Fat Grafting of the Face
The first change of facial aging is deflation – loss of volume which occurs in all the tissue layers of the face: the skin, fat, muscle and bone. Very old women often look skeletal – their face takes on a skull-like appearance – due to this loss of soft tissue. This process starts early, in the 20s or 30s, is progressive – becomes worse with age – and I believe that the general pattern is a volume loss from above down and around the facial orifices – the eyes, nose and mouth.
The areas affected are the temples, forehead, under eye area and upper cheek. Also, the naso-labial folds (from nose to mouth), the lips and the marionette lines (from the mouth down) to the depression in front of the jowl. While this is the general pattern every face is different, not just in how it looks, but also how it ages. Facial fat grafting done to correct this should be individualised according to each patient’s unique face. It is in essence a sculpting procedure.
Correction of this facial deflation may be with filler or fat. However I do not believe that you can correct the deflation of aging properly, even in younger women, with filler. In my practice the application of fillers is limited to lip enhancement and sometimes other specific anatomical areas. Fat grafting is my choice for correcting age related deflation even in younger patients (<50), and for older patients (>50), generally if I am doing a facelift I will correct the volume changes with liposuction and fat grafting. This is the facial rejuvenation, I do in most older women.
Fat grafting is a procedure where fat is transferred from one part of the body to another with the primary aim of providing additional volume. This is a very useful procedure and one of the most common procedures that I do. Typical areas affected and amenable to fat grafting are depicted in the image below.

Younger women can benefit from fat grafts to the lips, under eyes, cheek bone and other areas. In women undergoing facelift, fat grafting is most often needed to provide the curves and softness of youth as well as to correct the deflation. In fact as plastic surgeons got better at lifting in the 80s and 90s, facelifts patients started to look strange and operated on because the volume changes were not recognised and corrected. We know better now and can achieve a more natural rejuvenation. Patients who have had previous facelifts and still feel they look aged, often benefit simply from fat grafting (although they come asking for more lifting).
Fat grafts provide additional benefits over and above just simple volume correction. Adding volume to the upper face can provide some lift. Fat grafts also improve the quality of the overlying skin, possibly an effect of the fat grafts being the richest source of adult stem cells.
Compared with filler:
- Filler volumes used are generally much less (syringes typically contain 0.5 to 2 ml);
- The stem cell effect with filler, if any, is much less, and;
- Fat is cheaper in the long term. It has been shown that over time the cost of repeated filler injections are more expensive, whereas fat grafts, once they have taken, will provide a longer duration benefit, probably permanent (although facial aging and deflation continue).
A graft is a tissue transfer without a blood supply. Besides fat there are many other tissues transferred as a graft, for example skin, bone, cartilage, etc. Horticulturists frequently graft plants, eg vines or roses. Initially the grafts rely on a diffusion of nutrients, but in time new blood vessels grow in and the fat grafts take and live permanently in the recipient site.
The current method of fat grafting is based on the work of Sydney Coleman, a plastic surgeon from New York. He called the procedure lipostructure. While fat grafting was initially done to improve volume it became apparent that the overlying skin also improved. It has been discovered that fat grafts, particularly a portion known as the stromal vascular fragment, is very rich in stem cells. In fact fat grafts contain the highest concentration of adult stem cells, about 100 times more per gram than bone marrow. These stem cells have the ability to differentiate into other cell lines and I believe that this is what is responsible for the improvement in the skin quality that is seen.
Donor Sites
Typical donor sites for fat harvest are areas where there is fat excess. These are the usual sites treated with liposuction: abdomen, thighs, inner knees, love handles, neck, etc. For low volume facial fat grafting I often take fat from the neck if I am doing a concurrent neck liposuction (which I do in almost all facial rejuvenation patients) and frequently also from the tummy, usually the lower tummy via a small stab incision in the belly button. Other sites can be used but generally for facial fat grafting I don’t want to be turning patients over to harvest fat from the back. For large volume fat grafting I will need to do a proper liposuction in the typical areas between the breasts and the knees where there is fat excess.
Surgery
Fat grafting may be performed as a stand-alone procedure although it is usually combined with other facial procedures such as eyelid rejuvenation and/or facelift. I perform the surgery as a day case procedure (in and out the same day) in my own, private facility, Tranquillity Clinic. The procedure is usually done under light sedation and local anaesthesia. The surgery is day case surgery: in out the same day.
Complications
Complications are rare, but due to the variability of fat graft take these can include minor irregularities or asymmetries. Since the fat is injected (a needle hole is made and a blunt cannula is used to inject), there is no scarring.
Results
Fat grafting carries a number of benefits:
- correction of volume deficiencies
- skin improve: texture, thickness
- some minor lifting
- possible donor site improvement
Once the fat has taken it lives permanently in the recipient area. The improvement is permanent but of course aging continues and repeat fat grafting may be required with further volume loss.
Last updated 23 November 2022



