Facial Fat Grafting

Summary

Facial fat grafting is the augmentation of facial areas that have undergone deflation and descent, or have lost volume as a result of hereditary factors or trauma, with fat grafts harvested from another area of the body.  In essence, facial fat grafting is taking fat from an area of the body you don’t want the fat, having it prepared and injected into areas of the face where facial volume is required. Also see Fat Grafting and Fat Transplantation.

Procedure Details

How is facial fat grafting performed?

The facial fat grafting procedure starts with a consultation with Dr. Mulholland where areas of loss of facial volume is discussed and analyzed.  Dr. Mulholland will recommend the areas of the face that will benefit from facial fat grafting and facial fat transplantation and the techniques for his facial injectable using a small, blunt micro-cannula will be discussed.

On the day of the procedure, local anesthesia is instilled into the donor site or areas where the fat will be harvested.  The most common harvest sites for facial fat grafting include the abdomen, hips, outer thighs and, less commonly, the inner thighs, inner knees and arms.

Figure 1.  Common donor sites for facial fat grafting and facial fat transplantation.  The donor site does not need to be very large for facial fat grafting, as the amount purified fat cells and stem cells needed for facial fat grafting is usually in the range of 20-30cc. Toronto facial fat grafting patients must select, together with Dr. Mulholland the donor site with the most optimal fat for harvesting and transplanting.

A small, blunt harvesting needle is used to harvest the fat graft material.  Once the harvest is completed, the fat grafts are then prepared.  The preparation process includes centrifugation and separation of the fat cells and the stem cells (also found in the fat tissue) from unwanted elements, such as blood serum and local anesthesia.

2A.  A blunt needle is used to harvest the fat cells and stem cells.

2B. The post harvest process can include spinning  the fat cells and stem cells or washing the fat and stem cells and then transferring the prepared cells to grafting syringes.

Figure 2.  The harvest of fat cells and stem cells for facial fat grafting and facial fat transplantation involves using a blunt harvest cannula extract fat cells and stem cells from a donor site under local anesthesia.  2A shows fat cells and fat derived stem cells being withdrawn from a tummy.  2B.  Toronto Facial fat grafting patients then have their harvested fat graft cells “prepared”. There are several methods of preparing fat graft cells and fat derived stem cells for grafting and transplantation to the face.  Figure 2B shows the harvested cells getting centrifuged (spun) to separate the desirable cell fractions or washed and then placed in small facial fat grafting syringes for transplantation to the face.

The prepared fat grafts, including fat cells and stem cells, are placed in small injection syringes. The facial area is then prepped and draped in a sterile fashion and local anesthesia inserted.  Once the local anesthetic is inserted, the fat grafts are expertly placed, using a multiple-level, blunt micro-cannula technique pioneered by Dr. Mulholland.  The fat grafts are injected in very small, toothpick-like structures from just above the bone right through the soft tissue of the face.  Multiple levels and multiple directions are injected and each injection usually involves .1 to .2 ccs of fat graft material, so that no fat cells are more than one millimetre away from a new blood supply.  This very sophisticated and refined technique has been perfected by Dr. Mulholland over the past 20 years, which is why he has a high fat graft survival rate.

Figure 3.  Purified and prepared fat cells and fat derived stem cells are placed in small syringes and a ready for transplantation to the planned facial areas.

Figure 4.  Dr. Mulholland uses very small, delicate, blunt tipped, specialized transplantation cannulas to transfer the purified fat cells and stem cells in his Toronto Facial fat grafting patients. Figure 4 shows the blunt and traumatic nature of these facial grafting cannulas.

Who is a candidate for facial fat grafting and facial fat transplantation?

Good candidates for facial fat grafting are those individuals that have either a hereditary or traumatic loss of volume of their face or have normal aging loss of volume of their face.  These individuals have decided that autogenous and natural volume replacing using their own fat is the best option for them, as opposed to artificial silastic or silicone facial implants.

Good candidates for facial fat grafting have donor fat in areas of excess that they can donate to their face, where they have lost localized or generalized volume.

