Fat transfer has been successfully performed for the last 25-30 years. It has a long track record of success with proven permanent results. It has been documented that fat transfers do live through techniques used by many plastic surgeons. Fat transfer has fallen into more respect in recent years. In the past, many physicians and plastic surgeons believed that fat taken from one part of the body and put into another part of the body absorbed in its new location. Photographic documentation has shown this not to be the case, as a few examples have occurred in which a person having had fat transfer into the face gained a significant amount of weight, as much as 80-100 pounds. In locations where the fat transfer took place in the face, the area was actually overly protruding and did not look like a normal contour. These are rare exceptions but, in fact, it is advisable for a person who has had fat transfer not to gain large amounts of weight because the living fat cells that have been transferred into their face can, in fact, enlarge and potentially even distort the area where they are located.
Physicians doing fat transfer need to have experience in performing this procedure, which takes approximately one hour under local anesthesia and should be done in a clean, certified operating room facility. Many physicians who do cosmetic surgery are not equipped to do fat transfer because of the technical considerations and the sterility needed along with the one hour of operating time under local anesthesia. This is why fillers made by pharmaceutical companies have come into favor, in that they take only a few minutes to place into position and can be ordered directly in a sterile vial and injected to fill in soft tissue areas throughout the face; however, all of these are temporary and ultimately do absorb; therefore, in the long-term picture, they are much more expensive. However, fillers are favored by many physicians because they do require a far less degree of surgical skill and are ultimately absorbable, therefore, any over-correction would self-correct after several months. Any filler that is permanent, I feel, is potentially risky because it is a foreign body injected into the face, which could cause problems in the future. Many new fillers are coming into the market on an almost monthly basis. Many have not had a proven track record, and the consumer should be wary of having the newest and latest filler injected into the facial area.
Fat Transfer usually takes one to three sittings in order to increase the subcutaneous tissue where it is injected. Common areas for fat transfer are in the upper and lower lips, laugh lines, frown lines, and cheeks. Fat transfer is also used to fill in soft tissue defects from various traumatic injuries or possibly even cortisone injections that cause fat atrophy in the trunk or extremities. Fat transfer is highly successful. The only uncertainty is whether the end result can be accomplished in one, two, or three sittings. There is an absorption rat of anywhere from 20% to 60% of the fat that is transferred from, let's say, the abdominal or hip area into the facial area; however, a certain portion of the fat does live forever. These are living fat cells and, whether they represent 20% or 50% of the fat that is transferred, they will stay permanently in that location. Fat transfer sessions are usually spaced three months apart and, at that point in time, the experienced physician would know that percent of the fat has survived and what portion of the fat will have absorbed; therefore, a decision is then made between the physician and the patient as to whether any further fat transfers are indicated to get the ultimate result.
In summary, fat transfer is by far the most proven technique and the safest technique to augment various facial features, including the lips, laugh lines, frown lines, and cheeks. As a person ages, fat atrophy occurs throughout the face and often, with age, a person looks thinner. This occurs commonly in all parts of the face and, therefore, fat transfer would be the most logical choice for reversing signs of aging. Fat is taken from areas where normally fat will even be more prominent as one ages such as the abdomen, thighs, or the lower back area. This is one of the favorite spots to take fat from and to transfer it into areas where the normal aging process has led to absorption of fat cells.
Dr. Brian Evans is a board certified plastic and recontructive surgeon practicing in West Hills, California. Dr. Brian Evans's background is wide and varied. He received his medical degree from Case Western Reserve University School of Medicine and has been in practice for more than 20 years. He is one of 4 doctors at Cincinnati Veterans Affairs Medical Center and one of 11 at San Joaquin Community Hospital who specialize in Plastic Surgery.
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