Fat Transfer (Lipofilling) of the Face
Risks and limits of the procedure
Will I look unnatural?
The media is full of images of celebrities and others who have had filler treatments to their faces with a wide range of materials including fat, commercially available absorbable fillers (eg Juvederm) and some of the older style permanent fillers. Restoring volume to the face so that it looks natural requires an understanding of facial aging good judgement and an expertise in the treatment itself. One of the commonest reasons that patients are overfilled is when filling techniques are used inappropriately to combat more advanced facial aging.
Although a small amount of filler in the right place can make the face look fresh and youthful, the face is not a balloon that can be pumped up indefinitely to stretching point. This kind of approach will always lead to a very unnatural heavy looking face that makes it obvious the patient has had treatment and is not at all appealing. My aim when I treat you is to restore the volume to your face without those around you being able to tell exactly what has happened. Patients tell me that friends and colleagues will admire their faces but find it difficult to pinpoint what has actually been done in any given area. This type of natural youthful look is the aim from any filler treatment and in my view is most effectively achieved with fat transfer.
Are there any risks?
Like all surgical procedures fat transfer carries some risk and although these are uncommon if carried out carefully by a trained professional. I will go through these in detail with you at consultation.
What is the recovery time?
Following your fat transfer most of my patients go about their day to day business within 12 hours. It is sensible not to carry out major exertional activities for a few days or at least until any swelling has settled. In general many patients are fine to go back to work within one or two days and can carry out normal day to day activities the day after treatment.
I have heard fat transfer looks great but does not last.
I have been carrying out fat transfer to faces for 10 years or more and it is now more popular in my clinic than conventional filler treatment as part of the facial rejuvenation programme. In that time I have come across occasional patients in whom fat transfer has not had a positive effect but these are very few. In most women the commonest reason for patients assuming their fat transfer has not worked is that they have only had one treatment. If for example 30% of your fat survives after that treatment, there may not be enough to give a visible effect. If that patient underwent a further treatment and a further 30% survived it is highly likely they would be able to see the effects of their treatment permanently.
Another reason why some people feel that fat transfer is not successful is that it is about technique. Fat cells are very delicate and need to be handled carefully. Every stage of the process is carried out in a particular way that ensures maximum fat cells survival. If the process is not carried out carefully then fewer fat cells will survive and of course this will impact the result. Finally fat transfer in my experience is more successful in women than men although the reasons for this are not clear.
Can fat be used to treat other areas?
Fat is a very valuable filler with excellent qualities and can be used to fill other areas of the body. I first started using fat nearly two decades ago as a filler for defects following injuries or cancer treatment. As well as these reconstructive uses of fat it can be used for breast enlargement and is most useful in patients who want a modest increase in their breast size and do not wish to have breast plants. I also use it in the breast to correct breast asymmetry and for conditions in which there is under development of one breast.
Fat transfer or lipofilling of the face is a technique in which you own fat is harvested from another part of the body, most commonly the flanks, and introduced into the face to restore volume in key areas as part of a facial rejuvenation programme. As we get older a number of changes take place in the face. These changes are influenced by genetic factors, gravity and lifestyle. Our understanding of how these factors work together to age the face has altered dramatically. This in turn has altered the way in which we approach the ageing face. We now understand that loose skin is an end-product of this process rather than the fundamental cause.
The face and neck are supported by two important arches – the first is an arch of bone and soft tissue that extends from the temples, around the eye and to the side of the nose. This arch is important in supporting the cheeks. The second arch is the lower jaw which is important in supporting the lower mouth area and the neck. Over time bone thins in these areas and fat is also lost. The skin is no longer as well supported and the cheeks start to sag forwards and downwards, deepening the fold that runs from the nose to the corner of the mouth (nasolabial fold). This same migration of the cheek leads to jowls disrupting the line of the jaw and giving the face a rectangular appearance instead of a more youthful almond shape. The cheek also pulls away from the lower eyelid area creating a groove between the two. Sagging of the muscles in the neck and accumulation of fat under the chin starts to obliterate the normal tight contours of this region and excess skin can develop folds, which are both unsightly and ageing. Similarly, folds and lines develop in front of the ears. These changes can also affect younger individuals after weight loss in the face. The result is that you who may feel young and fit but you have the outward appearance that is older and tired.
My patients are not typically looking for a radical change in their appearance, rather they are looking to set the clock back to when they were happier with their face, in a way that looks natural and restores that energetic look. The fat is used to combat these changes by restoring support. Fat has a soft consistency and can be moulded to give natural and accurate results. In most patients even when carrying out major fat filling of the face, the amounts used are relatively small which means in most patients there is an abundant supply. The procedure is simple and the fat can be harvested under local anaesthetic and introduced into the face by injection making this an outpatient procedure. The technique is not new and I have used it for many years to reconstruct tissue defects and improve the quality of scarred areas of the body. For the last 10 years or so I have been using it for facial rejuvenation and in my experience the results are the gold standard for fillers. At present most studies show that between 30 and 50% of the fat that is injected survives. Immediately following a fat transfer procedure you will see and a result that gives your face a youthful glow. Fat cells are very delicate and over the next few weeks the ones that do not survive will gradually disappear from the face and following one treatment with fat transfer you may find that at six weeks your appearance is largely unchanged from your pre-treatment appearance. This does not mean that fat transfer has not worked for you it simply means that the amount of fat that has survived from one session is not enough to correct the area we are treating. Those fat cells that have survived are permanent and will behave like the fat that is already in your face and age at the natural slow rate. Following a second treatment a further 30 to 50% of cells will add to this layer and several weeks after this treatment, you should see a permanent change in the way your face looks. If at this stage we do not see a response I switch to conventional fillers as there is a small group of patients in whom an insufficient number of cells survive following fat transfer which makes the treatment unsuccessful. In most patients however this is the time when they start to really see the effects on a long term basis. Usually three to four treatments are required to achieve a full effect and thereafter top-ups can be arranged every two or three years to keep up with the natural aging process in which small amounts of fat thin from key areas.
