule a time for you to visit our offices or participate in a virtual consultation.

doctor's signatureUpdated August 13, 2015
Ricardo L Rodriguez
Board Certified Plastic Surgery