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CosmeticSurg Blog

Dr. Rodriguez discusses Plastic Surgery, Medicine, and Stem Cell Research

Why Laser Resurfacing Can Cause Facial Fat Loss

skin layers epidermisLaser resurfacing is a procedure which is aimed at rejuvenating the face. It works by injuring the top layers of your skin, the epidermis, causing a signal which promotes regeneration of new skin at the top layer of the skin.

While laser skin resurfacing is an effective method for prompting fresher, more youthful facial glow, there are some risks that take place at various layers in the skin which can cause fat volume loss.

Because of this fact, I rarely, if ever, use laser resurfacing for facial rejuvenation. Instead I use fat grafting, aka fat transfer. Why? Because with laser, regeneration of the skin is prompted by destruction and that destruction can also cause fat volume loss. With fat grafting, regeneration of the skin is prompted by signals sent by adipose stem cells which reside in the fat that is injected into the subcutaneous layer. With fat grafting, instead of a loss of volume, there is an increase in volume. Volume is increased by direct injection of fat as well as the fact that the process does not destroy cells as laser can do.

Why do some people experience facial fat loss after laser resurfacing?

To answer this question, continue reading or listen to this audio:

Anytime you introduce an energy source into the body, whether it be radiofrequency, or laser, or even CoolSculpting – which is specifically designed to injure fat cells – the cells that are damaged release what’s called DAMPs (Damage Associated Molecular Pattern Molecules, aka Danger Associated Molecular Pattern Molecules) and those DAMPs signal other cells.

lasers can trigger a process called apoptosis, aka cell death

-Ricardo L Rodriguez, MD

If the signals are severe enough, or a particular kind,the DAMPS can trigger a process called apoptosis, which is programmed cell death, and that keeps on going for weeks or months after the original injury so that patients that have had laser, or patients that have had radiofrequency, or patients that have had CoolSculpt, will continue to have subcutaneous fat tissue loss as a result of that radiofrequency.

Something that is designed to tighten your skin, ends up causing damage further on below the skin and to the fat tissue that’s right under the skin.

skin-layers-fat-transfer-cannulaThe correction for this, of course, is fat grafting. Fat grafting works in two ways:

  1. It replenishes the fat that was lost.
  2. The stem cells and regenerative cells in the fat, restore the integrity of the tissue that was lost after the injury.

I now rarely, if ever, offer laser resurfacing as I feel that fat grafting does a much better job at facial rejuvenation. I have been talking about the benefits of facial fat grafting for years and I find that we are doing more and more facial fat grafting procedures as an alternative to facelifts.

Likewise, fat grafting is the perhaps the single best solution to fat loss that occurs following laser resurfacing. If you have had this happen, a fat transfer may be exactly what the doctor ordered!

By Dr. Ricardo L Rodriguez
Board Certified Plastic Surgeon
Baltimore, Maryland
Ricardo L Rodriguez on Google +

Dr. Rodriguez currently serves as President of the International Federation for Adipose Therapeutics and Science (IFATS), a non-profit, scientific organization devoted to studying the properties of adipose fat and related technology.

The illustrations above were created using the skin (layers, glands, vessels) illustration by Don Bliss via Wikimedia Commons.

Posted in Face Fat Stem Cells

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  • wrote
    October 5, 2017 at 5:23 pm

    The more superficial a laser is, the less damage- but also the less effect on the skin. IPL’s are a little different because they target specific pigment types.
    But my general point is that most energy based therapies work by injuring the tissue in one way or another then creating an inflammatory response followed by a regeneration response. The new “collagen” formed is not the elastin type but predominantly the collagen associated with scar tissue.
    The ultimate aim of all these therapies is to make the skin BE younger so it will appear younger. That is why I love fat grafting. The act of liposuctioning activates the stem cells in fat tissue, and if you process the fragments carefully, when they get injected into solar damaged or aged tissue the stem cells trigger a regenerating response that actually replenishes and rejuvenates the tissue. Many studies have been done to show increase in dermal thickness and restoration of elastin fibers, both characteristics of younger skin.

  • wrote
    September 23, 2017 at 9:12 am

    Wouldn’t the type of laser or radiofrequency device differ in their affect on fat, related to the fluence of the laser or the type of penetration? Ulttherapy skin tightening, for example, I would expect to have some impact on the subcutaneous fat. But why would something that doesn’t penetrate past the dermis – like clear + brilliant, lasergenesis, even light based like IPL affect the fat cells? Is the mechanism you’re suggesting that if any layer of the skin creates DAMPS that it triggers DAMP cascades in other layers nearby that weren’t directly affected by the laser? I’m interested in getting IPL and have been considering clear+Brilliant or lasergenesis but wanted to clarify first so as to not worry about fat loss. If that is the case I’d prefer to avoid! Also I’m a biochemist and this is really interesting. Thanks for sharing.

  • wrote
    October 5, 2017 at 4:45 pm

    At this point the solution to your problem is not more machines, but restoring what you lost. What you lost is fat, therefore you would benefit most from fat grafting to the face. In addition to the restoration of volume the stem cells in the fat graft will regenerate the tissue and make your skin younger and more healthy.
    Be very careful about who does the fat grafting, they should use very specific methods to process and purify the fat.

  • wrote
    September 10, 2017 at 9:02 am

    I have suffered fat loss from just one fraxel treatment. I am shocked!.

