We are all seeking the “holy grail” of anti-aging and one of the most frequent questions I’m asked by patients for whom I recommend using fillers is, “what about injecting my own fat for that?” Isn’t that permanent and therefore less costly?
The short answer is no. The more intelligent response follows:
1. Fat injections are not permanent in most cases, at least not with a single treatment
Firstly, while you might think you wanta permanent filler, what looks good at 30 or 40 may look awful and unnatural at 50 or 60. We aren’t permanent. Our faces and bodies are made of living tissue that is constantly changing as we age. Something that looks great after your treatment today, in five years invariably doesn’t look as good, and can even look really bad, after mother nature does her bit on your face (if you’re lucky). Nonetheless, the permanence of fat is a misconception:
When fat grafting is successful in the face, we consider it “permanent” after about 8-12 months. Just like fat elsewhere in the body, however, if you gain or lose weight, those fat cells will enlarge or shrink. Watching your weight becomes that much more important, as you don’t want a face to get bigger in certain areas as your weight increases. But most patients require several treatment sessions until the grafted fat survives in quantities where it even makes a noticeable and natural improvement.
The reality I have observed over my 24 years of practice was summarized nicely in this month’s premier evidence-based medicine magazine on plastic surgery, “The Journal of Plastic and Reconstructive Surgery” wherein the authors reviewed all the research studies on fat grafting to date. They concluded that fat cells can resorb as much as 70% of the time. The results from injections may be replaced in some cases entirely by necrotic or dead cells, and that inflammation–mere swelling–may be the only real success of a fat injection at all. In short, fat grafting comes with no guarantees.
While there is one “permanent” FDA approved product in the US for cosmetic treatments of the face (now Belofill, previously named Artefill, useful in certain applications) it is not reversible, is not widely used, and I choose it only for selected treatments.To date, there is no non-surgical modality to correct unsightly fat (should it end up in your face) though several new injectable agents are in the FDA approval pipeline for selectively dissolving fat; should these prove effective in their applications, the indications for using fat may change.
Many of the common facial fillers such as Voluma, Restylane, Juvederm are both lasting, and easily reversible with an enzyme, hyaluronidase, that dissolves the product within several hours. This group of Hyaluronic Acid based fillers are therefore ideal for first time patients who are nervous that they won’t like the results, or are comforted by knowing that some, or all, of the product can be dissolved if they are unsatisfied.
2. Fat injections are not more “natural”
The fat cells in your flanks, thighs and buttocks are all slightly different from each other, and from the fat that you have (and lose) in your face; injecting these fat cells from one body area to another is not exactly natural. On the other hand, off the shelf fillers are usually designed to be well tolerated by the body because they are purified versions of the body’s own building blocks (hyaluronic acid, calcium and collagen, for instance, are all naturally occurring) making for a low risk treatment with high patient satisfaction, good bio-compatibility, and the ability to customize the procedure to the exact tissue response in the location of treatment.
Long-lasting injectable products like Sculptra can be a great solution for those who want a “natural” product, as it simply stimulates your body to form its own collagen in the locations where it is injected. To maintain the results and continue to look your best, a maintenance treatment every year or two is ideal, and during those treatments, the product is placed in the location it is needed at that time, thus ensuring the best, most natural looking result.
3. Fat is unpredictable
In addition to there being no guarantees that a fat graft will even take, fat is finicky. It needs to be “overcorrected” (due to its high resorbing rate), and after a fat graft your face will look very puffy for several weeks (or longer), bruised (the cannulas we use are larger than the fine needles and cannulas we can use with today’s fillers), and when it settles, hopefully enough of it will be viable to give a long term result.
Because it is so unpredictable, asymmetry, uneven contours and bumps usually require more surgery or hiding the imperfections with fillers.
On the other hand, fillers provide a wide selection of tools available to finely treat each area of the face: some to lift, other to shape and contour, some to tighten skin, and yet others for fine lines. There is usually no down time, and the results are far easier to control and maintain.
When it’s a good idea to use fat
So when is fat a “good” idea? In patients having liposuction for example, where we are already harvesting fat, it can be injected in areas of the face such as the cheek or chin or for asymmetry with the understanding that often areas won’t “take”, and that most patients require several treatment sessions until the grafted fat survives in quantities where it makes a noticable and natural improvement. Additionally, in patients having face-lifting procedures where they’ll be very bruised and swollen anyway and volume is needed for a balanced result, using fat may be a viable option, (at least as far as recovery time, etc. for the patients). We carefully counsel patients that it is common to either need more fat injections for the grafts to “take” in a natural appearing fashion, and patients should expect that we’ll be using other injectable synthetic fillers to treat surrounding areas as needed.
While adverse events are much higher with fat injections compared with the new injectables, both can result in rare but serious complications including blindness and skin or soft tissue death (if the product is injected into a vessel by mistake), and lumpiness or uneven results. Only skilled, experienced and artistically talented physicians or surgeons who are dedicated to treating the face should perform even these “minimally invasive” procedures.
Aesthetic medicine is an exciting and quickly advancing field requiring an artistic eye and a scientific mind. It is ever changing, and brings great satisfaction for well trained, board certified doctors who are passionate about fusing art and science, and for patients who want to look and feel their best. But both must be prepared to embrace the challenges and opportunities that each new decade brings.