Feb. 6, 2015
Dominic Brandy, MD

Fat Transfer: What You Need to Know

So often patients who have previously had a QuickLift™ facelift come in a few years later to ask me what they can do to further enhance their appearance to maintain the results of their QuickLift.  Invariably, I start talking about volume restoration.  From the moment I put into place that final suture, the aging process continues.  And the most significant aspect of that aging process, in my mind, is volume loss.

When I meet with my patients, one of the first topics I discuss is volume loss and how it contributes to the aging process.  Within this volume loss, bone loss is the most significant factor.

About Bone Loss

I show my patients’ an artist’s rendition of the bone deterioration that occurs with age (Figure 1).  I show them how the jawbone denigrates and the cheekbone atrophies.  The sockets of the eye and the nose expand.  I point out how the overall size of the skin shrinks with age.FatTransfer_Figure1_BoneLoss

About Fat Loss

Then, I show an artist’s rendition of how the fat pads and muscles of the face deteriorate over time (Figure 2).FatTransfer_Figure2_FatLoss

Volume Loss Over Time

You can see on the photos of this aging man (Figure 3) how the volume of his face significantly declines with age.FatTransfer_Figure3_AgingMan

How to Restore Lost Volume

I tell my patients the good news is that you can restore lost volume – and you have options, too.  You can use temporary or permanent fillers.  Temporary fillers include:

  • Restylane®
  • Juvéderm®
  • Voluma®
  • Radiesse®
  • Sculptra®

The longevity of these dermal fillers range anywhere from 3 months to 2 years.  Essentially, a doctor, nurse practitioner or physician’s assistant injects the filler into the area where the volume loss has occurred.  The upside of using dermal fillers to restore volume loss is that there is no downtime.  The downside to using dermal fillers is they are temporary and over time can become costly.

For clients wanting a permanent solution to volume loss, I recommend fat transfer.  Fat is by far the very best permanent filler because it is long-lasting, it is natural (it comes from the patients’ own body) and it can be used to restore volume in many areas of the face and body.

Removing the Fat and Placing it Back

When performing a fat transfer treatment, first I need to collect the fat.  I can harvest fat two different ways – through liposuction surgery when body contouring is needed or by means of a small cannula that is attached to a syringe.  When collecting the fat (by means of the syringe) I insert the cannula under the skin and gently and systematically move it back and forth.  The fat fills the syringe; a nurse then purifies the fat and places it into another syringe with an extra small cannula for injecting.

Why Technique Matters

FatTransfer_TopoMapThe fat transfer injections are done using a topographical map layering technique (Figure 4 to the right) I developed several years ago.  With a topography map, the smallest circle is the highest point and the largest circle is the lowest point. 

The fat is artistically layered into the different circles, creating the exact shape I want.  Layering the fat in this manner also guarantees the highest rate of fat survival.

As illustrated by the black lines in Figure 4, you can see that from one single injection point I can improve the cheek, the tear trough, the nasolabial fold, the marionette lines, the chin and the jowl area.  I then inject the brow and the area between the eye brows.  Normally, 50 percent of this injected fat survives.  Therefore I overfill the area by 25 percent to ensure optimal results.

The Best Time for Fat Transfer

Not only am I performing fat transfer for former QuickLift patients, in many cases I am also recommending fat transfer to QuickLift patients who could benefit from added volume during their QuickLift procedure.  In both scenarios, patients have been thrilled with the natural-looking results.

Not only is fat transfer enhancing the results of my former and new QuickLift patients, but I am also recommending fat transfer, when appropriate, to people interested in upper eyelid surgery or chin augmentation surgery.  Fat transfer to the upper eyelid eliminates the need for an incision, greatly reduces the post-operative recovery and restores the volume and fullness with a very natural-looking result.  After the fat transfer, I apply a physician-grade chemical peel to the surrounding eye area to tighten the skin and improve skin tone.

I also prefer to use my fat transfer technique for chin augmentation.  From a single injection point, I am able to create a more prominent chin which creates facial balance and soften the nasolabial folds and marionette area for a cosmetically pleasing result.

Results:  What to Expect

After a fat transfer, you will see immediate improvement to the facial areas being treated.  You may then start to see some areas lose a bit of the volume and fullness for a few months.  This is due to the tendency for about half of the fat cells to die off.  However, at about six-months post procedure, you will then start to experience renewed volume as the surviving fat cells begin to grow.

Optimal – and permanent – results can be seem about one year after the post procedure.  My patients often comment how they love looking better and better over time!

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