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Facial Fat Grafting

Facial fat grafting is a tremendous tool for facial rejuvenation. It is good for volumization and restoring appropriate proportions to the face by replacement of the bony resorption and volume deflation that occurs with aging. It also improves skin thickness, reduce wrinkling and pores with its regenerative adipocyte-derived stem cells. It has the potential for permanence when compared to fillers. This is performed by placement of small but adequate volume of fats, often nano fat, into well-planned areas of your face. Common areas include the forehead and temples, under the eyes, cheeks and nasolabial folds. Facial fat grafting can also be used for facial soft tissue defect that occurs congenitally or acquired from trauma or a tumour resection.

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What is Facial Fat Grafting?

Fat is also known as adipose tissue or adipocyte. When we transfer fat grafts, we not only transfer the adipocytes, we also transfer other active tissue like adipose-derived stem cells and progenitor cells which helps with the rejuvenation process.

Facial fat grafting is a tremendous tool for facial rejuvenation. It is ideal for volumization and restoring appropriate proportions to the face by restoring loss from bony resorption and volume deflation that occurs with aging. The rejuvenating effect from the adipocyte-derived stem cells also helps improves skin thickness, reduce wrinkling and pore size.

It has the potential for permanence when to fillers and collagen stimulators. However, if you have excessive loose skin and saggy face, it may not be adequate as the primary treatment option.

Facial fat grafting can also be used to treat facial soft tissue defect that occurs as a result of birth defects or when acquired from accidental trauma or from tumour resection.

Benefits of Fat Grafting

  • Fat is abundant and readily available
  • Easily harvested repeatedly
  • Compatible with one’s body
  • Adipose derived stem cells which will improve your skin condition
  • Versatile and it can be placed in different planes – periosteal, subcutaneous, subdermal or intradermal to achieve different desired effects

Where can Facial Fat Grafts be placed?

Facial fat grafting will help improve facial aging and volume loss. It also helps improve the texture of your skin, improve skin thickness, reduce wrinkles, reduce pore size and improve facial scarring.

Upper third of the face:

  • Forehead and Glabella wrinkles can be smoothened out
  • Forehead irregularities can be filled
  • Forehead contours can be changed
  • Temporal hollowing can be improved
  • Upper eyelid hollowing can be improved
  • Tear trough deformity and dark eye circles can be improved

Middle third of the face:

  • Malar prominence can be improved
  • Cheek hollow can be filled out
  • Deep nasolabial folds can be filled out
  • Overall lifting of the midface can be achieved

Lower third of the face:

  • Lips can be augmented
  • Jawline can be defined and strengthened
  • Chin projection can be improved
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How is it done - Where is fat harvested?

Liposuction is done to harvest the fat grafts. Common areas for fat harvest include the abdomen, flanks and medial thighs This is performed through sub-centimetre incision in the area of choice.

How is it done - Type of Anaesthesia

Facial fat grafting can be performed under local anaesthesia with or without sedation, as well as general anaesthesia depending on the patient’s comfort level and desires.

For concomitant larger volume liposuction, it may be more comfortable to be performed under sedation or general anaesthesia.

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Preparation of nanofat grafts

How is it done - How is the fat prepared and injected?

The fat grafts are harvested through sub-centimetre incision using cannula.

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Preparation of nanofat grafts

They are then centrifuged to separate out the unwanted components (oil, blood, local anaesthetic and other noncellular material). These fats can be further processed into nanofat grafts for more superficial injections, particularly for facial fat grafting. It can be injected into any areas of the face.

Injection of the fat grafts are in tiny aliquots to the desired areas. Placement of fat in tiny aliquots is crucial to the survival of the fat grafts, as it will allow for adequate blood vessel to supply the fat graft and reduce complications.

Generally about 60-70% of the fat grafts will survive and remain permanent.

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How is Facial Fat Grafting different from fillers or collagen biostimulators?

Placement locations

Fat grafts can be placed into any location over the face. From the deep periosteal layer and the subcutaneous layer as volume enhancement, to the sub-dermal region for as nanofat graft to improve skin quality and wrinkles.

Fillers or biostimulators are not suitable for certain areas of the face due to palpability or visibility.

Longevity

Generally, once the fat grafts survive, they are generally permanent.

