Dr. Dirk Lazarus

Plastic, Reconstructive & Cosmetic Surgeon

MBChB (UCT), FCS (SA) Plast & Recon Surg

Fat Grafting of the Face

Facial fat provides the softness and curves of youth to the face. If you look at very old people, their face can appear skeletal (see below). This is due to thinning of the skin and atrophy of fat, muscle and bone from the face. In fact these changes begin early in the process of facial aging. So while facial fat grafting is an essential component of facial rejuvenation, it is also a procedure which can benefit younger patients too.

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:

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Facial fat grafting can be done at any age. Younger women can benefit from fat grafts to the lips, under eyes, cheek bone and other areas. Facial fat grafting is useful as part of facial rejuvenation and is performed with facelift to add softness and curves to the face. It is one of the modalities which helps prevent the over-pulled, operated look. Patients who have previously had a facelift may benefit with just fat grafting and frequently need this volume correction over further 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.

Before, 3 months after and 1 year after showing improvement in lower lid appearance.

Before, 3 months after and 1 year after showing improvement in lower lid appearance.

The alternative to fat grafting is 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.

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.


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 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.


Fat grafting carries a number of benefits:

  1. correction of volume deficiencies
  2. skin improve: texture, thickness
  3. some minor lifting
  4. 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.

Fat grafting

Before and after fat grafting to lower lids, cheeks and lips.


From a cleft patient who had secondary surgery to help her speech: It is one year ago that i was blessed to meet and know you. Thank you very much for the support you rendered to me while I was in South Africa. I will never forget your acts of kindness. I am fine now and my speech has greatly improved! I think I don’t need another operation. Even though I don’t communicate that often, you are always at heart.