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Posts Tagged ‘facial fat injections’

Fat Injections in the Treatment of Facial Aging

Sunday, June 23rd, 2013

 

The use of one’s own fat for the correction of a variety of aesthetic and reconstructive soft tissue needs in plastic surgery is now more than just a fad. It has rapidly become an established technique even though much of the science as to how it works, and sometimes does not work, is far from established. While it is now widely used, there are still a relatively small number of clinical articles that document the outcomes of its use.

By far and based on frequency, fat injections to the face make up its most common clinical application. The recognition that volume loss is a major contributing factor in facial aging has led to a fat replacement approach. As the volume of fat injections needed in the face is relatively small, compared to body uses, most facial aging patients have more than enough. As it adds little to the recovery process, fat injections can be combined with any number of other facial rejuvenation procedures.

In the May 2013 issue of the Annals of Plastic Surgery, an article appeared in print entitled ‘ Autologous Fat Transfer for Aesthetic Facial Contouring’. In this paper the authors report on their experience with fat transfer for facial grooves and facial volume correction. This was a retrospective review of seventy-five (750 autologous fat transfers over a three year period performed in 8 female patients between the ages of 45 to 75 years old. The injections were performed to improve facial aesthetic contours of which 22 were for correction of grooves and creases,  nasolabial folds (12), glabellar furrows (4), and nasojugal folds. (6) Fifty-three (53) transfers were performed for volume augmentation, malar (17), submalar (14), lip (11), temple (8), chin (2), and jowl. (1)  The injected fat was harvested using a tumescent technique with manual syringes from the abdomen. The fat was prepared by decanting, discarding oil and nonviable fat layers.Care was taken to reduce the time from harvest to transplantation with no syringe transfers. The mean volume of fat transferred was 24 mL (range of 4 to 54 mls). The mean follow-up was 25 months, ranging from 6 to 36 months. A second session of fat transfer was required in some patients. Complications included minor asymmetry in 1 patient (resolved with graft manipulation) and prolonged swelling in another. No postoperative cellulitis or fat necrosis was reported. A patient satisfaction rating was 88% and all patients reported (100%) that they would have the procedure performed again.

This is a fat grafting clinical study that has a lot of flaws, a low number of patients, no method to measure actual volume retention and a satisfaction assessment based on surgeon and patient perceptions. (which, of course, is the most important measure) But this study is also a likely sample of how fat grafting is now widely performed in the U.S. and its facial uses, fat graft volumes needed, and postoperative results would be considered typical.

What this study demonstrates is that facial fat grafting is very safe, has no significant costs and has very few complications. Other than the potential need for repeat grafting or inadequate volume retention or symmetries, there is little downside to its use. Injected fat may not always survive but it causes no problems and is almost always available from any patient. For these reasons, fat grafting in the aging face has become a useful rejuvenative method to consider. How to make it an even more predictable facial volume enhancement method will become apparent over the next few years as more and more patients receive it and plastic surgeons learn and refine their techniques.

Dr. Barry Eppley

Indianapolis, Indiana

Patient Testimonials: Facial Fat Injections

Sunday, February 17th, 2013

 

Just want to thank you…for two actually three reasons

First… It was a 100% HIT… That’s exactly where I wanted the fat grafts placed and needed it and I think you actually filled in the atrophic scar!! My learning experience with where to place it is that no matter where I think I need it, higher is better than lower as the youthfulness part comes from loss higher first then lower so replacing higher instantly youthens.

Second… Doing it under local…So much better!!! I would rather do two or three small timer hits under local than a major hit under general any day… Got to get up, walk out and fly home!

Thirdly, thank you and your staff for getting me… Ms impulsive and impatient… in so promptly!

Thanks again!