With fillers or biostimulators, they generally last for a period of 6 to 12 months, with some biostimulators lasting 24 months. These will need to be repeated within a shorter time frame.

Volume injected

The amount of fat harvested is more than sufficient to rejuvenate the entire face in the same setting. Often the volume of fat graft injected into the face can range between 5ml to 30ml depending on your facial assessment.

Fillers come in 1ml preparation and Biostimulators come 8ml preparation. The volume of filler/biostimulator used will depends on what you want to achieve and your budget.

Procedural comfort

With fat grafting, an additional area will need to be anaesthetised for the harvest of the fat graft. This is commonly the inner thighs or the lower abdomen. This can be done by simply injecting local anaesthetic agent into the area involved, or if you prefer, we can arrange for sedation for you.

With fillers or biostimulators, generally only topical numbing cream is sufficient.

Where else can fat grafting be used?

Fat grafting by volume:

    • Small volume <100ml is generally for facial rejuvenation
    • Moderate volume 100-300ml for body contouring and breast contouring
    • Large volume >200ml for buttock augmentation

Fat grafting by location:

Facial aging and volume loss

Fat will improve the texture of the skin, improve skin thickness, reduce wrinkles, reduce pore size and improve facial scarring.

Fat grafting by location:

Breast augmentation

This can be done as a primary procedure to increase the size of the breast by about half to one cup size each time. The procedure can be repeated till the desired results are achieved. It can also be used as a hybrid augmentation together with breast implants to further enhance certain areas like the cleavage.

Fat grafting by location:

Back of the hands

An often-overlooked area that does reveal our age. With fat grafting, it can fill out the hollows between the fingers to give the hands a younger and fuller appearance.

Fat grafting by location:

Any scars that are indented

A combination of treatment with subcision and filling with fat graft will improve the overall contour.

Fat grafting by location:

Previously irradiated tissue and chronically inflamed tissues that are stiff and inelastic

Free fat grafting can bring in soft pliable fat cells that act as an additional layer of cushioning, and together with the adipose-derived stem cells that it brings in, it can also stimulate new growth.

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What you should Avoid Before and After the Surgery

Certain medications like blood thinners, aspirin, non-steroidal anti-inflammatory drugs, certain supplements that cause bleeding should be stopped.

Smoking will affect the fat graft survival and should also be stopped for at least 4 weeks before and after the surgery.

Avoid deep massage to the grafted areas, as it can cause the fat grafts to migrate or undergo necrosis.

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Frequently Asked Questions about Fat Grafting

Yes, it looks and feel very natural. Fat is naturally present in our body and the fat grafts will be placed in areas where we naturally have fat. Furthermore, once the swelling has settled, the fat will be indiscernible from your native fat. It generally takes about 3 months for the swelling to subside, over these 3 months, you will continue to see improvements.

Yes, this is almost scarless. The tiny incisions used to harvest the fat and to inject the fat are sub-centimeter. Once they heal, they are barely visible. Additionally, with scar management, these scars will be barely visible.

Most people are suitable for fat grafting as we all have localized fat in areas of our body.

During the consultation, we will discuss which areas are most ideal to harvest the fat from. This is dependent on the volume required for fat grafting. We will also evaluate your pre-existing medical condition and fitness for sedation or general anaesthesia, to ensure that it is safe for you to undergo the procedure.

This procedure takes less than 1 hours. For facial fat grafting, it can be done in the clinic procedure room under local anaesthesia or sedation.

During the surgery, local anaesthesia will be administered to the areas involved. Sedation can also be arranged for you if you prefer. The area may feel sore after the surgery, but this is easily managed with oral analgesia.

Common side effects are swelling and bruising. About 70% of the fat graft will survive, the remaining fat graft that does not survive will eventually be broken down and removed by the body. During this process, there may be a period of lumpiness or cyst formation. There is also potential risk of asymmetry, skin irregularities as well as infection. Sometimes a touchup procedure maybe required.

Generally, about 70% of the fat graft will survive and remain in the grafted areas permanently.

There will be bruising and swelling in the area of fat harvest and grafting. These will generally settle down after 2-4 weeks. There will be some discomfort that is easily managed with oral analgesia. The overall downtime is less than 1 week.