It seems that our society mostly looks upon fat with disdain. There are millions, perhaps billions, of dollars spent annually trying to get rid of it, and indeed, I participate in that process too. But, there are some times when fat can have a beneficial effect and actually be something patients want more of.
As we age, some areas of the face lose fat while others gain. The fat pad in the upper cheek tends to shrink and move downward. We usually gain fat along the jawline contributing to formation of a jowl. The neck almost always accumulates fat, especially centrally under the chin. To reverse these changes, the modern facelift not only addresses skin excess, but also modifies the fat distribution in the face to generate a youthful, and natural appearing result.
The youthful cheek should be full (convex) in the upper portion, and more concave just below. In architecture, this is called an ogee curve. It is a pleasing shape to the human eye. As the cheek fat pad loses volume and descends, the cheek contour becomes more flat. Both surgical repositioning of the cheek fat pad and restoration of its volume with fat grafting can have a powerful effect on this area. In some cases, dermal fillers, such as Restylane® or Juvederm®, may offer enough volume to restore the youthful curve. A new product, Juvederm Voluma XC™, has recently been FDA approved for this specific purpose. Our early experience with it has been favorable. It is important to note however, that dermal fillers are always temporary and eventually wear off.
Fat grafting has become a core technique in my practice and that of many other plastic surgeons. We primarily use it to restore volume to the face. Not only the upper cheek, but also folds around the mouth, and the lips may all benefit from fat transfer. As a natural filler, fat gives a very smooth result and feels soft. Since the fat cells used are your own, there is no risk of allergy or reaction. Fat grafting may also be used for a variety of other applications including treatment of depressed scars, buttock enhancement, and as a treatment for contour problems after liposuction, to name a few. Although fat grafting has many useful applications, it remains a technically demanding procedure which requires proper equipment, finesse, and gentleness of technique.
Fat grafting is best thought of as a process rather than a one time treatment. My favorite analogy is to liken fat grafting to filling a hole in your yard with dirt. You put dirt in the hole and bring it up to level. With time, the dirt settles and sinks down a little. Sometimes the settling is minimal, and the process is finished. But, in other cases it is helpful to add some more dirt. As with the analogy, achieving quality results with fat grafting requires time and patience, both on the part of the patient and the surgeon. The good news is that once the desired amount of fill has been achieved it tends to remain for a long period of time. Note however, that since it is your own fat, it will behave like normal fat and again be subject to normal changes with time and gravity.
The versatility of fat grafting allows it to be performed along with a larger surgical procedure in the operating room or in the office under local anesthesia. Likewise, recovery time depends on the treatment area and the amount of fat to be transferred. As with most procedures in plastic surgery, the plan is individually customized to the patient’s needs. An American Board of Plastic Surgery Certified Surgeon who routinely performs fat grafting is the best resource to help you determine if fat grafting might be a good option for you. So, there might be some fat you will like after all!