For years I agreed with the critics, and chose not to offer fat injections as part of my practice….. So how come the switch?

I always have told patients that the fastest way to start a fight at a cosmetic surgery convention was to bring up facial fat injections. Some surgeons love them, while others believe they are a total waste of time. “It takes too long, the results are inconsistent and patients are unhappy. It is not worth my time.”

However, year after year fat injection results were presented at the national meetings, and slowly more surgeons began offering the procedure. I now offer the procedure in Portland – cautiously. So how come the switch?

To understand the situation, let me give you some history. Fat grafting has been around for over 100 years. It was mainly used to fill defects after trauma or surgery, and the results were varied. When I finished training in 1996 the consensus among my peers was that the results were too unreliable to offer to cosmetic patients. Some of the fat survived and some of the fat did not. The final result was “permanent”, which was great if the result looked good. However, usually patients healed with some degree of “lumpiness”, so they had a permanent result that they didn’t like. Surgeons like to please people, so fat transfers were not very popular.

Over the last 20 years fat grafting techniques have changed and improved. Results are more consistent. Patients are also more educated, and willing to have multiple procedures if necessary to achieve a natural, long-lasting result. Surgeons and patients alike now recognize that rejuvenating the face requires replacing volume. We have all experienced wonderful results with temporary fillers (such as collagen, Restylane, Juvederm, Radiesse, among others).

This summer at the Annual Facial Cosmetic Surgery Convention in Las Vegas fat transfer was wholeheartedly endorsed – even by the same surgeons who denounced it 20 years ago! It was this meeting that convinced me to re-introduce the procedure into my practice. While I don’t have patients yet that are willing to share their result on the internet, I think it is a great procedure for the right person.

Are you the right person? To answer that, I would ask you to consider the following:

• Fat injections are expensive, if done right. The procedure is a surgical procedure and involves taking fat from the abdomen or thigh slowly, without using high speed liposuction machines or lasers. The fat is processed and then injected – hopefully by a well trained physician who understands the facial anatomy, such as a facial plastic surgeon, or a specially trained dermatologist. You are seen before the procedure so that the grafting can be mapped out, and then multiple times after the procedure. You probably will also require “touch ups”, at additional cost. The whole process can actually take more time and involve more follow-up care than a facelift. The average cost of the procedure in the US is $4,362, less for small areas and more for the whole face.
• You should expect to have more than one procedure. Techniques have improved, but there still is not a 100% survival rate for fat grafts. The actual survival rate varies from individual to individual, and also from region to region on the face. In general the grafts have a higher survival rate in the cheeks and other areas with less movement, and a lower survival rate in the lips and nasal-labial folds, which have a lot of movement. The fat grafts now are very small – like grains of sand, so irregularities are more minor. However, you should expect to have a “touch-up” in 6 months to address areas that have had significant fat loss.
• Fat injections cause more bruising and swelling. If you are used to having a filler injection (like Juvederm) and then going back to work, fat injections are more involved. It is truly a surgery with swelling and bruising that can last weeks. You also will have some swelling and bruising in the area where the fat was taken – so expect a few weeks with no exercise.
• Take internet reports with a grain of salt. When researching for this blog I went to the RealSelf site, and read that patient satisfaction with fat grafting was only in the 30% range. However, when I read the specific complaints, it was obvious that many of these patients were not prepared ahead of time for the procedure. Several patients were unhappy because they looked bad at 4 days – when the real results are not known for weeks or even months.
• Bond with your surgeon. Since fat grafting has the possibility of producing permanent results, make sure you and your surgeon have a similar idea of what looks good. Picasso was a fantastic artist, but you may not want one of his paintings hanging in your Renaissance home. Also, you will need follow-up and touch ups, so choose a physician and office where you feel comfortable.

Fat grafting is not for everyone, and I still guide patients with one small crease to consider temporary fillers. However, for patients that require large volumes of filler or who use fillers regularly, fat transfers make sense. I guess this is just another case of never say never.