Tonya M

Atlantic City, NJ

Commentary

Fat grafting over the past decade has brought in an entirely new treatment option for facial contouring and rejuvenation. Using your own fat, which was once merely discarded after liposuction, has become recognized as the safest and most effective method for larger volume facial fills. Almost everyone has some fat available for harvest that can be processed and put in the face. With specific innovative techniques, fat can be harvested from the stomach, hip, inner thighs or knees and injected into the face for a variety of aesthetic issues from softening deep folds and lines, filling in acne scars, and augmenting weak skeletal features. But the greatest use of facial fat injections is in the aging face. The ability to restore loss volume in the face and reinflate a sagging hollow appearance can not be done very well or economically with most off-the-shelf synthetic injectable fillers. Your own fat has numerous unique advantages over any foreign material injected into your face. New advances in harvesting, concentrating and injecting your own fat has made it an important part of facial restoration and anti-aging treatments today. No longer is lifting and tightening alone the only way to turn back the hands of time on one’s facial appearance.

For the patient who does not have significant loss skin but has only lost volume (facial deflation) as in this patient’s testimonial, fat injections are an ideal treatment. No longer does one have to wait until the facial aging is so severe that major facelift surgery is warranted. Many fat injections can be done under local anesthesia and ‘spot fills’ can be selectively done to treat the earliest signs of facial volume loss.

Dr. Barry Eppley

Indianapolis,Indiana

Autologous (Patient-Derived) Fillers For Facial Rejuvenation

Saturday, June 16th, 2012

Filling of the deflated and aging face has become as popular as any method of facelifting. Using numerous and differing combinations of injectable fillers, certain areas of the face can be volumetrically expanded. To some degree and in the right locations, this does create a lifting effect although the use of that term is a bit overstated. Filling can certainly have a facial rejuvenating effect but it should never be confused with repositioning tissues.

 

Facelifts have a prominent role in facial rejuvenation, as they should, but they provide virtually no volumetric enhancement. For some patients, particularly those women with thinner faces, a facelift may actually have a negative volumetric effect. As the tissues are tightened across the cheek and lateral facial areas, an almost collapsing effect can be seen with less visible midface fullness. This is one reason many contemporary facelifts employ the use of injectable fillers, particularly using the patient’s own fat.

 

There are numerous proponents for filling and lifting in facial rejuvenation and much of the controversy about which is better is rooted in the doctor’s specialty and training. For those who are trained and experienced in facelift surgery (e.g., board-certified plastic surgeons), it is more of a matter of mixing in fillers with traditional facelift techniques to get the best overall surgical result. For those doctor’s who practice is limited to non-surgical approaches to facial rejuvenation, the use of injectable fillers is the backbone of their offerings. They understandably are devout believers in the exclusivity of their approach and that has lead to a lot of creative marketing that largely uses the concept of a liquid or filler ‘facelift’ treatment.

 

These different facial rejuvenation approaches are confusing for potential patients. Much of that comes from the hope and perception that that a more youthful appearance can be obtained by a simple injection rather than a surgical tissue lifting approach. Aiding this potential confusion has been the more recent technologic innovations in autologous tissue harvesting using one’s own blood, fat and stem cells. Their liquid compositions make them easy to be used as injectable agents. While the science behind their effectiveness in facial rejuvenation is largely limited to photographic demonstration, their autologous nature nonetheless makes them very appealing to patients…who are susceptible to overzealous promotion.

 

But marketing issues aside, these autologous filling agents do have real clinical value. It is just a matter of how much and at what cost. The most proven autologous filler is fat. For effective facial volumizing, it is the most cost effective because there is virtually an unlimited source. But its harvest and placement may require some form of anesthesia and more equipment for processing. This makes it harder to apply as an isolated injectable filler in an office setting. Because it is packed with cellular material (adipocytes, fibroblasts, stem and blood cells), fat would seem to have real tissue stimulating, and maybe even anti-aging, effects. At the least, injected fat can add sustained volume even if it is not always completely predictable.