Contraindications for facial fat grafting would be those individuals who are either unrealistic or may be pregnant at the time of the treatment or have inflammatory, infectious or cancerous lesions either from the donor site where the fat is harvested or the recipient site where it is placed.  During your consultation with Dr. Mulholland, all the various zones and buttress zones of support will be reviewed. Dr. Mulholland has pioneered volume replacement, called the Volumalift, with fat grafting and non-fat grafting techniques.  He will outline the areas of facial volumization, using fat grafting and fat transplantation, that your aesthetic contour will most benefit from.

Figure 5.  There are common areas of age related facial volume loss.  These buttresses of support can benefit greatly from facial fat grafting and fat transplantation. Toronto facial fat grafting patients will meet with Dr. Mulholland to decide which facial support buttresses and areas they would most benefit from facial fat grafting and facial fat transplantation.

What is the fat distribution in a youthful face?

A youthful, fresh looking face has nice skin with contours that are supported by facial fat tissue and fat buttresses over lying the underlying bone. Dr. Mulholland divides these fat buttresses of support and beauty in to the Supraorbital-temporal (above the eye extending into the temple), Infra-orbital (below the eye), Malar zygomatic (cheek and cheek sweep), Perioral (smile line, lips and marionette lines) and mandibular buttress (jawline). In youth, these buttresses are full and supportive. As we age, these buttress lose fat, deflate (like air out of a balloon) and the overlying skin, now without fat buttress support sag, droop and descend, giving rise to lax facial skin.

Figure 6.  6A.  A  youthful face is supported by facial fat buttresses that lay on top of the bone and give rise to the attractive facial curves and contours we associate with youth and beauty, also known as the “fullness of youth”. 6B.  It is the underlying fat buttresses that provide this support and youthful contours.

7A. Age related loss of Fat. 7B. The loss of fat, like “air out a balloon, results in sagging and descent of the skin overlying skin.

Figure 7. Age related loss of fat results in loss of facial fat buttresses. Without this overlying fat buttress support, the deflation results in a descent of skin and soft tissue giving rise to facial laxity.

How and why does the face lose fat. Where does it lose fat?

There are many factors that lead to facial fat loss, including the normal aging process, where there is a natural catabolic or break down of face and body fat. Other factors can include hereditary factors (fat loss and laxity run in the family),  over exercising and weight loss and certain fat wasting diseases or medications.  Of course, Dr. Mulholland will rule out any reversible causes of facial fat loss, before you would consider facial fat grafting or fat transplantation.  The common patterns and locations of facial fat loss using can be divided into the upper face (around the eyes, temples and cheeks) and lower facial areas, (around the mouth and jawline).

Figure 8.  Toronto Fat grafting patients usually present to Dr. Mulholland complaining of an age related loss of fat which often starts in their 40’s, progresses through the 50’s and gets most advanced in their 60’s and 70’s.  Facial Fat grafting to the areas of volume loss helps to restore soft tissue buttress support and fills out areas of hallowing and provides a natural facial structure and volumization. It is important to seek out a plastic surgeon with years of experience in creating facial volumization, to avoid the “dreaded Filler Face”.  Dr. Mulholland has been a pioneer in injectable facial volumization and has taught doctors through the United States, Canada and the world his VolumaLift technique using fat grafting for facial shaping.

Is facial fat grafting just for women, or do men undergo facial fat grafting?

Men can also under go natural facial fat loss, though not a pronounced as in women and is usually in 1-2 buttress and is not a pan-facial as in women. From an aesthetic perspective, as men age, a strong jawline and neck angle is important, where fat volume replacement of the cheeks and mid-face is usually a “feminization” procedure and usually to be avoided in male facial rejuvenation. The under eye fat buttress is occasionally involved in volume loss in the male and may benefit from fat grafting.

Figure 9.  Males undergo age related fat loss, but is usually less pronounced than women and only selected buttresses benefit from fat grafting to avoid “feminization” of the aging male face.

What kind of anesthetic is used for facial fat grafting?

The most common anesthetic used during facial fat grafting and facial fat transplantation is local anesthesia, combined with oral sedation.  Local anesthesia is instilled into the donor site to ensure the harvest is painless, as well as the recipient site, rendering the procedure very comfortable.  For patients who are excessively nervous, or are undergoing other procedures in addition to fat grafting, then Intravenous sedation (twilight sedation, as is used during colonoscopy) can be used, only rarely if a full general anesthetic used.  SpaMedica is a fully government certified outpatient and over night surgery centre, offering Dr. Mulholland’s plastic surgery patients 20 years of excellence and safety.