More recently I have added platelet rich plasma to the fat as there is growing evidence that this increases the survival of fat cells and may result in fewer treatments to achieve the final result. A fat transfer to the face is a specialist procedure and requires a good understanding of facial anatomy, the handling of fat cells and facial aging. It also requires experience in knowing the right place to put the fat and the amount to use to maintain a youthful natural look rather than someone who has been overfilled and looks artificial and abnormal.
In general my aim is to rebuild the soft tissue extending from the temples around the eye and to the nose. This upper arch is what suspends the cheek and helps reduce the depth of the fold that goes from the nose to the outer lip (nasolabial fold). I also use fat along the jaw line as this is another area where most patients will lose volume. This gives the face a firmer younger look and helps reduce lines in the lower lip area extending outwards to the lower cheeks, as well as giving support to the neck. Fat transfer into this area can also be used to add additional projection to patients who have a small chin. When carrying out volume restoration in the face using your own fat I am using your own material so there are a few reactions although the procedure is not without complications. In properly trained hands it is a safe and effective procedure and most of my patients who have had a fat transfer prefer it over conventional fillers as the result is soft and once the tissues have settled it is impossible to tell that anything has been added to the face as it has a completely natural appearance.
My preference is to carry fat transfer out under local anaesthetic (with you awake) so that you can monitor the effect as we go along and I can fine-tune it to your preferences. On the day of your treatment I will see you in my clinic and go through the procedure again with you as well as the aftercare and recovery times. You will then move to the treatment room where the area that the fat is to be harvested from is marked and anaesthetised using local anaesthetic. Almost all patients find this process surprisingly straightforward with hardly any discomfort.
Harvesting the fat takes around 15 minutes and after this I process it before putting it into syringes. At this point a local anaesthetic is given to your face at the point through which the fat will be injected and once this is working I then start to inject the fat into your face. Normally you will be given a mirror so that you can follow the process and my patients find this very interesting and reassuring. Once the fat has been injected I then take some blood to prepare platelet rich plasma which is effectively serum from your blood that is full of growth factors. This is injected through the same points around the fat. If you are having platelet rich plasma for your skin surface this is also carried out with a fine needle at multiple points. Vitamin C serum is then rubbed gently into the facial area followed by a cool, soothing cream.
At this point your treatment is complete and after half an hour or so you will be able to go home. You will be given antibiotics to take for two days and Paracetamol will suffice as a painkiller. For the site where the fat is harvested a dressing is applied. This is kept in position for 24 hours and thereafter you can shower and change the dressing daily. You will be supplied with dressings for this purpose.
At your consultation I will examine your face for facial aging and put together a treatment plan of which fat transfer may be the sole component or one of many components. Typically patients who are undergoing fat transfer are also having Botox treatment in the upper third of the face, platelet rich plasma aiming to increase fat cell survival and to improve the quality of the skin surface giving a fresh complexion. Vitamin C as a topical serum can also be used to improve skin quality and patients sometimes also have fillers to the lips. Other patients will undergo fat transfer and these treatments following more involved surgery to reposition their tissues such as face lifting, brow lifting, neck lifting and eyelid lifting.
At your consultation I will formulate a treatment plan that is bespoke to you and the aging process in your face. I will take your full medical history and go through any important measures that you need to take in preparation for your fat transfer. It is always very helpful for me when planning your treatment if you can bring some photographs of yourself at various ages. The most helpful is if you can bring me a series of photographs from your late teens, late 20s, late 30s and so on. One photograph from each decade will suffice and you should not worry about it being a professional facial photo, anything that gives me a clear view of your face will be very helpful. This aids in establishing how your face has changed and to what degree loss of volume is a factor. This will determine the treatment programme that I put in place for you. I will go through all the potential risks and complications of the procedure and once we have established a plan I will ask you to think over it and return for your treatment when you are ready.
Once your treatment is complete I will arrange to see you a week later to check that all is well. At this point you will still have most of the fat cells that I have transferred although over the next few weeks the cells that are not going to survive will gradually disappear. For this reason I would like to assess you again at around six to eight weeks after your first treatment which will give me some idea of how effective the treatment has been in your case. At this point we plan your second treatment. Whatever fat has survived is permanent and whether or not this is visible after one treatment it is still there. This means that you can arrange further treatments around your convenience as long as you allow a minimum of 6-8 weeks between them.
When you return for your subsequent treatment I will be putting another layer of cells on the cells that are already present and in most cases after the second treatment a visible result is obtained. Third and fourth treatments are used to top-up as required to obtain a full correction and again can be timed according to your own convenience. There is normally very little swelling and bruising following a fat transfer but sometimes both can occur. Swelling typically settles within three to five days but bruising can persist for 7 to 14 days and varies from individual to individual. Bruising can track to other areas in the face. The donor site from which the fat is harvested is a tiny hole which will heal with daily Sudocrem dressings in around 5 to 7 days. The area where the fat was taken however can be a little tender for around 3 weeks you should gently massage this area with a moisturiser to help resolve swelling and discomfort. For your next treatment I use the opposite flank, returning to the original side for the third treatment and so on. I found the flanks are the best place to take the fat as they have little impact on the contours and in most people there is an abundant supply of fat.