 

The other autologous injectable filling agent is that derived from blood. PRP or platelet-rich plasma is a processed extract from a patient’s blood. It is easy to draw in an office, created by centrifugation and readily injectable because it is a pure liquid and not ‘chunky’ like fat. It has no cellular component and relies on its effect through high concentrations of growth factors in the isolated platelets. PDGF, bFGF, EGF, VEGF and other growth factors have all been found in PRP concentrates. It has been injected alone, or more commonly combined with synthetic hyaluronic fillers, to create a ‘blood-derived facelift’. In theory, it has a collagen-stimulating effect but its sustained effect is unproven beyond that of the lifespan on the synthetic filler. As long as the patient understands that this is a bridging or delay therapy until one is ready to commit to a surgical approach, they will not be disappointed.

 

Autologous injectable facial rejuvenation can use either fat or PRP, both patient-derived agents. They each have a role to play in facial anti-aging therapies but they are not interchangeable. PRP is used exclusively in non-surgical approaches while fat injections can be used in both surgical and non-surgical treatments.

 

Dr. Barry Eppley

Indianapolis, Indiana

Eyebrow Rejuvenation with Fat Injections

Tuesday, February 28th, 2012

Fat grafting to the face, done by injection, has become incredibly popular in the past decade. The recognition that most faces lose fat volume as they age has led to fat grafting done alone or in conjunction with other facial lifting procedures. One such area of volume addition in the aging face is that of the eyebrows. Adding fat not only fills them out but can create a lifting effect as well.

In the January 2012 issue of Aesthetic Surgery Journal, a study is reported that looks at this issue of volume loss in the eyebrow as one ages.With the underlying tenet that the eye brows and the eyebrow fat pads are vulnerable to age-related changes, this study looked at the eyebrow region through 3D volumetric analysis. Over a five year period at an Eye Institute, patients that had undergone orbital CTs for medical purposes were evaluated. This included 52 CT scans that were fairly equally divided between men and women. 3D reconstruction techniques were used to calculate volumes of the retroorbicularis oculi fat (ROOF), galeal fat (ROOF and subcutaneous fat), and soft tissue muscles.

The study showed that overall eyebrow volume does not change appreciably with age. However, the contribution of fat and soft tissue to total eyebrow volume does seem to change. This pattern differs between males and females. As women age, the fat volume increases and the soft tissue volume decreases. In men, the shift from soft tissue volume to fat volume is less pronounced.

While fat volume deflation is a key component in facial aging, this study does not support this aging phenomenon in the eyebrow fat pad. This may be due to the reality that this is true or could be a reflection of how the study was done. After all, these were not serial CT scans done on the same patient over many years (which would be a near impossibility) but were random points of information on different patients at one point in time. They were all then collectively compared which could be misleading.

Does this mean that fat injections into and around the eyebrows is a flawed aesthetic approach? My answer would be no. I have seen too many patients who were quite pleased with their fat injection results even if research does not indicate that they were really down in fat volume to begin with. Whether it is an eyebrow lifting effect, creating a better skin tone by expansion, or even some purported effect of skin rejuvenation by fat or stem cells, judicious placement of fat into the eyebrow can produce a rejuvenative effect in their appearance.

Dr. Barry Eppley

Indianapolis, Indiana

Facial Fat Compartments and Fat Injection Augmentation

Tuesday, January 10th, 2012

‘Fat in the Face’ has become a topic of great interest in plastic surgery in the past few years. Understanding where the fat compartments and layers are in the face and how they influence the outward shape of the face has undergone a lot of anatomic study and descriptions recently. The main emphasis of these fat studies is to better understand how the face ages and what causes the many classic findings in the aging face. With this knowledge has come innovations in facial aging management such as fat resuspension and volumetric addition by fat injection.

As another anatomic study of facial fat, a recent paper in the January 2012 issue of Plastic and Reconstructive Surgery looked specifically at midfacial fat compartments. While most facial fat studies use injectable dye techniques, this study out of Germany used computed tomographic scanning. From twelve cadaver heads from two different age groups (aging age 54 to 75 and old age 75 to 10 years), CT scans were evaluated of the various midface fat compartments. (nasolabial, medial cheek, middle cheek, deep medial cheek, sub-orbicularis and buccal fat)

The study finds that the midfacial fat is arranged into two and paranasally into three independent anatomical layers. The superficial layer is composed of the nasolabial fat, the medial cheek fat, the middle cheek fat, the lateral temporal cheek compartment and three orbital compartments. The deep midfacial fat compartments is composed of the sub-orbicularis fat and the deep medial cheekfat. Three distinct fat compartments are found laterally to the pyriform aperture including the buccal extension of the buccal fat pad from the paramaxillary space to the subcutaneous plane. This study showed that an inferior migration of all of the midfacial fat compartments and an inferior volume shift within the compartments occurs with aging.

