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Fat Grafts – Fat Transfers for Volume Correction and Hollowing

One of the major aspects of facial aging is volume loss, and much of that is due to the gradual diminishment of fat (medically known as buccal fat, but commonly referred to as “baby fat”).

It leads many people to conclude that lost fat in the facial area, that once gave a youthful appearance, should be replaced by fat from other parts of the body, such as the thigh or abdomen. However, the fat transfer/fat graft procedure is not that simple or straightforward. Since fat is a physical volume that needs a blood supply (unlike hyaluronic acid synthetic fillers), it is unpredictable if that volume will take the way the doctor wants it to. Fat transfers should only be done where the skin is thick, such as the lower face, and not where skin is very thin, like the lower eyelid area.

lumps after fat grafting illustration
FAT GRAFTING UNDER THIN EYELID SKIN CAN SHOW THE LUMPY, INCONSISTENT SHAPE AND TEXTURE OF FAT. REVISING EFFECTS OF FAT TRANSFER UNDER THE EYES REQUIRES EXTENSIVE SURGERY.

Appropriate Areas for Fat Grafting

Lower Face Fat Transfer

Fat transfers can be done successfully around the mouth and lower cheek area where the skin is thicker. We use this regularly to treat the deep folds around the lower mouth area called mesolabial folds, or commonly referred to as “marionette lines”. Lines that form at the corners of the mouth can also be treated with fat grafts in the same treatment session. The corners of the mouth are called nasolabial folds, and are commonly referred to as “parentheses lines”.

before and after fat transfer for volume loss
MESOLABIAL FOLDS (MARIONETTE LINES) AND NASOLABIAL FOLDS (PARENTHESES LINES) TREATED WITH A FAT TRANSFER BY DR. AMIYA PRASAD
before and after fat transfer for volume loss
MESOLABIAL FOLDS (MARIONETTE LINES) AND NASOLABIAL FOLDS (PARENTHESES LINES) TREATED WITH A FAT TRANSFER BY DR. AMIYA PRASAD

This area can also be treated with hyaluronic acid fillers like Restylane and Juvederm to produce similar results. Treating volume loss with hyaluronic acid fillers is more economical since there are no extraction or purification processes needed. Hyaluronic acid fillers also have more predictable results, and are easier to remove using a dissolution enzyme called hyaluronidase if too much is applied.

Fat Grafting on Upper Eye Area/ Sub Brow

Volume loss due to facial aging can affect the sub brow area, leaving a hollow appearance above the eye. Fat transfers can be made to the area near the eye socket as the skin here is thicker, as opposed to the nearby upper and lower eyelids where skin is the thinnest. Dr. Prasad does not advise fat transfers in these areas where the skin is too thin.

before and after fat transfer to sub-brow to address hollowing
FAT TRANSFERRED TO AUGMENT VOLUME LOST FROM FACIAL AGING. FAT IS TRANSFERRED TO THE THICK SKIN OF THE SUB-BROW AREA, NOT TO THIN UPPER EYELID SKIN.
before and after fat transfer to sub-brow to address hollowing
FAT TRANSFERRED TO AUGMENT VOLUME LOST FROM FACIAL AGING. FAT IS TRANSFERRED TO THE THICK SKIN OF THE SUB-BROW AREA, NOT TO THIN UPPER EYELID SKIN.

Hyaluronic acid fillers can also be applied in place of a fat transfer in these areas.

Fat Transfer to Hands

Hands are prone to volume loss due to aging as they are constantly exposed to environmental elements that accelerate aging, such as sun exposure and loss of moisture. The thick skin of the hands make it an ideal place for fat grafting to give them a more youthful, plumper appearance. Added volume from a fat graft also smoothes out the appearance of lines and wrinkles on the hands that become more pronounced when fat diminishes.

Fat transfer to hands before and after results
FAT GRAFTED TO HANDS TO ADD YOUTHFUL VOLUME LOST FROM SKIN AGING.
fat transfer to hand before and after
FAT GRAFTED TO HANDS TO ADD YOUTHFUL VOLUME LOST FROM SKIN AGING.

Fat transfers to the hands are often complemented by platelet-rich plasma (PRP) injection treatment to improve the skin quality and further enhance volume.

Fat Transfer Complications and Limitations

Fat transfers are essentially grafts of fat taken from parts of the body that commonly have excess fat, such as the thigh or abdomen. The grafted fat is purified before transfer so anything that can cause infection or adverse reactions are removed. However, the purification process does not eliminate complications entirely.

When fat is grafted, it is taken from its natural blood supply. When it is transferred, it is introduced to a new blood supply and may not always take. Since fat doesn’t always take to the new blood supply, it may still scar, become irregular, or even lumpy, which can be seen through the surface of the skin, especially when some doctors do fat grafts on very thin eyelid skin. This is why Dr. Prasad does not perform fat transfers in the eyelid area.

Can I have fat grafted under the eyes to treat hollowness?

People suffering from hollowness under the eyes often consider fat grafting after doing

research online.

They like that fat is natural and can last longer than cosmetic fillers.

Fat grafting can help with volume correction areas where the skin is thick.

I have had good results with fat grafting for hand rejuvenation.

