Fat Transfer

A major component of facial aging is volume loss. This may appear in areas like the cheeks, around the eyes and temples, and the lips. While dermal fillers offer a temporary option for restoring volume in the face, the popularity of Boston fat transfer (fat injections) for a more permanent anti-aging option is growing exponentially. Many patients prefer augmentation using only their own natural tissues. 

The fat transfer procedure

Facial fat grafting is completely customized to the patient’s anatomy and pattern of volume loss. 

Fat is harvested from the abdomen or inner thigh through a very small incision. The fat is processed and carefully placed in small droplets in areas of volume loss, most commonly cheek, nasolabial fold, marionette lines and pre-jowl sulcus but also for many patients in temples, brow, chin, and earlobes. Approximately 60% of the fat that is grafted takes, as the blood vessels adapt to the grafted fat to ensure it has proper blood supply. The portion of fat that takes remains permanently.

Fat transfer to the face can be performed on its own, or in combination with eyelid lift surgery or facelift surgery if you are looking for a comprehensive transformation. 

What fat transfer can treat

  • Facial volume loss
  • Deep wrinkles and folds, such as marionette lines and nasolabial folds
  • Under-eye hollows
  • Small lips
  • Sunken cheeks and temples

Good candidates for facial fat grafting

Good candidates often seek treatment for specific concerns such as hollow cheeks, sunken areas under the eyes, deep nasolabial folds, or loss of facial volume due to aging. You should be at a stable weight, and prepared to commit to a restful recovery (you will have some limits, such as on exercise, for up to 6 weeks after the procedure).

While there is no specific age limit, candidates should have sufficient skin elasticity. Younger patients with more elastic skin tend to see better results. However, older patients can still benefit from the procedure, especially when combined with other facial rejuvenation treatments such as a facelift or eyelid surgery. It is also important to have enough donor fat in areas like the abdomen that can be harvested and transferred.

Finally, you should be a non-smoker in good overall health, with clear expectations for the outcomes of this procedure after you’ve met with one of our plastic surgeons at our Boston plastic surgery office.

Key Benefits
  • Natural-looking volume enhancement
  • Long-lasting rejuvenation results
  • Minimal scarring and downtime
  • Utilizes your own body fat
  • Improves overall skin texture
Glossary
  • Autologous: Refers to the use of a patient’s own tissue, such as fat cells, for grafting or transfer.
  • Blepharoplasty: A surgical procedure to correct deformities, defects, and disfigurations of the eyelids.
  • Cannula: A thin tube inserted into the body to remove or inject fluids, commonly used in fat transfer surgery.
  • Centrifugation: A process that separates fat cells from other components by spinning them at high speed.
  • Donor Site: The area of the body from which fat is harvested for transfer.
  • Fat Embolism: A serious complication where fat enters the bloodstream and causes blockages.
  • Fat Necrosis: The death of fat cells, which can cause lumps and irregularities in the treated area.
  • Fat Graft: The fat tissue that is harvested, processed, and then injected into another area of the body.
  • Fat Grafting/Fat Transfer: The process of transferring fat from one part of the body to another to add volume and contour.
  • Graft Viability: The likelihood that the transferred fat cells will survive and integrate into the recipient site.
  • Harvested Fat: Fat that is collected from a donor site for use in a grafting procedure.
  • Intravascular Injection: An injection directly into a blood vessel, which is a risk if not done correctly.
  • Nasolabial Folds: The lines that run from the sides of the nose to the corners of the mouth, often treated with fat transfer.
  • Recipient Site: The area of the body where the fat is injected during a transfer procedure.
  • Stromal Cells: Cells found in the supportive tissue surrounding fat cells, important for graft viability.
  • Stromal Vascular Fraction: A component of fat tissue that contains stem cells and other regenerative cells.
  • Tumescent Technique: A method used in liposuction (liposculpture) where a large volume of dilute anesthetic solution is injected to reduce pain and bleeding.
  • Volume: The amount of fat injected into the recipient site to achieve the desired contour and fullness.
  • Glycolic Acid Peels: A chemical peel that can improve skin texture and tone, often used in facial rejuvenation treatments.
  • Injections: The process of administering fat or other substances into the body using a needle.
  • Dermal Fillers: Injectable substances used to restore volume and fullness to the skin, often used in conjunction with fat transfer.
  • Dermabrasion: A skin-resurfacing procedure that uses a rapidly rotating device to remove the outer layers of skin, often used in facial rejuvenation.
  • Juvederm: A brand of dermal filler made from hyaluronic acid, used to add volume to facial tissue.
  • Intravascular Injection: An injection directly into a blood vessel, which can be a complication if not performed correctly.
  • Fat Necrosis: The death of fat cells, which can result in lumps and irregularities in the treated area.
  • Good Candidate: A patient who is well-suited for a particular procedure based on health, expectations, and other factors.
  • Severe Complications: Serious potential adverse effects that can occur during or after a procedure.
  • Side Effects: Common, often temporary effects that occur after a procedure, such as swelling or bruising.
  • Recovery Time: The period needed for a patient to heal and see the final results after a procedure.
  • Youthful Appearance: The goal of many cosmetic procedures, to restore a look of youth and vitality.
  • General Anesthesia: Medication-induced unconsciousness used during surgery.
  • Local Anesthesia: Medication used to numb a specific area of the body during a procedure.
  • Facial Rejuvenation: Procedures aimed at restoring a youthful appearance to the face.
  • Reconstructive Surgery: Surgery performed to restore function and normal appearance, often following trauma or medical conditions.Fat Injection: Another term for fat transfer, where fat is injected into the face or other areas.