While such anatomic studies can seem overly detailed and one can easily get lost looking for the forest in the trees, there are a few points of good clinical relevance. As is well recognized, loss of the buccal extension of the buccal fat pad can lead to lack of support to the overlying medial cheek and deep cheek fat compartments causing an outward hollowing effect. Augmentation of this area by fat injections can restore support. Another good point is that the best method of nasolabial fold reduction is by augmentation of the deep medial cheek fat and the deep fat compartment known as Ristow space which sits just above the bony pyriform aperture.

The further detailing of the various facial fat compartments furthers the concept of site-specific augmentation by fat injection. It is now becoming more obvious that deeper levels of fat injections are important for not only increased survival but for better outward volume effects as well.

Dr. Barry Eppley

Indianapolis, Indiana

Preparation Methods For Facial Fat Injection Surgery

Thursday, June 16th, 2011

Fat appears to be a near ideal material for facial volume restoration or augmentation. Known as lipofilling, it is a very safe and relatively inexpensive method of adding volume to either the aging or lipodystrophic face. While injecting fat into the face is straightforward, the important question becomes how to ensure that most of it will survive. Post-injection resorption is a well known problem with fat injections. There are undoubtably many factors that influence survival, but one of the most obvious is its preparation prior to injection.

Despite many espoused methods of fat preparation, which all boil down to how it is processed, no ideal method has yet been proven. The most commonly used methods include either filtration/washing and centrifugation of the fat. Filtration is done through a fine mesh screen which is washed with saline prior to placement into a syringe. Centrifugation is a more sophisticated method of machine separation which appears more effective at isolating pure fat. It is the basis of ‘structural fat grafting’. Is one way really better than the other?

In the June 2011 issue of Plastic and Reconstructive Surgery, a study was published comparing the clinical results obtained using filtered and washed fat with that of centrifuged fat in facial transplantation. In a prospective double-blind study of 25 patients over a six month period, fat injections into the face were assessed after a 12 month follow-up based on before and after photographs. The authors concluded that there was no significant difference between the two fat-processing methods based on their assessment of implanted hemifacial regions.

While one would assume that centrifuged fat should survive better, due to higher concentrations of fat cells, this study done by experienced fat injectors refutes that claim. On the one hand, this probably brings joy to those plastic surgeons who do not employ centrifugation due to the extra time and expense to do so. Centrifugation does involve a lot more effort and potential expense given the equipment needed to do it. It is an arduous step that one hopes is really worth that effort. To those who are devout believers of fat centrifugation, they can argue that this is a limited study based on the number of patients and uses only a very subjective method of postoperative evaluation.

Despite arguments that can be made on both sides, the ideal method for fat preparation remains yet unknown. This is also conflicted by the likely fact that the survival of fat cells depends on many other factors as well including the anatomic source of the fat, its method of harvest and the qualities of the recipient bed into which it is implanted. Since there is no way to control all of these variables, we are unlikely to know anytime soon how to best inject fat. For now, I will continue to use filtered/washed preparation method for facial fat injections as it offers the shortest time between harvest and implantation.

Dr. Barry Eppley

Indianapolis, Indiana

Fat Injections In Facelift Surgery

Saturday, April 30th, 2011

As the face ages, deflation through fat absorption occurs for many people. This loss of facial fat causes a sunken appearance and significantly affects the cheek and orbital areas. As a result, restoring some fullness to the cheeks has been part of many facial rejuvenation strategies and a wide variety of materials have been used including implants, resuspension of sagging tissues, and fat injections.

