What it treats

Facial fat transfer directly treats volume loss caused by aging or injury, or a normal anatomic trait. It indirectly treats skin sagging and wrinkles that are caused by deflation. Around the eyes, it can be used to improve hollowing, tear troughs, eyebrow deflation, sunken cheeks, and sunken temples.

Why it is done

Facial deflation secondary to fat atrophy is a hallmark of aging. Fat transfer by injection restores youthful contours with natural, living tissue that can have long-lasting effects.

How fat grafting is done

One or more donor sites are selected based on body habitus and fat availability. Favorable sites include the abdomen and waist, hips, and thighs. A tumescent numbing fluid (consisting of saline with dilute lidocaine and epinephrine) is used to anesthetize the donor area. The fat is gently suctioned from the donor site using a small tube (cannula) with small holes that extract fat cells, along with the tumescent fluid. The suction tube is typically smaller than the usual liposuction tube and the force of the suction is less to reduce the stresses applied to the fat cells.

The harvested fat cells are purified and condensed with one of several techniques which may include spinning in a centrifuge, filtration, washing, and/or other methods of separation. The fat is kept in a sterile, closed system so it is not exposed to potential contaminants.

Fat is injected in thin strips in the deep layers of the face in the areas where additional volume is needed. The fat is injected with a thin, blunt cannula and a small syringe (1 milliliter) so that it gradually and precisely builds up the target area. Each pass of the cannula deposits less than 0.1 milliliter of fat, ensuring that each fat cell has the potential to develop its own blood supply, increasing the likelihood of fat survival.

Around the eyes, fat is grafted deeply along the bony orbital rim where hollowing is most visible, and blending is done into the surrounding regions including the temples, cheeks, and brows. Slight overfilling of the target areas is performed, taking into account some post-procedure volume loss from swelling, fluid, and fat reabsorption.

Follow-up care

Approximately 50% to 90% of the transferred fat cells will survive, depending on the transfer technique and patient healing variables. Acute swelling is expected to last from 1 to 3 weeks and bruising may also occur.

The final result may not be seen until 6 to 12 months. During this period the fat cells may fluctuate in size until they finally stabilize.

Potential risks after fat transfer

Risks include irregularities or lumps which are uncommon when a deep mini-threading technique is used during the fat transfer procedure. Oil cysts can occur which may be drained with a needle. Overcorrection or undercorrection may occur, depending on fat cell survival which can exhibit variability from person to person.

Dr. brett kotlus cosmetic oculoplastic fat injection