‘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