As fat grafting has become widely accepted in plastic surgery, fat injection for facial volume loss is becoming commonly performed. Injecting fat into the cheeks, orbital and midfacial areas is part of ‘liquid facelifts’ and is used in conjunction with standard facelifting techniques as well. A very relevant question  with this technique is…does the injected fat grafts last? We know it can be done and the method to do it but does it work?

In the May 2011 issue of the Plastic and Reconstructive Surgery journal, the retention of fat injected into the cheeks during facelift surgery was studied. In a single plastic surgeons practice, five patients who had deep-plane facelifts with fat injected into the cheeks were studied. The fat was harvested from the abdomen and prepared by centrifugation.  Each patient had about 8 to 9ccs of fat injected into each cheek. Most of the fat was injected over the maxilla to optimize the ogee curve of the youthful face. MRI scans were obtained before surgery of their faces and then up to six months after surgery. Specifically, the thickness of the malar fat pad was measured.

Malar thicknesses were significantly increased at one and six month follow-ups in all patients. The amount of thickness did not change from the first MRI measurement to the last. The T1 and T2 weighted images showed that the increase in malar tissue was due to fat density and not fluid. The average increase in cheek projection was around 0.6 cms for each cheek.

This study shows that fat injected at the time of facelift surgery produces an increase in malar volume that is maintained at 6 months after surgery. This is the first study that documents that viability and value of adding fat at the time of facelift surgery. The fat assists by adding back the soft tissue volume that is lost from the deflation that occurs from facial aging.

Fat grafting as part of facial aesthetic surgery continues to gain momentum although the exact science remains to be precisely defined. There is a lot of reported evidence that fat does survive in the face provided good preparation and injection techniques are used. This reported study is the first that provides quantitative evaluation of fat graft survival.

The real value of this study for me is that it confirms what I have seen clinically with facelift fat injections. I always tell patients that the amount of facial augmentation that one sees around 6 to 8 weeks is what will remain. This study shows that the degree of malar augmentation present at one month after surgery tends to stay. It also demonstrates that adding soft tissue volume from elsewhere is likely better than simply trying to move local tissues around in the effort to gain volume. When you factor in the relative simplicity of fat injections compared to more complex tissue flap and suspension techniques, the use of fat injections as an adjunct to facelift surgery will continue to become more popular.

                  Dr. Barry Eppley

Indianapolis, Indiana

The Role of Graft Preparation in Fat Injection Therapies

Monday, November 1st, 2010

Fat grafting is a hot topic in plastic surgery. Over the past ten years, it has emerged from its dark ages in which it was viewed as unsuccessful and in disrepute. Historically, fat grafting in cosmetic surgery was completely unpredictable. The transferred fat would usually completely resorb and, if not, it left lumps and contour irregularities in its wake. The technology of how the fat was processed was as unique as many kitchen preparations and the science of how it should work was more theoretical than fact.

But the age of enlightenment has come to fat transfer. Considerable research efforts have been made in plastic surgery that has led to the widespread clinical use of fat grafting with improved volume retention results. This is particularly evidenced by the rollout of devices and machines to help with fat processing (cleaning and washing) and transfer. When you factor in that most fat sites in the body are invested with high numbers of stem cells, the interest in the science and expanded use of fat transplantation becomes more appealing.

The technology of clinical fat injection grafting is based on isolation and concentration. Prior to transfer the objective is to purify the fat graft and remove any extraneous fluid, effectively increasing the volume of viable cells that is being transferred. This is traditionally done through centrifugation or straining methods in an open system. Machine technology offers to do the same thing but in a closed system. The advantages of a closed system are less potential for contamination and a more standardized processing method.Whether an open or closed system is faster to process depends on the techniques and the device used.

My current open method is a common one and consists of a strainer to remove excess fluid by gravity, a Lactated Ringer’s solution wash and then manually placing it into syringes for injection. One of the current advantages of an open approach is the ability to add differing components to the graft. While it is unclear exactly what ‘stimulants’ may be beneficial for fat grafting, the concept is theoretically appealing.

