Facial Fat Grafting

Facial Fat Grafting in Singapore

Facial fat grafting is a surgical procedure that uses a patient's own fat tissues to restore volume, enhance facial proportions, and address structural concerns ranging from age-related hollowing to soft tissue defects from birth or trauma. At Argent Plastic Surgery, facial fat grafting is performed by Dr Lee Hanjing, a fellowship-trained specialist plastic surgeon based at Mount Alvernia Hospital. Whether pursued for cosmetic refinement or reconstructive necessity,  the approach begins with an individual assessment to determine if surgery is appropriate for your unique anatomy. 

Facial Fat Grafting
Facial Fat Grafting

What is Facial Fat Grafting (Autologous Fat Transfer)?

Facial fat grafting, medically referred to as autologous fat transfer and facial lipofilling, involves harvesting adipose tissue from a donor site on the body and transferring it to the face. Because the procedure uses the patient’s own living tissue, it is inherently biocompatible and carries little or no risk of allergic reaction or foreign-body rejection. 

Fat is composed of adipose tissue, which includes not only fat cells (adipocytes) but also adipose-derived stem cells and progenitor cells. These cellular components contribute to a long-term rejuvenating effect, supporting natural improvements in skin thickness, cellular health, and overall tissue texture over time.

Depending on your specific anatomical goals, the harvested tissue can be processed and refined to different degrees:  

  1. Structural fat grafting uses larger fat particles placed in deeper tissue planes to restore volume and facial contour. 
  2. Micro fat grafting uses more finely processed fat for precise placement in specific areas. 
  3. Nanofat grafting processes the fat further, producing a finer preparation suited to superficial injections that target skin quality concerns such as fine lines, wrinkles, and enlarged pores rather than volume.

When the transferred fat successfully establishes a localised blood supply and integrates with the surrounding tissue, the results can be long-lasting. This distinguishes autologous fat transfer from temporary options like dermal fillers or collagen stimulators, which break down over time and require ongoing maintenance sessions.

For patients presenting with pronounced skin laxity or advanced sagging, volume restoration alone may produce a heavy or unnatural appearance. In these instances, fat grafting is often considered with a surgical facelift to address both volume loss and structural tissue descent.

Benefits of Facial Fat Grafting

Facial fat grafting has a number of characteristics that make it a useful option for the right patient.

 

  • Biocompatibility: Because the fat is harvested from the patient's own body, there is no foreign material introduced and no risk of rejection or allergic response.
  • Potential Longevity: Once the grafted fat establishes a blood supply and survives the integration process, it tends to remain in place, unlike fillers and biostimulators which are absorbed over time.
  • Stem Cell Activity: The adipose-derived stem cells transferred alongside the fat cells contribute to improvements in skin quality, including skin thickness, texture, and pore size, beyond what volume alone produces.
  • Versatile Placement: Fat can be placed at multiple depths within the facial tissue, from the deep periosteal layer for structural volume to the subdermal layer as nanofat for skin quality, allowing the procedure to address different concerns in a single session.
  • Reconstructive Application: Fat grafting is not limited to cosmetic volume restoration. It is also used to address soft tissue defects arising from congenital conditions, accidental trauma, or tumour resection, where restoring facial contour and tissue quality is the primary goal.

Who Is Suitable for Facial Fat Grafting?

Suitability for facial fat grafting depends on the current facial structure, personal aesthetic or reconstructive goals, and overall medical health. A comprehensive consultation with Dr Lee Hanjing helps clarify whether fat grafting is the appropriate path forward, and whether it should be performed as a standalone treatment or combined with other procedures.

Ideal candidates typically include:

  • Adults with Volume Loss or Facial Hollowing: Age-related fat loss and bony resorption can produce a deflated or sunken appearance that fat grafting may address effectively.
  • Patients with Facial Asymmetry: Where asymmetry arises from uneven volume distribution, targeted fat placement can improve facial balance.
  • Patients with Soft Tissue Defects: Those with defects from birth conditions, trauma, or previous surgery may benefit from fat grafting as part of a reconstructive approach.
  • Patients Seeking Skin Quality Improvement: Nanofat grafting is an option for those whose concern centres on skin texture, fine lines, or pore size rather than volume alone.

Individuals for whom fat grafting may not be appropriate, or may need to be combined with other procedures, include:

  • Those with Significant Skin Laxity or Sagging: Volume restoration in the presence of excess loose skin may produce an unsatisfactory result. A surgical lift may need to be considered either instead of, or alongside, fat grafting.
  • Smokers Who Cannot Stop: Smoking affects fat graft survival and wound healing. Dr Lee Hanjing advises stopping smoking for at least four weeks before and after the procedure. Patients who are unable to stop may not be suitable candidates.
  • Those with Insufficient Donor Fat: A usable volume of fat must be available for harvest. Patients with very low body fat may not have sufficient donor tissue, and this is assessed at consultation.

