Overview

Facial plastic surgery in the 21st century can be conceptualized as a surgeon’s expertise and knowledge meeting patients’ expectations for aesthetic improvement while applying advanced surgical techniques to address the anatomic changes caused by the aging process. Therefore, surgeons specializing in reversing the aging process must fully recognize the fundamental aspects of facial aging and the underlying tissue transformation responsible for these changes to attain desirable results for their patients.

Facial aging is a process that should be viewed as a consequence of three distinct phenomena that alter the shape and contour of youth. Loss of skin elasticity due to the breakdown of collagen fibers and sun damage is responsible for the aging of the skin envelope, clinically manifested by wrinkles, folds, and pigment changes. A second category of aging is tissue sagging, caused by the laxity of the tissues underlying the skin and the yielding of the ligaments that hold tissue planes together under the weight of gravity.

The third component of aging is facial hollowing due to the loss of volume in the superficial and deep fat compartments. For decades, surgeons were accustomed to addressing the first two components of aging through skin resurfacing procedures and traditional surgical lifts of the face, cheeks, and neck while neglecting facial atrophy. Eventually, less-than-ideal results lead them to turn their attention to volume restoration and to appreciate the importance of fat grafting as the best option to address it.

Why add fat to an aging face?

Fat transfer offers many advantages over dermal fillers as a means of volumetric rejuvenation. Fat fully integrates with tissues to become part of the structural framework of the face, providing a predictable, sustainable, and natural improvement in facial contour. In addition, its stem cell effect produces a desirable improvement in skin quality without the irregularities and pigment changes induced by non-autologous injectables.

Targeting volume depletion while performing a lifting procedure of the face introduces a new frontier in total facial rejuvenation. Fat transfer improves facial contour by addressing the deflation component of aging. By filling sagging tissues, fat grafting is employed synergistically with contemporary lifts that restore tissue descent in the forehead, eyelids, and cheeks.

The benefits of using fat for volume restoration

Fat is a readily available and inexhaustible source of volume for the surgeon performing facial rejuvenation. It is more than just a filler; it is a living tissue graft that provides growth factors, stem cells, and age-reversing substances. This is why fat grafting not only has a volume-enhancing effect but also improves skin quality and provides nutrients for the multilayer tissue planes of the face.

Fat grafting can be performed with other facial plastic surgery operations, providing volumetric rejuvenation to complement a surgical lift. Simultaneous fat transfer and a brow lift, blepharoplasty, or facelift produce a more significant and sustained improvement in facial appearance.

Fat transfer technique

Facial fat transfer is not a simple procedure done in your doctor’s office. On the contrary, this delicate and precise operation must be performed in a sterile environment with special equipment. Surgeons must follow these tenants for the procedure to succeed and avoid significant complications.

The first step consists of harvesting the fat from the abdomen, thighs, or flanks, depending on the patient’s habitus and availability of subcutaneous fat. The fat is harvested with small gauge liposuction cannulas and transferred to sterile syringes for subsequent processing. Centrifugation separates the stem cell-rich fat from oil and water to guarantee that only the best fat cells are injected into the face.

The fat is then transferred to small syringes coupled to special cannulas. Finally, the surgeon infiltrates the fat into the facial fat compartments according to the degree of volume depletion and before beginning any other surgical procedures.

Who is a good candidate for facial fat grafting?

The best candidates for this procedure are healthy individuals who present with facial volume loss, manifested by low eyebrows, wrinkles under the eyes, and saggy cheeks, and who desire a significant and sustained improvement in facial appearance.

Fat transfer may be performed as a single procedure in younger patients who require subtle volumetric rejuvenation. More commonly, it is performed simultaneously with lifting operations of the eyebrows, cheeks, and lower face to restore youthful facial contours and reverse facial atrophy.