Fat: Your Natural and Ideal Filler

by Lawrence Janowski, MD

Taking fat out of areas of your body where you don’t want it and injecting into areas where you need it sounds like a fantastic idea, because it is!  Facial fat transfer (also known as autologous fat grafting) has been around for decades, and the technology for harvesting, processing and injecting it has improved dramatically over the past few years.  Fat can be considered the ideal filler for several reasons:  Firstly, because it comes from your own body, it is completely compatible with your tissues.  Second, it lasts a very long time, 10 to 20 years is not unusual.  Third, unlike other fillers, it is a bioactive, living tissue that is chock full of stem cells, growth factors, and stromal cells, which promote new tissue regeneration and dramatically improve skin quality.

The next logical question is:  Who is a good candidate for facial fat grafting?  Someone who:

1. Has significant volume loss in multiple areas of the face (though spot treatments can be done)
2. Is interested in a long-term or semi-permanent result
3. Has sufficient donor fat that can be harvested from the body (only about 50-100ccs is needed)
4. Understands that fat cannot do everything fillers can do (about 80-90%) and that filler supplementation may still be needed from time to time

The incredible value proposition for fat as filler is that most individuals in their 40’s and older need anywhere between 10 and 50ccs of volume replaced.  Remember that one syringe of filler is 1 (one) cc.  A cc is roughly the size of a sugar cube.  Purchasing 50 syringes of filler is completely unreasonable.  Not to mention it will all be gone in a year!  A facial fat transfer procedure costs roughly the same as a Sculptra series, but will last many times longer.

The procedure is simpler than many people think.  A small area of fat is harvested from any number of body areas such as abdomen, love-handles or thighs, using a gentle, painless liposuction technique.  It’s not enough to give you liposuction results, unless it is a very small area.  The fat is then washed with special filters, and fractionated into different “sizes”, similar to the way fillers come in different thicknesses based on their particle size.  It is then injected into the face using micro-cannulas, much in the way fillers are, with different fractions deposited at different depths.  I perform nerve blocks prior to the fat injections to make sure you are comfortable during the procedure.  Recovery can include bruising and swelling for several days.

What are the downsides?  Fat can be over-injected, causing too much fullness, which cannot be easily corrected.  This is why I tend to be conservative and not attempt to create a “perfect” result.  You are going to keep this a long, long time, so it’s always better to under-do it and come back some time later for further correction.  Some of the fat injected will not survive the graft, so final results will be at about 80% of full correction.  Certain areas like the mouth area do not keep as long as others, and may need more filler supplementation.

I am excited to be able to offer this advanced procedure here at Sonata, and I look forward to discussing it with you in detail, should you be interested in it.

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