Common Treatment Areas for Facial Fat Grafting

Fat can be placed across all three zones of the face, with the appropriate technique and depth determined by the specific concern in each area. The procedure addresses both volume loss and skin quality concerns, depending on how the fat is processed and where it is placed.

Upper third of the face:

  • Forehead and Glabella: Volume loss in the forehead can be addressed with fat placement to smooth irregularities and soften deep lines.
  • Temporal Hollowing: Loss of volume in the temples is a common sign of facial ageing that fat grafting may improve.
  • Upper Eyelid Hollowing: A sunken or hollow upper eyelid, often associated with a tired appearance, can be partially addressed with carefully placed fat.
  • Tear Trough and Periorbital Hollowing: The tear trough is one of the more prominent applications for fat grafting around the eyes. Hollowing in the periorbital area contributes to dark eye circles and a fatigued appearance that volume restoration may improve.

Middle third of the face:

  • Malar Prominence and Cheek Hollowing: Fat grafting can restore volume to the cheeks and improve the definition of the malar region, addressing the flattened or drawn appearance that tends to develop with age.
  • Deep Nasolabial Folds: While folds in this area are partly structural, fat placement can reduce their depth and may improve the transition from cheek to lower face.
  • Overall Midface Projection: Restoring volume to the midface can help improve the appearance of overall facial lifting without surgical repositioning of tissue.

Lower third of the face:

  • Lip Augmentation: Fat grafting can add volume to the lips, including in patients who prefer not to use filler or who require a larger volume than filler would typically provide.
  • Jawline Definition: Fat placement along the jawline can help improve definition and contour in patients where volume loss has softened the lower facial border.
  • Chin Projection: Where a modest improvement in chin projection is the goal, fat grafting is one option for consideration alongside other approaches.

If you are experiencing structural volume loss and wish to evaluate whether facial fat grafting is appropriate for you, schedule a consultation with us.

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How Is Facial Fat Grafting Performed?

Fat Harvest

The first stage of the procedure is harvesting the fat from a donor site on the body. Common donor sites include the abdomen, flanks, and medial thighs. The harvest is performed through sub-centimetre incisions using a fine cannula, with local anaesthesia applied to the area. The volume harvested depends on the volume required for grafting and whether any additional body contouring is being performed at the same time.

Fat Centrifugation and Purification

Preparation of nanofat grafts

Once harvested, the fat is processed by centrifugation to separate out the unwanted components, including oil, blood, local anaesthetic and other noncellular material, leaving a concentrated preparation of viable fat cells and associated stem cells.

Depending on the treatment goal, the processed fat may be further refined into nanofat grafts for more superficial injections targeting facial, skin quality concerns such as fine lines, wrinkles, and pore size, rather than structural volume.

Micro-Aliquoting and Injections

The prepared fat is then injected in tiny aliquots to the desired areas. Placement of fat in tiny aliquots is crucial to the survival of the fat grafts, as it allows the surrounding tissue to supply adequate blood flow to each deposit. Injecting in larger volumes reduces the likelihood of successful integration.

Anaesthesia Approaches and Comfort

The anaesthetic approach is determined by the scope of the procedure, the volume of fat being harvested, and the patient's preference. Dr Lee Hanjing will discuss the most appropriate option at consultation.

  • Local Anaesthesia Without Sedation: For smaller-volume facial fat grafting performed in the clinic procedure room, local anaesthesia to the harvest and injection sites may be sufficient for patients who are comfortable with this approach.
  • Local Anaesthesia With Sedation: Sedation can be arranged for patients who prefer to be more comfortable during the procedure, and is generally advisable where a larger volume of liposuction is being performed alongside the grafting.
  • General Anaesthesia: For more extensive procedures, or where fat grafting is combined with other surgical work, general anaesthesia may be the most appropriate option.

On average, approximately 60% to 70% of the transferred fat successfully establishes a blood supply and integrates permanently. The portion that does not survive is naturally broken down, metabolised, and safely cleared by the body's lymphatic system over the ensuing weeks.

Facial Fat Grafting vs Dermal Fillers and Biostimulators

Patients considering facial fat grafting often ask how it compares to dermal fillers and collagen biostimulators. The differences are meaningful and affect both the experience of the procedure and its longer-term outcome.

 

Facial Fat Grafting

Dermal and Hyaluronic Fillers

Collagen Biostimulators

Placement Locations

Can be placed at any depth across the face, from deep periosteal layers for structural volume to subdermal nanofat for skin quality

Not suitable for all areas due to risks of palpability or visibility in certain planes

Placed in specific tissue planes; not suitable for all facial zones

Longevity

Transferred fat that  integrates into the target areas becomes a lasting part of your natural tissue structure. While it offers durable, long-term volume, it remains subject to natural ageing and lifestyle changes. 