Recovery and side effects

Most patients experience minimal pain, typically taking only Tylenol after surgery. There is bruising and swelling for a few days, but you can return to work within a few days. You will have restrictions on strenuous activities and exercise for 4-6 weeks, or until Dr. Alannah Phelan clears you. Dr. Phelan will provide specific post-operative instructions tailored to your procedure and individual needs. It’s essential to follow her advice closely to ensure the best possible outcome and a smooth recovery.

Results

After about 6 months, the body will have absorbed any fat cells that did not “take,” and you can assume that the fat grafts that remain at this time will remain in place long-term. Still, the natural aging process will continue, so we recommend following up your facial anti-aging procedure with regular facials and Botox®-type injectables as needed, as well as medical-grade skincare to prevent sun damage, exfoliate the skin, and maintain a smooth complexion.

FAQs

Fat grafting provides much longer-lasting results for years, while dermal fillers offer temporary volume and contour for anywhere from 6 months to 2 years depending on the formula.

Yes, fat injections are often combined with facelifts, eyelid lift surgery, brow lift surgery, earlobe repair, or other facial rejuvenation treatments for optimal results. Combining a facelift with fat grafting often provides more comprehensive rejuvenation, addressing both sagging skin and volume loss.

About 60% of transferred fat cells remain in the skin after you’ve healed, on average.

Facial fat grafting typically leaves minimal scarring. Very small incisions are used for liposuction to harvest the fat, and we use thin cannulas for injecting the fat back into the face. Incisions are very small and strategically placed to be as inconspicuous as possible.

Yes, you can get a second fat grafting procedure. In some cases, patients may not achieve their desired volume or results with a single session. A follow-up procedure can be performed to add more fat and further enhance the outcome. 

The timing for a second procedure is typically determined by your surgeon, who will assess the initial results and ensure that the first graft has adequately settled and healed. Usually, a waiting period of at least 6 months is recommended before undergoing a second fat grafting session.

AIf you lose weight after facial fat grafting, the transferred fat cells can shrink, just like the other fat cells in your body. This may result in a reduction of the added volume in the treated areas. Since fat cells are living tissues, their size can fluctuate with changes in your overall body weight. Significant weight loss can potentially diminish the results of the fat grafting procedure. It is advisable to maintain a stable weight to preserve the optimal results of your facial fat grafting.

