Facial Fat Transfer | Fat Grafting

Facial fat “grafting” is a technique in which Dr. Rad harvests fat by liposuction from one area of the body, typically lower abdomen or inner thighs, purifies it and then carefully injects the fat into areas of the face to restore volume, smooth contours, soften features, plump skin and improve overall facial symmetry and proportions. Target areas typically are forehead, temples, under eyes, midface (cheeks), upper eyesockets, glabella (between brows), radix (top of nasal bridge), and upper and lower lips. Both men or women can benefit from fat transfer especially those who have age-related tissue atrophy (shrinkage), prior filler treatments and now want a permanent option, and those who have good bone structure but have mild hollowing, such as temples and tear troughs, thinning of upper facial skin and lips, and fat loss from aging or weight loss.

“In facial aesthetic surgery, details are everything.”

- Ariel N Rad, MD, PhD, FACS

book consult

real patient resultsgallery

Facelift before and after photos by Sherber and Rad in Washington, DC

before

after

before

after

before

after

before

after

before

after

before

after

before

after

before

after

before

after

before

after

view gallery

01Artistry

Dr. Rad has treated several thousand patients with fat grafting, and his artistry is customized for each patient whose anatomy and needs are unique. Having an appropriate artistic vision is crucial because too much or too little can give undesirable results. In Dr. Rad’s experience the key to artistry is to view a face holistically and artistically rather than in individual parts or by following some “recipe” or rote formula. The reason behind this is because volumizing one area will influence the relative contour of adjacent areas and change the overall balance of a face. Furthermore, following a “recipe” for injecting the same volumes in each face rarely works well. So, knowing exactly how much and where to inject is a very artistic endeavor. How much fat to inject in each facial region, at what tissue depth, direction and rate of injection, as well as the method of fat harvest, purification and injection cannulas to use take years of experience to perfect, especially given that fat grafting can be somewhat unpredictable in its degree of fat “take.” Dr. Rad also believes it’s crucial to assess facial bone structure because if it is severely deficient, then fat grafting won’t work well for 2 reasons: much of the fat will be absorbed, and also an unnatural balloon-like facial appearance can result (witness the overfilled celebrities we see in the popular press). However, for the right patient who has favorable facial bone structure and therefore needs only subtle volume correction, fat grafting is a highly effective technique.

Since aging causes both shrinkage (atrophy) and droop (ptosis), fat grafting can synergize with deep plane face and neck lift very beautifully. Dr. Rad also routinely uses fat grafting to smooth contours after lower blepharoplasty, facial optimization and facial skeletal implant augmentation. Fat grafts act as “molding clay” for blending tissues to create smooth transitions from one facial area to another. Also, fat grafting is key in the forehead to correct concave, flat or irregular contours, to hide prominent brow bones (called “frontal bossing”), and to volumeize hollows of the temples. Fat grafting in the lips can restore volume especially in patients with thin lips or those who’ve had prior filler treatment. The artistry of lip fat grafting lies in maintaining a proper 40 : 60 ratio of upper lip to lower lip volume, and to preserve the natural contour of the upper lip which has a central tubercle (fullness) and tapered fullness from central to lateral, and for the lower lip, fullness on either side of midline. Avoiding a “sausage” lip appearance from either overfilling or unartistic filling is crucial to natural results. Finally, fat grafting to the dorsal (back of) the hands can transform vein-y, aged appearing hands to smoother and more youthful surface. Especially when aged hands can give away one’s true age despite a youthful facial appearance, dorsal hand fat grafting is a powerful way to ensure harmony in all areas that can show age. Overall, Dr. Rad’s artistry is rooted in his deep experience treating thousands of patients and his deep focus on facial aesthetics at the highest level!

02Safety

Dr. Rad considers safety as the highest priority and in his hands facial fat grafting is very safe with low risk of complications. This is due to his deep experience treating thousands of patients and continuously refining his technique. In addition to working with board-certified anesthesiology teams in hospital-based operating facilities, Dr. Rad’s ensures safe injection by the following guidelines:

For your safety Dr. Rad performs surgery in a hospital-based operating room, considered to be the safest environment, rather than in the office. Anesthesia is delivered by a board certified anesthesiologist (MD) and you’ll be under light anesthesia which is important for your safety and comfort. Medical clearance by your primary physician is required prior to surgery and you will be guided step by step through our unique process.

Dr. Rad avoids intravascular (inside blood vessel) injection by using Coleman injection cannulas, the gold standard for fat grafting, which feature blunt side-port injection tips. These are not sharp tipped which can pierce blood vessels and other critical structures.