Is facial fat grafting and facial fat transplantation painful?

Facial fat grafting is generally not painful.  Once the local anesthetic and oral sedation has been deployed and has taken full effect, patients feel no discomfort or pain. Like going to the dentist, the “freezing” hurts briefly, then the procedure is painless.  Following the facial fat grafting and facial fat transplantation procedure, there is swelling and bruising but very little discomfort.

How long with my facial fat grafting and facial fat transplantation last?

Dr. Mulholland deploys a precise “structural fat grafting” technique during his VolumaLift facial fat transplantation procedure.  The goal of facial fat grafting and fat transplantation in general, is to perform an a-traumatic harvest, fat cell and stem cell preparation process and then gentle a-traumatic injection technique that optimizes graft and transplanted fat cell and stem cell re-vascularization, or picking up a new blood supply, so that the transplanted fat cells and stem cells can live for many years. In structural facial fat grafting, blunt nosed tip micro fat graft cannulas are used to place the grafts in “structural rows’, like tooth picks in sequential layers providing structural support to the overlying facial soft tissue.  This precise technique of “structural fat grafting” relies on placing small “toothpick” sized parcels of fat cell and stem cells close enough to each other so they provide smooth, support and shape, but far enough away from each other that they can pick up a blood supply (neovascularization) so that the grafted and transplanted fat and stem cells can live for many years.  If the grafted and transplanted fat cells and stem cells fail to pick up a blood supply, they will not survive and not contribute to structure, shape or volumization. Dr. Mulholland is a pioneer and recognized world expert in facial volume restoration, facial fat grafting, fat transplantation and Volumalift procedures.  Fat Grafting and fat transplantation is highly technical and requires experience and skill.

Figure 10.  Toronto facial fat grafting and facial fat transplantation patients undergo a “Structural Fat Grating” technique.  During structural facial fat grafting, the small, blunt tipped fat grafting cannulas are advanced through the deflated facial soft tissue. Then, upon the retrograde motion, small “tooth picks” of fat cells and stem cells are placed within the soft tissue.  This technique places the grafted fat cells close to the soft tissue, to receive a new blood supply and, as the blunt tip cannula is with drawn and the fat cells deposited, the localized soft tissue closes around the transplanted fat cells and stem cells to stabilize them, so they do not migrate or move elsewhere when grafted.

Figure 11.  A. Layered “Structural Fat Grafting” results in smooth results and support of overlying contours.  B. Each layer of Fat graft cells and transplanted stem cells must be within  1-2 mm of host tissue, to ensure a new blood supply can be picked up, a process called neovascularization.  Fat cells survive by simple nutrient diffusion until a new blood supply can occur. Simple diffusion of nutrient, called cellular imbibition, is only successful if the fat cells and stem cells are no more that 2 mm in width.

Will there be lumps or bumps after my facial fat grafting?

Excellent facial “Structural Fat Grafting technique”, places fat cells in multiple, sequential layers, like “stacks of tooth picks”, which results in very smooth contours and optimizes the grafted fat cells and stem cells picking up a blood supply.  The fat should not be injected in round globs, or spheres, or the inside cells with not get a blood supply, will die and the outside cells may live and the results can be “bumpy and lumpy”.  To avoid this, it is important to select a plastic surgeon with years of facial fat grafting and facial fat transplantation experience and an excellent reputation performing this procedure.

Figure 11A.  Fat grafts and fat transplants should NOT be injected in large round spheres or globs or the centre will undergo a necrosis or death from a lack of a blood supply. This will result in lumpy, bumpy scar tissue. This is a bad result that occurs from poor technique and highlights why you should seek out an experienced facial fat grafting plastic surgeon.

Figure 11B. Smooth, sequential layers of “tooth pick” sized fat grafts is the goal of “Structural Fat Grafting” and results in a smooth restoration of contour. It avoid “lumps” and “bumps” and optimizes early diffusion and then a return of a blood supply and thus long term fat graft survival.

Can the facial fat grafts migrate or move once transplanted?