Currently, I am using a mixture of PRP (a plate-rich concentrate) and Matrigel collagen matrix. The high concentration of growth factors in platelets, and that it is obtained and concentrated from the patient’s own blood, seems like a natural choice. At the worst it causes no harm and the potential stimulation of growth factors, such as PDGF (plate-derived growth factor), on stem cells is more than just theoretical. Matristem is a lyophilized porcine-derived extracellular matrix which comes in a powder form. Mixed in with the fat graft, it adds a potential source of collagen stimulation and matrix onto which cells may attach and proliferate. While neither one alone, and most certainly together, has not been proven to help with injected fat survival, it is easy to make a composite fat grafting mixture before placing it into syringes. Neither interferes in any way with the ease of fat injection through a needle.

The flip side of fat processing is that of the donor site. Which part of the human body has the best quality fat?Which donor site offers fat with higher numbers of stem cells? What type of fat will survive the best after transfer? The scientific answer is that no one knows. Convenience is the usual reason a fat donor site is used or one in which the patient most highly wants the fat reduced. Often times it is a simple matter of volume. The amount needed for augmentation requires a donor site that has two or three times the volume to provide due to loss in the processing and concentration method. In facial grafting due to the low volume needed, the number of donor options is considerable. For high volume fat transfers such as buttock augmentation, every donor site the patient has may need to be used. The by-product of that need is that they are also going to get a good liposuction reduction result.

Injected fat has many body uses from body contouring to facial rejuvenation. For the body, buttock augmentation and breast reconstruction (lumpectomy defects) are being widely done. Fat breast augmentations are being approached more cautiously but is gaining some momentum also. The other good body use is that of hand rejuvenation, using the injected fat to fill hollows between the extensor tendons and to camouflage prominent veins. The face continues to be a rich and diverse area for fat injections from lipoatrophy to rejuvenation through volume restoration.

The future of injected fat grafting is bright with continued refinements in technology a certainty. With these technologic improvements will come better clinical results and new clinical uses not yet envisioned.

Dr. Barry Eppley

Indianapolis Indiana

Changing Facial Shape with Fat Injections

Tuesday, May 18th, 2010
There are numerous types of facial shapes. (eight to be exact) Described as well known geometric outlines such as round, oblong,  and square, they impart to a face a certain look. There are many anatomic components that come together to make up that geometric shape. The prominence of the bones and the thickness and amount of the overlying soft tissues collectively impart a face its shape.

One very important area or facial zone that makes a major play in imparting this shape is the lateral facial triangle. Positioned between the bony points of the cheek bone, chin and jaw angle, the lateral facial triangle is comprised of soft tissue only. There is no underlying bony support of any significance.

In some people the lateral facial triangle has a thicker soft tissue thickness, imparting a more round facial shape. In other patients the lateral facial triangle has much less soft tissue thickness. When this area contracts inward, the face appears more triangular in shape which some call a gaunt appearance. The influence of this soft tissue zone on facial appearance is well illustrated in patients with facial lipoatrophy. While some have it naturally, an extreme example is what happens in certain medical conditions such as AIDS. (facial HIV lipoatrophy)

Filling in the lateral facial triangle with fat injections is the only surgical approach for augmentation of this zone. Because it is not supported by any underlying bone, traditional facial implants will not help. In fact, augmenting the cheeks or jaw angles will only make this appearance worse. Injecting this zone with fat, filling it up at least to the level of a plane that touches all three points, will change the facial shape. This can soften a long more angular facial look by adding width or improve a gaunt facial shape by filling out the concave shape to the lateral facial triangle.

