Loss of facial volume is now a well recognized phenomenon of aging as well as part of certain disease processes. As subcutaneous fat volume is lost in the cheek, side of the face, and the temporal areas, one can acquire a more gaunt facial appearance. While this may be somewhat desirous when one is young as it highlights the cheekbones and other facial skeletal structures, it has the opposite effect as one gets older, creating a more aged and unhealthy appearance.
Fat has turned out to be a good, although often only, option for facial volume restoration. Although its survival after injection is variable, many parts of the face have at least a 50% or more long-term volume retention.
One of the consistent comments that I hear from my plastic surgery colleagues who perform the procedure is that it has a beneficial or rejuvenative effect on the skin. Anectodal reports abound that the skin looks better after fat transplants have been under it.
In the September 2009 issue of Plastic and Reconstructive Surgery, the concept of improvement in facial skin quality after fat grafting was experimentally evaluated. Using a mouse model, a study looked at skin histology after fat grafting to their backs. After eight weeks they were histologically able to show that the skin was thicker and with better texture. There results suggest that besides adding volume underneath the skin, fat grafts have the potential to have a regenerative effect as well on the skin itself.
The motivation for performing this study was undoubtably the consistent observation of how much better facial skin looks after fat graft volume has been added underneath it. And like many experiments, you can find exactly what you are looking for. Having performed many animal implantation experiments in the past, I can testify how you can design and conduct experiments that will ultimately support the premise (motivation) for the study. You often find what you hope you would.
Does fat grafting really change the quality of the skin overlying it? It may well do so but the biologic evidence remains absent despite this recent experimental report. It is hard to imagine how the subcutaneous biologic mileau, regardless of how it has been supplemented, would change the epidermis-dermis structure of the skin. More likely, this is the effect of ballooning the skin back out which reduces wrinkles and makes it look better. In my Indianapolis plastic surgery practice, I have observed this many times with injectable fillers which creates very much the same effect. Despite the injectable manufacturers claims no one has yet been able to show maintained long-term skin thickness in a convincing fashion. The effect lasts as long as the injectable filler and is mainly mechanical.
From a patient’s perspective, however, they really don’t care about the science. All they want to know is will it make me look better and how long will it last…and how much does it cost? As such, fat injection facial volume restoration in the properly selected patient does work and the skin will look improved with less wrinkling. But we should hesitate to promote fat injections as a primary skin rejuvenation method. Skin improvement, for now, is a secondary benefit that is caused by the volume restoration and not necessarily by fat graft-induced stimulation on the skin directly.
Dr. Barry Eppley
Indianapolis, Indiana