Next, when injecting around the eyes, such as in the region of the tear troughs or upper eyesocket regions, Dr. Rad protects them by placing corneal shields and lubricating ointment. His injection technique is also extremely meticulous to protect the eyes by always feeling where the tip of the injection cannula is located so as not to inadvertently come too close to the eyes.

If you’ve never had a revolumeizing injection treatment before, and you’re hesitant about fat grafting, then a good “test run” is to have treatment with injectable dermal fillers which are the most effective non-surgical treatment for facial volume and contouring; the downside is that it is temporary, lasting 6 to 12 months.

Dr. Rad has treated even members of Congress and plausibly deniable is the optimal aesthetic for which he strives!

03Technique

Fat grafting success or failure depends on multiple factors, controllable and also uncontrollable, which experienced surgeons routinely weigh. The importance of excellent surgical technique cannot be overstated and based on over 5,000 patients treated, Dr. Rad has a “6th sense” for fat injection, using the most science-based techniques and instruments to give his patients a safe and effective treatment.

During the procedure, Dr. Rad contours the face by judiciously adding fat to deflated areas or removing fat from overly voluminous areas. Fat transfer is particularly useful to treat deflated or sunken areas of the face such as the eye sockets (“orbits”), tear trough (under-eyes), temples, cheeks/midface, nasolabial folds (“parentheses lines”), lips and chin. Carefully sculpting facial contours is a critical step and requires an aesthetic eye and meticulous attention, areas in which Dr. Rad excels. In facial fat grafting, Dr. Rad removes fat via liposuction from the abdomen and/or thighs, purifies it in the operating room and then carefully injects it into facial tissues using state-of-the-art injection cannulas (long thin tubes designed for this purpose) into deflated or hollowed areas.

First, Dr. Rad harvests fat from the abdomen and/or the inner thighs, safe regions where an excess of fatty tissue can typically be found regardless of how slender one may be. Dr. Rad always uses safe Coleman harvesting cannulas, and he suctions fat from the superficial subcutaneous layer, not venturing deeply to avoid piercing muscle.

When treating patients, Dr. Rad injects tissues using a “micro-aliquot” dispersion method in which small fat particles are injected by 40-60 in-and-out passes per 1 cc of fat. This assures diffuse dispersion of fat by “fanning” out tiny particles of fat, in contrast to the incorrect method of slow, large “bolus” injection which can risk intravascular injection.

04recovery

The recovery from fat grafting is quite straightforward and involves very mild discomfort and moderate temporary swelling. Patients often feel sensations such as a dull ache, however this is mild and easily controlled with pain medicine taken for a few days. Mild to moderate bruising and swelling are normal and resolve over 5 to 10 days though it depends on how much fat grafting was done and which areas were treated. For example, under eyes will more readily show bruising and swelling that is evident to others as compared to other areas like the temples which don’t show much evidence.

Return to work and daily activities (except exercise) can occur between 1-3 weeks after surgery depending on various factors. If someone is more prone to bruising and/or their day-to-day work requires that they look absolutely perfect without makeup, then they may need more time to stay under the radar. While healing and recovery will be different for each patient, a quick return to work and going to social outings 1 to 2 weeks after surgery is common. Return to full unrestricted activities depend on how vigorous your work and exercise are, and generally ranges from 2-6 weeks.

05Aftercare

There is no particular aftercare routine that is required aside from good skin care and following Dr. Rad’s post-operative instructions. Applying extremes of cold or hot to your face is not advisable, however returning to your normal activities including exercise within a few weeks is generally fine. Fat grafting improves visible volume, contours and skin texture, but it does not replace the need for non-invasive dermatologic treatments such as Clear+Brilliant laser, injectable neuromodulators such as Botox and Daxxify, and result-oriented skincare with SPF30 sunscreen daily.

06longevity

Fat grafting is a worthwhile alternative to injectable fillers because it offers permanence and the most natural results safely and with little downtime. Because fat grafts are permanent additions of volume to your tissues, there is likely no need for repeat injections for “maintenance”, a key difference from fillers. Incomplete “fat take” is a phenomenon where not all of the injected fat survives the transfer. This is understandable given that fat cells are delicate and, extracting by liposuction from one area and then injecting into another is a somewhat traumatic process for fat cells, causing some to perish. Keep in mind that this is a normal expectation that not all fat will “take.” However, while incomplete fat “take” is a limitation of fat grafting, this is to be expected and Dr. Rad anticipates this partial loss of volume and makes subtle corrections at the time of surgery. Furthermore, fat loss is not a significant downside because, in Dr. Rad’s experienced hands, fat take is excellent and approaches 75-90%, and the fat that remains is welcome volume, now living in its new “home” and behaving like fat in the target areas. Revisions are very unusual. In over 5,000 patients treated, Dr. Rad has performed only a handful of revisions to add more fat or to revise for reasons related to asymmetry. His revision rate is about 1 in 1,000, a very low incidence. Overall, when performed by an experienced surgeon, fat grafting is a safe and reliable method of restoring volume, smoothing contours and improving skin texture and tone.

frequently askedQuestions

How do I know if I’m a good candidate for Facial Fat Transfer | Fat Grafting?