When considering facial fat grafting, there are several important considerations that patients need to know. Even though injectable fat grafting is fairly simple (no open incisions), it is not fool proof and outcomes can be variable. Fat grafting can only be done using your own fat. No other person’s fat will be accepted by your body. The amount of fat to fill in the lateral facial triangle can be anywhere from five to fifteen ccs. Even in a thin person, you can usually still get enough from the abdomen using the inside the umbilicus as the harvest entrance site. Concentration is the key after harvest to eliminate injecting as many impurities as possible. Adding PRP extract (platelet-rich plasma) may have a positive effect on fat survival, particularly in small-volume fat injections, but this has yet to be scientifically proven. Injection technique is important so multiple passes from different injection angles is necessary. One ball of injected fat will likely lead to complete resorption.

The only risk of this surgery is the unpredictability of fat survival. Complete fat retention can not be guaranteed which is why I, in my Indianapolis plastic surgery practice, always overfill it somewhat. A patient can expect to look a little too full for several weeks after surgery until the fat and swelling settles. What is retained in the lateral facial triangle after three months can be expected to be retained.

Dr. Barry Eppley

Indianapolis, Indiana

 

 

 

 

 

 

 

Volumetric Facial Augmentation with Fat Injections

Saturday, August 29th, 2009

‘I am very lean and have lost volume in my face. I would like to find a permanent solution and have read about fat grafting. Is this done with local anesthesia and how much fat do you need to extract to get enough and where would you extarct the fat from? Also what is the average cost?’

These are very common questions that I get in my Indianapolis plastic surgery practice about facial fat grafting and is actually an exact quote from an inquiry that I just received recently.

Loss of fat in the face can be the result of three causes. Most commonly, it is an aging issue. Someone who has been naturally lean their entire life is prone to lose fat as they age and will develop more of a gaunt facial appearance with age. Some people, again who are usually lean, have a naturally thin and more sunken  in face as they never had the typical facial fat pockets develop. Lastly, facial lipoatrophy is a common sequaelae of certain diseases or the medications used to treat them, such as HIV disease and Waldenstrom’s disease.

Fat injections to the face for volumetric fill are the only treatment option that offers any chance for a permanent solution. While many off-the-shelf injectable fillers are available, specifically Sculptra, for volumetric facial filling, none offer a natural, long-term solution. Your own fat is certainly natural and harmless…and relatively inexpensive compared to synthetic injectable fillers.

One of its only downsides is that it is not predictable in terms of how much will survive. As a result, I have adopted three strategies to help improve its biologic outcome. First, maximal concentration by washing and centrifugation. You want to be sure that you are injecting solid fat material and as little of extraneous fluids as possible. Secondly, I mix concentrated facial fat with PRP (plate-rich plasma), an extract from your own blood. This is drawn out while you are asleep. Your platelets contain powerful growth factors which may have a stimulatory effect on not only the fact cells in the graft but on the tissue bed into which it is injected. Lastly, some overfilling is done in acknowledgement that 100% of what is injected may not turn into a permanent fat deposit.

How much fat any face needs is quite variable and depends on how many areas need to be filled. Usually the common areas are the submalar, lateral face, and temporal areas for ‘classic’ facial lipoatrophy. But other areas can be done as well including the nasolabial folds and the lips. The volume of injected fat needed can vary from 10 ccs up to 35cc for a total face. No specific harvest site has yet been shown to offer better post-injection survival. Thus, the grafts are liposuction harvested at a convenient site such as the abdomen, flanks, thighs or knees.

Because of the multiple site nature of the surgery (harvest and numerous facial injection sites), I prefer to do the procedure under general anesthesia as an outpatient. It is more comfortable and allows the procedure to move quicker with less time on the operating room. Others may perform it under local or sedation anesthesia and that is perfectly appropriate also. It is really a matter of surgeon preference and their own comfort zone.

Costs of the facial fat injecting will be in the range of $ 6000 – $ 7500, including all associated costs of surgeon’s fees and operating room and anesthesia costs.

The outcome of facial fat grafting, as previously mentioned, is somewhat different for each patient. My experience has been that everyone gets a result, it is just a matter of how much ranging from 25% to 100% improvement and patient satisfaction. On average, about 50% of patients are satisfied with one facial fat injection session and the half either undergo a second session or are accepting of the outcome.

Dr. Barry Eppley

Indianapolis, Indiana 


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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