    Is microcurrent, as in a microcurrent facial damaging as well? And if I may ask what machines use radiofrequency?

  • wrote
    October 5, 2017 at 4:41 pm

    Not everybody loses subcutaneous fat with CO2 laser. But when it does, it’s a big headache.

  • wrote
    September 7, 2017 at 4:59 pm

    I did profractional laser with 25 microns. I didn’t experience fat loss, maybe bcs it’s not deep. It’s good to know that laser can cause fat loss so we don’t go for deep treatment. Thanks.

  • wrote
    July 18, 2017 at 2:01 pm

    Sorry for getting back at you so late. This blog is more for giving out information than as a social network so I check it out only once in a while.
    At this point, your best option might be fat grafting. The stem cells in the fat graft will not only replenish lost tissue but also rejuvenate existing tissue.

  • wrote
    May 6, 2017 at 9:28 pm

    Thank you for your sharing of information! I believe that volume loss has started since getting fraxel laser 1 week age. Is there a way to stop the apotosis process to prevent further loss? Please advise. I am willing to try anything to stop it.

  • wrote
    June 8, 2017 at 11:08 am

    The first thing to do after any treatment is to wait for at least 2-3 months to see what the ultimate results are going to be.
    We have seen a lot of cases of fat loss after Laser, and for that reason I got rid of my own Laser service.
    Fat grafting does have stem cells in it which would help rejuvenate the skin and thicken the dermis.
    As to you in particular, If you want a more specific answer I would need to know more. You can contact Kelly at kelly@cosmeticsurg.net if you are interested in a virtual consultation.
    Thanks for looking us up!

  • wrote
    May 4, 2017 at 1:26 pm


    I have come across this because I had a very strange experience after laser hair removal on my face. I’m 39 and I just wanted to stop shaving and to get rid of the 5 o’clock shadow. I went to a board-certified dermatologist to have this done. I only had 2 sessions and 2 and half weeks after my 2nd session, I noticed a wrinkle or laugh line. I had absolutely no wrinkles or laugh lines before this. None. I noticed this immediately.

    It seems to have gotten marginally better since the day I noticed it but it’s still not anywhere near where it was before. Like I said, I had nothing. I’m starting to believe that this was because of some sort of volume loss (which I guess is the same as fat loss).

    I went to the doctor yesterday and showed him. He said that he didn’t think it was because of the laser. It is. There is no doubt about it. I’ve never had this before and now it’s there, all of a sudden. It was 100% because of that.

    Anyway, he said that he has seen fat loss because of laser hair removal before but those cases were when the settings were extremely high and were accompanied by burns on the skin. I did not burn in any way but I must admit that the first session, in particular, was very, very painful. Again, I didn’t get any burns or anything but I did experience folliculitis for a couple of weeks.

    The second session was also somewhat painful but nothing like the first. I think that this may have caused this wrinkle that I’m seeing. Maybe it resulted in some fat loss or something.

    So, I have a couple of questions, if you don’t mind:

    1. Could this be just temporary fat loss and can my body replenish it in time? Could it be that the actual cells weren’t damaged and it was temporary fat/volume loss? I’ve read that laser hair removal is a relatively minor procedure. It’s so hard for me to fathom that it could cause permanent damage such as this.

    2. If I ever were to do a fat transfer, would that solve my problem? Is this a temporary fix that will eventually wear off or will my body just accept it and pick up where it left off before the laser hair removal?

    I’m sorry for the length of this post but would like to thank you in advance for your time.

  • wrote
    December 27, 2016 at 11:23 am

    I hope everything turned out right from your carbon peel. By now it has been approximately 6 weeks and things should be stable.
    As I have said before, the solution to this laser damage to the subcutaneous layer of fat loss is to restore the fat.
    You may need fat grafting, but I would have to see pictures or have a virtual consultation with you .
    I will give your info to Kelly at kelly@cosmeticsurg.net
    Don’t despair, there is a solution!

  • wrote
    November 5, 2016 at 9:48 pm

    Hello, I have been doing some research online over the past couple of days, and you are the only doctor that I have run across that admits to the possibility of fat and volume loss from Laser treatments. Have you ever heard of Carbon Peels? If so, how likely is it that someone would experience fat loss with this. I had some damage with IPL in the past, and a lady just talked me into having a carbon peel done, and said it was simple like a chemical peel, but with a light laser. I am very concerned about the some of the ways that my skin is responding. I believe that I have lost even more volume in my face, and when I pinch the skin under my eyes, it sticks together. This has never happened. It has been three days since the procedure. I am hoping and praying each day that life jumps back into my skin. Please feel free to respond to my email thanks.

  • wrote
    October 16, 2016 at 1:39 pm


  • wrote
    September 12, 2016 at 9:32 pm

    Thank you for this information. After reading it I must agree that lasers aren’t the best way to go!

  • wrote
    October 31, 2016 at 9:29 pm


  • wrote
    August 29, 2016 at 10:16 pm

    Grafting is the perhaps the single best solution to fat loss

  • wrote
    October 16, 2016 at 2:01 pm

    I love Yoga!

  • wrote
    August 17, 2016 at 1:49 am

    Thank you for sharing the information about fat Loss. It is very beneficial for all who are little bit or more fat. Yoga is also beneficial for reducing fat.