As the face matures ages over time, some people will develop fat loss which can make the face appear somewhat hollow and sunken. While this may have been a good look when one was young, in the older face such fat loss makes it appear much older and even a bit ill-appearing. A good analogy is a partially deflated balloon that appears smaller with more fold and wrinkles in understanding what happens when fat is lost in the face over time.
The relocation or transplantation of fat from one part of your body (usually the stomach, flanks, or thighs) is a currently popular method of rejuvenating one’s facial appearance. By adding or restoring fat volume to select areas of the face, such as the cheeks, side of the face, jawline or temple areas, a less sunken in and more rounded face is created. Such a change can make the face appear more healthy and youthful and helps plump out some folds and wrinkles that have developed. This technique of fat grafting is done by an injection technique so that there are no incisions or scars that result from doing it.
The harvest or removal of the fat from the body is of a small amount so no ‘liposuction’ result is obtained from doing so. Many times, I will be performing liposuction on the body anyway and this is an ideal time to do simultaneous fat injection enhancement of the face. The harvest of the fat is done by traditional liposuction techniques but the processing of it for re-injection requires special methods for purification and concentration. At this time, I prefer the addition of PRP (platelet-rich plasma), a natural extract of blood from the patient which is concentrated for its platelet growth factors), as an addition to the fat. It is not yet scientifically proven that any alchemy approach is beneficial for fat graft survival, but there is no harm in doing so with a patient’s own blood products.
Fat injections should be thought of as an additive or adjunctive procedure for facial enhancement, usually not a stand alone procedure that can solve all facial aging concerns. Proven traditional anti-aging facial procedures such as facelifting techniques and facial implants are still the cornerstone of facial rejuvenation. Fat injections can be combined with any of the traditional facial surgery procedures to augment and optimize results. Most of the time when I do facial fat injections, it is with other facial procedures not as a stand alone procedure.
The one drawback to facial fat transfer is it unpredictability. No one can predict with any accuracy how much fat that is injected will survive. This is why I almost always overcorrect. In many parts of the face it does fairly well, but the area around the mouth (including the lips) seems to be the least predictable area. For this reason, other more traditional methods of perioral enhancement (such as synthetic injectable fillers, implants, and skin resurfacing) are currently better in my experience.
Dr. Barry Eppley
Indianapolis, Indiana