Dr. Andres Bustillo has maintained a successful facial plastic surgery practice for over ten years in the Miami area. He limits his practice to cosmetic surgery of the eyes, face, and neck. Fifty percent of his practice is focused on the rejuvenation of the aging face. He has written and published many chapters on his facelift and eyelid surgery techniques.
What a is Fat Transfer?
As the face ages, there is both a descent and a loss of the facial fat. This usually begins during the mid thirties and continues from then on. One of the first signs is the development of the nasolabial folds, which are created by the descent of the midface (cheeks). As the face continues to age, the midface region undergoes a significant loss of volume. Patients that develop loss of fat in this area tend to have certain “flatness” in their cheeks. In addition, a sharp line demarcating the cheek can sometimes be seen in these patients. This line runs from the eyelid-cheek junction to the mid-cheek region.
The second area that can sometimes become pronounced with the loss and descent of the facial fat is the tear trough. The tear trough is a valley that runs from the inner corner of the lower eyelid to the junction between the cheek and the lower eyelid. The descent and volume loss of the midface coupled with the lower eyelid “bags” accentuates the valley. The rim of the orbital bone can sometimes show through the thin eyelid skin.
The third area that can sometimes become pronounced with the loss of fat is the temple. Hollowness in this area can sometimes be seen in older individuals and can occasionally make the person seem older than their actual age.
Fat transfer is a procedure that I commonly perform to replace some of the volume lost in the face. The areas that are most successfully treated with fat transfer are the midface, tear trough, and temples. These are areas were the fat has a good blood supply and the fat tends to survive best. The other areas where fat can also transferred to are the nasolabial folds, marionette lines, and the pre-jowl areas. Because these areas do not have the best blood supply, the fat transferred has a lower survival rate in these areas. By placing fat in these areas, the hollowness is replaced by fullness, thereby rejuvenating the face.
The procedure can be performed either in conjunction with other facial rejuvenation procedures or by itself. The procedure involves three separate parts. First, the fat is harvested, or obtained with a small liposuction cannula. It can be taken from the abdomen (via a small incision hidden inside the belly button) or from the flanks. The fat is then processed and separated from the body fluids by centrifuging (spinning) it. The fat is then placed into the various areas of the face with very small blunt needles.
I believe that all patients that are considering a facial rejuvenation procedure should at least ask their surgeon about fat transfer. While there are many patients that do not need it, I believe that many may benefit from it. The huge success in the facial filler market clearly proves that volume replacement improves the aesthetics and rejuvenates the aging face.
The fat transfer procedure can be performed with either with IV sedation or general anesthesia. The procedure takes approximately one hour. The majority of the time is spent placing the fat in the various facial compartments through many small passes underneath the skin. The fat is placed at various depths into the facial tissues. The survival of the transferred fat largely depends on the fat obtaining a good blood supply so that it can “live.” Approximately 50% of the fat that is transferred survives. While I sometimes get a higher percentage, I can safely say that at least 50% stays. I believe that the survival of the fat is also location dependant. Some areas, such as the tear troughs, temples, and cheek provide for a higher percentage of fat survival. The nasolabial folds and the marionette tend to have a lower fat survival rate.
Post-operatively, the face swells for about seven days. The swelling then gradually decreases. Patients that have the fat transfer as a stand-alone procedure are usually able to return to daily activities and work at about seven days. Patients that have the procedure in combination with other procedures may have a longer recovery depending on the other procedures were performed.
Several weeks after the procedure, as the swelling decreases, the patient may feel that he or she might have lost some of the volume. This is normal, as this is the period where the swelling disappears and the fat grafts are just starting to regenerate. After approximately two months, the fat grafts begin to take and the volume is replenished.
A phenomenon that I sometimes see in my patients is the improvement of the facial skin. This does not occur in all patients, but it is definitely visible in some. Some scientists have attributed this to the possibility of a stem cell effect that the fat cells may have on the surrounding tissues. This is currently an exciting area of research and the “jury is still out” on this topic. Certainly, more research is needed in this area.