Typically last 6–12 months and require periodic retreatment

May last up to 24 months, with effects that are still temporary

Volume Availability

Fat can be harvested in sufficient volume to treat the entire face in a single session; typical volumes range from 5ml to 30ml depending on individual assessment

Available in 1ml preparations; volume used depends on the areas treated

Available in larger preparations; volume used depends on treatment plan

Procedural Focus

Requires anaesthesia of both the harvest site and the facial injection sites; sedation can be arranged if preferred

Typically requires only topical numbing cream

Typically requires only topical numbing cream

Cellular Skin Rejuvenation

The adipose-derived stem cells in the transferred fat may improve skin thickness, texture, and pore size beyond what volume correction alone achieves

No inherent skin quality benefit beyond the filling effect

Some biostimulators work by stimulating collagen production, which may improve skin quality over time

Other Applications of Fat Grafting

Facial fat grafting is one application of a procedure that is used across several areas of the body. In each case, the volume of fat required varies, and the appropriate volume category is part of the surgical planning.

Facial Ageing and Volume Loss

For facial rejuvenation, smaller volumes are typically involved. Procedures in this category generally require less than 100ml of processed fat. Beyond restoring facial proportions, the adipose-derived stem cells within the transferred tissue may contribute to improvements in skin quality, including skin thickness, texture, and pore size, and may improve the appearance of facial scarring.

Breast Augmentation

Fat grafting for breast augmentation surgery typically involves moderate volumes, generally in the range of 100–300ml. As a primary procedure, it can increase breast size by approximately half to one cup size per session. The procedure can be repeated to build toward a desired outcome over time. It can also be used alongside breast implants in a hybrid augmentation, where fat is placed in specific areas such as the cleavage to supplement what an implant alone achieves.

Buttock Augmentation 

For buttock augmentation, larger volumes are required, typically exceeding 200ml, and the procedure is planned accordingly in terms of donor site selection and anaesthetic approach. Fat grafting to the buttocks can help improve contour and projection using the patient's own tissue rather than an implant.

Rejuvenation of the Hands

Age-related volume loss on the back of the hands often causes the underlying tendons and veins to appear prominent through thinning skin. Transferring small volumes of fat (under 100ml) restores a smooth, youthful fullness that traditional topical skincare cannot achieve.

Indented Scars

Scars that sit below the level of the surrounding skin, whether from acne, surgery, or injury, can be improved with a combination approach. Subcision releases the fibrotic attachments that tether the scar, and fat grafting then fills the resulting space to improve surface contour.

Radiated or Chronically Inflamed Tissue

Tissue that has been exposed to radiation, or that has become stiff and inelastic through chronic inflammation, presents a specific reconstructive challenge. Fat grafting introduces pliable, vascularised tissue into an area that has lost its normal properties. The adipose-derived stem cells within the transferred fat may also stimulate new tissue growth and improve the quality and flexibility of the surrounding tissue over time.

Preparing for and Recovering from Facial Fat Grafting

Preparation and aftercare both affect how well the fat grafts integrate and how the final result settles. Dr Lee Hanjing will provide specific instructions at consultation based on the planned procedure. The following outlines the general framework.

Before the procedure:

  • Suspend Blood-Thinning Medications: Aspirin, non-steroidal anti-inflammatory drugs, anticoagulants, and certain supplements that increase bleeding should be stopped in advance. Dr Lee Hanjing will advise on the appropriate cessation window based on each patient's specific medications.
  • Cease Smoking: Smoking impairs fat graft survival and wound healing. Patients are advised to stop smoking for at least four weeks before the procedure.
  • Disclose Medical Conditions: Existing medical conditions and current medications are reviewed at consultation to confirm that the planned procedure and anaesthetic approach are appropriate.

After the procedure:

  • Expect Swelling and Bruising: Both the harvest site and the grafted areas will swell and bruise. This typically settles within two to four weeks, though the final result continues to evolve over approximately three months as swelling resolves and the surviving fat integrates.
  • Avoid Massage to Grafted Areas: Deep massage to the face in the weeks following the procedure should be avoided, as it can displace the fat grafts before they have established a blood supply, leading to migration or graft loss.
  • Continue to Avoid Smoking: The four-week smoking cessation window applies after the procedure as well.
  • Manage Discomfort with Oral Analgesia: Some discomfort at both the harvest site and the injection areas is expected. This is generally manageable with prescribed oral pain relief.
  • Plan for Downtime: Overall downtime is typically less than one week, though social activities that involve close scrutiny of the face may require a longer adjustment period as swelling settles.
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Frequently Asked Questions About Facial Fat Grafting