The fat used for facial fat grafting is typically harvested from areas of the body where there is an excess of fat. Common “donor” sites include the abdomen, thighs, and flanks. The harvesting process involves liposuction, where a thin tube called a cannula is inserted through small incisions to gently suction out the fat. The harvested fat is then purified and processed before being injected into the face. The selection of the donor site depends on your body, preferences, and the amount of fat available.

The amount of fat that can be transferred during a facial fat grafting procedure varies based on individual needs and the specific areas being treated. Typically, only a small volume of fat is needed to achieve noticeable results in the face. The exact amount depends on factors such as the desired volume enhancement, the condition of the recipient site, and the technique. The goal is to achieve a natural, balanced appearance without overfilling.

Yes, we recommend that you sleep on your back after facial fat grafting. This helps to protect the newly grafted fat cells from pressure or movement, which can affect their survival and integration. Elevating your head while sleeping on your back can also help reduce swelling and bruising by promoting better circulation and drainage of fluids.

Tips for sleeping on your back:

  • Use extra pillows: Place a few extra pillows around your body to prevent you from rolling onto your side during the night. A wedge pillow can also help keep your head elevated.
  • Elevate your head: Use a pillow or adjustable bed to keep your head elevated at a 30-45 degree angle. This can also help reduce swelling and promote healing.
  • Body pillows: Consider using a body pillow or bolster to support your back and sides, making it more comfortable to stay in the back-sleeping position.

Practice before surgery: If you’re not used to sleeping on your back, try practicing this position a few weeks before your surgery.

Trust your appearance to Dr. Alannah Phelan

To learn more about how facial fat transfer in Boston can transform your appearance, schedule your consultation with Boston female plastic surgeon Dr. Alannah Phelan. Please call Boston Plastic Surgery at (617) 786-7600.

References »

Nemir S, Hanson SE, Chu CK. Surgical Decision Making in Autologous Fat Grafting: An Evidence-Based Review of Techniques to Maximize Fat Survival. Aesthetic Surgery Journal. 2021 May 18;41(Suppl 1):S3-S15. doi: 10.1093/asj/sjab080. 

Tonnard P, Verpaele A, Carvas M. Fat Grafting for Facial Rejuvenation with Nanofat Grafts. Clinics in Plastic Surgery. 2020 Jan;47(1):53-62. doi: 10.1016/j.cps.2019.08.006. 

Shauly O, Gould DJ, Ghavami A. Fat Grafting: Basic Science, Techniques, and Patient Management. Plast Reconstr Surg Glob Open. 2022 Mar 18;10(3):e3987. doi: 10.1097/GOX.0000000000003987. 

Bellini E, Grieco MP, Raposio E. The science behind autologous fat grafting. Ann Med Surg (Lond). 2017 Nov 10;24:65-73. doi: 10.1016/j.amsu.2017.11.001. 

Satish C. Fat Injection and Its Clinical Applications. J Cutan Aesthet Surg. 2022 Apr-Jun;15(2):124-130. doi: 10.4103/JCAS.JCAS_242_20. 

Hanson SE. The Future of Fat Grafting. Aesthetic Surgery Journal. 2021 May 18;41(Suppl 1):S69-S74. doi: 10.1093/asj/sjab130. 

Crowley JS, Kream E, Fabi S, Cohen SR. Facial Rejuvenation With Fat Grafting and Fillers. Aesthetic Surgery Journal. 2021 May 18;41(Suppl 1):S31-S38. doi: 10.1093/asj/sjab014. 

Dayal A, Bhatia A, Hsu JT. Fat grafting in aesthetics. Clinics in Dermatology. 2022 Jan-Feb;40(1):35-44. doi: 10.1016/j.clindermatol.2021.08.010.

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