The Fat Has It – For the Whole Face

Written by Frank P. Fechner, MD

When we thoroughly study the changes associated with facial aging we begin to understand that it actually is as straight forward as we may believe. One insight into this enigma of aging is gained by comparing the different procedures used, both surgically and non-surgically, to counteract changes that time has brought. Although fat grafting was described before, it was only about 8 years ago that a few aesthetic surgeons used fat injections to provide volume to the face for rejuvenation. Until then, the maxim was “lifting – lifting – lifting” until normalcy was entirely removed from a person’s face.

Although perfection is still not available, I believe that we moved much closer to where we really want to be. My view has been that the answer lies not in face lifting or volume. Rather, it is the combination of tightening what has dropped and volumizing what is sunken that will provide the most logical approach with the most natural looks. As a result from this revelation, I perform about 98% of facelifts in combination with some fat grafting.
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The Fat Has It – Especially For Our Eyes!

Written by Frank P. Fechner, MD

Before and After Photo of Young Man after Advanced Lower Blepharoplasty

“The eyes are the mirror of the soul!”
This saying reflects the importance we put on the eyes when looking at people. And it is not only the eyes themselves; rather their appearance is substantially influenced by the surrounding facial regions including the under eye area. This underlines why cosmetic eyelid is so important and popular: it supports the attractiveness of the eyes without “changing” who we are.

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Can Fat Grafting or Sculptra Be Used to Treat Prominent Skin Veins Below the Eyes?

Written by Frank P. Fechner, MD

Prominent Veins may develop around the eyes – how can they be treated.

These veins are located superficially, just underneath the skin. Fat grafting is very effective for under the eye hollowness (a.k.a. tear troughs).  We reserve Sculptra for other facial regions such as cheeks and jawline.

But for veins, both fat grafting or filler injections would likely fail to provide satisfactory results. One of the secrets to successful volume treatments is placement deep underneath the skin, especially in the lower eyelid region.

Vascular lasers (such as a YAG) can be tried. If this does not work, one may be left with 3 further options: attempt of micro-coagulation, make-up or surgical repair through a small incision.

Will Fat Grafting Replace a Facelift?

Written by Frank P. Fechner, MD

Aging of the face is not only due to sagging of facial tissues but also deflation: we lose youthful facial roundness over the years. Combine this volume loss with drooping of facial tissues and you see the early and advanced signs of aging: facial hollowness, loss of soft contours, jowls and neck looseness. Facial fat grafting is the transfer of fat from the patient’s own body to the face and injections of fat into the aging face represent an extremely valuable addition to a face and neck lift. But, it cannot replace it!

For best results in patients with significant facial aging, we perform facelift in conjunction with fat grafting.

Current research suggests that within the transferred fat plenty of stem cells can be found. These stem cells have the ability to develop into “new” cells of virtually any type including skin, fat and other soft tissues. Although the final scientific explanation is pending we certainly observe that fat transfer provides benefits beyond facial volume enhancement. For instance, Dr. Fechner commonly observes improved texture and elasticity of the overlying skin. Although this may be the result of providing the skin with its lost deeper support, research suggests that the stem cells are in part responsible for a true rejuvenation of the skin itself.

When we examine our patients after successful fat transfer, we are commonly amazed how gentle contour enhancements of the temple, under eye region, cheeks and jaw line can advance the facelift’s improvements for a remarkable, natural-looking and youthful appearance.


Infections after Fat Transfer

Written by Frank P. Fechner, MD

Infections after fat grafting are very uncommon, but certainly not impossible. We perform the fat harvest, fat preparation and the transfer using strict sterile conditions. In addition, our patients routinely receive antibiotics for prevention just before the procedure and continue the drugs for a few days afterwards. Although we have never seen an infection after fat transfer, I would expect it to take about 7 days after the treatment before an infection could show. Increase in swelling, pain and redness are usual signs to look out for.

How long can fat be stored before it is injected?

Written by Frank P. Fechner, MD

We like to inject the fat immediately after its harvest. The success of fat grafting procedure depends ultimately on the viability and survival of the fat cells. I do not store fat any longer for later treatments down the road because I prefer optimal fat quality for best fat survival. And it is relatively easy to obtain a little more fat during the next treatment.

Other surgeons may store frozen fat for up to 1 year, recognizing that survival will likely decrease.

What is the Best Treatment Approach to Tear Troughs?

Written by Frank P. Fechner, MD

The tear trough deformity (a.k.a. naso-jugal fold) represents the depression underneath the under-eye puffiness. They are absent in most young people and slowly develop in the 30s or 40s. People refer to tear troughs as “dark circles” under the eyes and they are responsible for a tired and worn out look.

Fortunately, modern cosmetic medicine offers options for correcting tear troughs. 

First, we usually consider non-surgical options like injectable fillers. We prefer Restylane for this particular region for its predictability and longevity. Commonly, Restylane lasts 1 year or longer in the under eye regions.

Second, fat transfer (a.k.a. fat grafting or fat injection) is a minimal invasive option for ultra-longlasting effects. Fat is usually harvested from the abdomen or hip region through micro-liposuction. Because only about 10cc of fat is removed, no significant effect develops in the donor region. The fat is then prepared, concentrated and injected into the region of volume loss. We use the micro-droplet technique and the fat is placed deep underneeth the muscle layer. Some bruising and puffiness is always present after the fat treatment; we recommend our patients to plan on a good week of recovery. There is usually no pain.

If aging of the lower lids also warrents tightening of skin and reduction of the lower lid puffiness, advanced lower blepharoplasty may achieve the best improvment. We perform these procedures in the office under local anesthesia with a sedative. Recovery is usually determined by puffiness and bruising afterwards; 10 days is usually sufficient.