Unfortunately, it can be problematic in the thin skin under the eyes, which is the thinnest in the body.

I’ve observed that many general plastic surgeons offer fat grafting under the eyes.

I will discuss the pros and cons of fat grafting under the eyes, in particular my experience caring for patients who had complications such as irregularities from variable healing, inflammation and scarring.

I’m Dr Amiya Prasad.

I’m a Board Certified Cosmetic Surgeon and Fellowship Trained Oculofacial Plastic and Reconstructive Surgeon.

I’ve been in practice in Manhattan and Long Island for over 20 years.

As I said earlier, it is understandable why people want a natural material like fat to be used to treat under eye hollowness.

They figure it is the lack of fat under the eyes that causes hollowness, so it is logical to put fat back in that area.

They also may think that fat is a natural material from their own body, so their body can accept fat more easily since it’s not a foreign material.

However, when you learn about the nature of fat, you will find that it does not behave like you assume it will.

The term fat graft means that the fat is harvested from its original location such as the abdomen with liposuction.

As a graft, it relies on the local tissue where it is transplanted to receive adequate blood supply so it can survive.

Unlike a cosmetic filler, fat needs to have a blood supply in order to continue to be viable.

If fat does not get adequate blood supply, it breaks down and can cause inflammation and the creation of scar tissue.

In addition, I’ve seen situations where the fat or fatty tissue partially survived and was placed at different levels of the under eye area resulting in highly irregular contour.

Lumps and irregularities are the exact opposite of the goal of creating smooth volume in hollow areas under the eyes.

I also often see people who had fat grafting elsewhere and complain that none of it stayed.

I say to them that they are actually fortunate since there is no need to do additional surgical correction.

As a cosmetic eyelid surgery specialist, I am frequently contacted by patients to surgically remove fat grafts under the eyes.

Removing grafted fat under the eyes is highly specialized procedure, and may take more than one revision surgery.

There are times where I need to actually restore tissue quality under the eyes with regenerative medicine technology such as the application of prp or platelet rich plasma and stem cell based wound healing technology such as extracellular matrix before performing corrective surgery due the degree of compromise in the delicate integrity of the lower eyelid anatomic support.

Fat grafting involves surgical recovery from where the fat was grafted, such as the abdomen, as well as the graft site.

The abdominal recovery is usually not an issue.

Swelling from the placement of fat under the eyes can be significant for weeks to months afterwards.

I’ve seen patients who had persistent swelling from damaged lymphatics years after having fat graft surgery.

People also think that fat from their own body will not cause allergic reactions like filler, or be more accepted by the body than filler.

Hyaluronic acid, which is used in popular fillers like Restylane and Juvederm, does occur naturally in the body.

The chance of allergy is so low that we routinely place filler without having to do any skin testing.

Hyaluronic acid fillers are safely metabolized by the body with time, and can also be easily dissolved using the injectable enzyme hyaluronidase.

In my practice, for under eye hollowness that requires volume correction, I use hyaluronic acid fillers like Restylane or Juvederm.

Softer or less thick fillers are ideal for the under eye area.

I place injectable fillers under the eyes using blunt cannulas instead of needles to minimize the risk of bruising.

Blunt cannulas are less likely to pierce a blood vessel to cause bruising.

Unlike fat grafting, this is a non-surgical procedure and can be done in minutes.

Placement of injectable fillers in a way that is harmonious with the face is an art.

Knowledge and experience as an Oculofacial Plastic surgeon has been very useful for me when I place hyaluronic acid fillers.

When it comes to lower eyelid aesthetics, I also look at the front of the cheek in an area called the eyelid-cheek junction.

Sometimes, volume loss at the cheeks may leave filler placed under the eyes without proper cheek support.

In such cases, I also add volume to the cheeks to support the under eye filler, and also improve the global look of the whole face.

After placement of hyaluronic acid filler under the eyes, there is little downtime.

Most patients don’t experience any bruising, so they can return to their normal activities afterward.

Some swelling can be present from the use of local anesthetic.

Swelling from injectable fillers is usually minimal, and if present, can resolve within the first week.

If, for any reason a hyaluronic acid filler needs to be removed, it can be easily dissolved with an enzyme called hyaluronidase.

Although most patients look good immediately after filler placement, I see my injectable filler patients two weeks after the original procedure to see how the filler has settled, and if any enhancement is needed.

Injectable fillers under the eyes can last up to a year before gradually being metabolized by the body.

In my opinion, fat grafting under the eyes is too unpredictable with a higher risk for undesirable outcomes.

Its for this reason, in my practice, I recommend the placement of hyaluronic acid filler which has the advantages of convenience, safety and even reversibility.

I hope you found this information helpful…thank you for your question

Fat Grafting Surgery

Since transferred fat needs blood supply to be viable, between 30-70% of fat grafts can be absorbed by the body. This is the reason that Dr. Prasad advises all his patients who want fat transfers to be prepared for at least two procedures, as further procedures are needed to replace fat that is variably absorbed. To schedule a consultation with Dr. Prasad fill up the contact form below or call us at (212) 265-8877 for NYC office or (516) 742-4636 for Garden City, Long Island office.

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