There is a common belief that fat grafts can migrate or move once transplanted or grafted. If Structural Fat Grafting is performed, fat cells moving elsewhere, falling or fat graft migration is not possible. During the “Structural Fat Grafting” procedure, Dr. Mulholland slowly withdraws the blunt tip micro cannula and lays down the small “tooth pick” sized packet of fat and stem cells. As the cannula is withdrawn, the host soft tissue wraps around the grafted fat cells and stabilizes them so they become incorporated in this secure soft tissue recipient tunnel and cannot move, shift, migrate or move.  Over many years, if the entire soft tissue envelope deflates and shifts or descends, then the now incorporated grafted fat cells will as well as they are “one with the tissue”.

12A. Structural Fat grafts, once incorporated can be depressed and deformed

12B. The fat graft cells have become incorporated and stabilized in host soft tissue tunnels and will respond with normal return of shape and form once depressed or deformed.

Figure 12.  Facial fat grafting performed with Dr. Mulholland’s Structural Fat grafting technique will result in soft, smooth structural volume restoration.  Each “tooth pick” row and layer of structural fat grafting and fat transplantation is stabilized inside its own host soft tissue tunnel where it attaches and gets its own new blood supply.  Once the structural Facial Facial Fat Grafts and Fat Transplants have survived and picked up a blood supply, they then behave like normal tissue, in that, when pushed, depressed or deformed, it will rebound to its normal shape with the force removed.  Structural Facial Fat Grafting, performed with Dr. Mulholland’s techniques and principle outlined on these webpages, do not migrate or move.

Can facial Fat grafting be combined with other cosmetic facial plastic surgery procedures?

Facial fat grafting and facial fat transplantation is quite commonly combined with other procedures. The ancillary or additional procedures can include completion liposuction to the donor sites or other sites and other body contouring procedures such as tummy tuck or breast augmentation, either Natural Breast Augmentation, or with Saline or Silicon Cohesive Gel Breast implants.

Other common adjunctive or ancillary aesthetic plastic surgery procedures that can be performed at the same time as facial fat grafting or facial fat transplantation include any synergistic cosmetic facial plastic surgeon procedures.  These synergistic fat grafting procedures often include:

Blepharoplasty

Endoscopic Browlift

Mini-Facelift or Midfacelift

Facelift or Necklift

ThreadLift

Fractional  Resurfacing

How long does the facial fat grafting procedure take?

Facial fat grafting takes approximately 30 minutes to harvest the fat and 30 minutes to inject the fat.  If facial fat grafting is the only procedure performed, it takes approximately 1 to 1.5 hours.  However, most facial fat grafting patients are also undergoing other concomitant synergistic treatments,  such as fractional resurfacing, thread lift surgery, mini or more standard facelift surgery, as outlined above and this will extend their treatment duration.

How long is recovery following facial fat grafting?

Facial fat grafting and facial fat transplantation does result in a lot of inflammation and swelling. The micro dissection with the blunt cannula results in swelling, as does the release of free fatty acids from the fat cells that do not survive, so post operative swelling and bruising are the most common side effects of the procedure.  It is recommended that most Toronto facial fat grafting patients take one week off following facial fat grafting, until the swelling subsides and they can return to activities of normal living.

What kind of results can I expect following my facial fat grafting?

Dr. Mulholland has 20 years of experience in facial volume restoration and fat grafting and has achieved world wide recognition as an expert in the techniques of facial fat grafting. Dr. Mulholland has a high degree of success following facial fat grafting.  In most areas of the face, between 30% and 60% of the facial fat grafts will survive.  In more mobile areas, like the lips, fat graft survival is less, but significant. In the immobile areas, like above the brows, the temporal areas, the bridge of the nose, under the eyes, along the cheeks and along the jawline, a high degree of take and longevity occurs.  In most successful fat grafting procedures, patients will find that their fat grafting results last several years.

However, the normal aging process is one of deflation or loss of facial fat. As Toronto fat grafting patients age, they will lose their normal non-grafted facial fat as well as the grafted facial fat and repeat procedures every few years may be required to maintain an optimal facial volume.

Figure 13.  A Toronto facial fat grafting client and patient of Dr. Mulholland.  This patient underwent 40 cc of facial fat grafting and facial fat transplantation to the undereye and cheek, as well as a synergistic upper lid blepharoplasty(upper eye lid surgery), as well as a mini-brow lift and a lower lid blepharoplasty.  The post photo is at one year and shows stable fat graft survival in the cheeks and under eye.

