By Samuel M. Lam, M.D., F.A.C.S.
Besides wrinkling and gravity, volume loss to the face has become increasingly recognized as an important component to the aging process, which can be restored with either office-based fillers or facial fat grafting.
Fat grafting, through a gentle hand-harvesting method, purification process, and microdroplet injection technique, has shown to improve durability compared with older techniques that could compromise transplanted fat longevity.
A metaphor can help people understand the role of fat grafting: when we are young we are a full, ripe grape and as we become older we deflate into a raisin. The question then is why should we cut and pull the raisin into a pea, when we should think about reinflating it back into a grape. Clearly, fat grafting is not a treatment for all aging, just the part that involves loss of volume.
Volume loss is particularly more pronounced around the eyes, cheeks, and jawline, where fat grafting can play the greatest role in creating a balanced and comprehensive rejuvenation strategy for the face that may include blepharoplasty (cosmetic eyelid surgery) and/or a facelift.
Fat grafting involves removing fat from one’s own abdomen or thighs to put into certain regions of the face that start to lose fat. Only tiny amounts of fat are removed so this should not be equated with liposuction. Using blunt cannulas (which are 1 mm hollow tubes with a blunt end and a small hole through which the fat comes out) the fat is injected as little droplets throughout the areas of facial hollowness. By using this microdroplet technique, grafted fat has a much higher blood supply so that survival is improved and the results are smoother given how small each individual fat parcel is.
To understand the role of fat grafting, we have to evaluate the general shape of a face as it matures. Oftentimes, when we look at a face we can immediately perceive the age of someone without even seeing wrinkles or gravity. Why is this? It has a lot to do with overall facial shape. A child, no matter how thin, tends to have a round face. That roundness is attributed to the abundance of baby fat that tends to stay until one’s late twenties.
Many women actually like the shape of their face better in their early 30s because they have lost a lot of their baby fat and start to have more of a triangular heart shaped face. As one continues to age the loss of fat in the eyes, cheeks and jawline, including some weight gain in the lower face, neck, and jowls starts to invert the triangle so that the base of the triangle is now at the bottom of the face. Conceptually, the goal of facial fat grafting is to invert the triangle so that the heart shaped face of youth returns.
Volume restoration for the face also adds more light to the face, which in turn can make the skin look more radiant. Adding fat back to the face can even begin to help the skin texture and tone through what is thought to be a stem-cell response that the skin undergoes over areas of transplanted fat. This phenomenon is only speculated and is not conclusive but can be evident towards a year following fat grafting.
Fat grafting also appeals to many prospective patients, as it is minimally invasive and does not require any traditional facial incisions. With a global perspective on the aging process, fat grafting has assumed a more prominent role in our ability to combat the signs of aging.
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