K

L

Aside from the expectation that patients should be in good overall health to undergo light anesthesia, ideal candidates for a facial fat transfer are those who have hollowing in the temples, under eyes, eye socket regions, flattened or concave midface (cheeks), thin lips, and a weak chin.

While the investment is more significant than in-office filler treatment, over time the cost of fillers far exceeds the cost of fat transfer. Good candidates for fat transfer recognize the long term advantage of having permanent volume restored for a lifetime which is much more cost effective as compared with injections of filler every 6-12 months.

Why might I benefit from Facial Fat Transfer?

K

L

Men or women who might benefit from fat transfer include those who have age-related facial atrophy, those who have had filler treatments and now want a permanent option, and those whose facial structure is deficient in certain areas where volume and contour are important (such as cheekbones, jawline, chin, lips, temples and eye sockets).

What are other options for enhancing your Facial Fat Transfer | Fat Grafting?

K

L

Facial contouring involves restoring volume in deflated areas of the face via Facial Fat Grafting, or removing volume from the lower cheek region to create a more chiseled appearance via Buccal Fat Removal. Often deflation is accompanied by skin laxity and sagging; therefore, Dr. Rad often performs Facelift and Neck Lift surgery concurrent with facial fat grafting.

Injectable Dermal Fillers are the most effective non-surgical treatment for facial volume and contouring; the downside is that it is temporary, lasting 6 to 12 months.

What is better: Facial Fat Transfer or Fillers?

K

L

Think of fat as the permanent version of fillers which are temporary. Your fat consists of living cells that are your own, and with meticulous technique you, fat volume transferred to your face is permanent. So you can enjoy the improvements for a lifetime, a significant advantage over fillers which require touch-ups every 6-12 months.

What are the downsides of Facial Fat Transfer?

K

L

The main disadvantage is that this is a surgical procedure requiring mild anesthesia. For safety Dr. Rad performs surgery under anesthesia in a hospital operating facility. While cost can be considered a short term disadvantage, the cost savings over years as compared with twice annual filler treatment vastly favors fat transfer.

Can this be combined with other procedures?

K

L

Yes! Facial fat transfer synergizes well with facelift, brow lift, upper and lower blepharoplasty, neck lift and lip augmentation/lift. Think of it as a powerful tool Dr. Rad uses to refine features and restore volume in specific areas to achieve balanced and nuanced results.

Testimonials

“Dr. Rad is not only a skilled and talented surgeon but a kind and compassionate doctor, who treats the whole person. For me, he exemplifies medical excellence.”

“He is the most gifted physician that I’ve ever met. Dr. Ariel Rad is in the top-echelon of physicians. He has a brilliant brain and a big heart. His skills as a surgeon are unparalleled.”

“He was very thorough, knowledgeable and most of all empathic to my situation.”

“He is not only a great surgeon, but an artist.”

“He is very skilled, his manner is absolutely delightful, and he is a truly kind, considerate person”

“He is an expert in his field. He is brilliant and very caring. I will never forget how compassionate he was on the day of my surgery”

“Dr. Rad is one of the world's best! His artistic eye and incredible skill shows in my incredible face lift results. His ability as a surgeon is surpassed only by his kindness and approachability as a person.”

View all testimonials

Next Steps

book consult

Related Procedures

Facial Fat Transfer | Fat Grafting

- Ariel N Rad, MD, PhD, FACS

real patient resultsgallery

01Artistry

02Safety

03Technique

04recovery

05Aftercare

06longevity

frequently askedQuestions

How do I know if I’m a good candidate for Facial Fat Transfer | Fat Grafting?

Why might I benefit from Facial Fat Transfer?

What are other options for enhancing your Facial Fat Transfer | Fat Grafting?

What is better: Facial Fat Transfer or Fillers?

What are the downsides of Facial Fat Transfer?

Can this be combined with other procedures?

Testimonials

Next Steps

Related Procedures

Facelift

Brow Lift

Neck Lift

Nose

Eyes

Chin + Jaw

Facial Implants

Facial Optimization

Other Facial Procedures

Breast + Body