What are patients saying about their facial fat grafting procedures?

Most well-selected SpaMedica facial fat grafting and fat transplantation patients are extremely happy with their facial fat grafting.  The restoration of volume and proportion is one of the most important ingredients in a youthful and natural-looking face.  Fat grafting combined with other non-excisional treatments such as Botox Injectable and fractional resurfacing and thread lifts can improve the result and fat grafting in the T-zone at the time of facelift surgery is one of the standards of Dr. Mulholland’s facelift and mini-facelift approach.

Figure 14.  The same Toronto Facial Fat grafting patient as in Figure 13., but in this view at one year you can see the stable long term improvement in cheek contour and shape provided by facial fat grafting and fat transplantation, in addition to the fat volumization around the mouth.

How long will the results of my facial fat grafting last?

Once you have successful “take”, or return of blood supply of your fat cell and stem cell grafts, good long-term results can be achieved.  In general, facial fat grafting to the non-mobile areas of the face, such as the temple, above the brow, bridge of the nose, under the eye, cheeks and jawline can last three to five years.  In more mobile areas, such as the lip and smile lines, fat grafting results are generally in the one to two year range.  Because the normal facial aging process is one of deflation – a loss of facial fat volume, both ungrafted and grafted fat – it is expected that patients who have a nice improvement following facial fat grafting may require another session or multiple sessions every three to five years.

Figure 15. New blood vessels are shown growing into the grafted and transplanted fat cells and stem cells.  Soft tissue stabilization and rapid neovascularization (new blood supply) are two of the important principles of “Structural  Facial Fat Grafting” or fat and stem cell transplantation. With a new blood supply, long term survival of the grafted fat cells and transplanted stem cells is ensured.

What are the common side effects or complications of facial fat grafting?

The most common side effects of facial fat grafting is swelling and bruising. In general, the swelling and bruising can be significant (similar swelling to a wisdom tooth extraction) and 7-10 days should be allotted for recovery. Taking anti swelling and bruising medication may be recommended. Persistent exacerbation of under eye swelling can rarely occur following fat grafting to the under eye and if this occurs, adjustment, reduction or removal of the grafted and transplanted fat cells may need to be performed

Performed expertly, there are very few serious complications of facial fat grafting, but reported complications include lumps, irregularities, asymmetry, complete loss of the fat grafts and localized infection around the nose and eye, even blindness has been reported. The best way to avoid or minimize moderate or serious complications is to choose the right surgeon, with years of experience performing facial fat grafting, with a very low complication rate and a great reputation.

If I don’t like the results of my facial fat grafting, can it be removed or reduced?

The good news is YES, Dr. Mulholland has perfected specialized injectable techniques to reduce any areas where there may have been too much fat cell graft survival. Through the injectable use of customized formulations and concentrations of Phosphatidyl Choline, Deoxycholate and corticosteroid, Dr. Mulholland can adjust results of facial fat grafting as needed and the fat graft cells can be reduced or even completely removed.

How much will my facial fat grafting and facial fat transplanting cost?

The cost of facial fat grafting is generally in the $3,000-to-$7,000 range, depending on all the areas of facial fat grafting performed and the amount of fat needed to be harvested and the number of donor locations accessed and management of the donor site.  Some patients also combine multiple-zone body liposuction at the time of facial fat grafting and this will increase the cost of the procedure, but volume procedural discounting for the liposuction areas is offered.

Why choose SpaMedica and Dr. Mulholland for my facial fat grafting and facial fat transplantation?

Dr. Mulholland and SpaMedica have been at the forefront in pioneering of facial fat grafting and VolumaLift techniques. He has taught doctors from around the USA and world fat grafting and fat transplantation techniques. Dr. Mulholland is one of the pre-eminent plastic surgeons in Canada and one of the busiest facelift and face and body fat grafting practices in the country.  By selecting Dr. Mulholland, Toronto facial fat grafting patients get the experience and technical skill required to optimize your result, as well as the aesthetic judgment to ensure that result is natural and attractive and beautiful.

Next Steps

To schedule a consultation for facial fat grafting and fat transplantation, simply call 877-695-2835 or fill out and the e-mail consultation request form and a SpaMedica client service representative will respond promptly.

Schedule a consultation today to restore natural facial volume, proportion and beauty.