Autologous Fat Grafting
The aging face has three main underlying causes: dermatologic changes, volume loss and gain, and descent of the tissues. If a youthful face is thought of as heart-shaped, or an upside-down triangle, an aged face is general thought of as rectangular or right side up triangle- with the lower face becoming wider and heavier than the midface. Another analogy often employed, is that of a youthful face being a grape, and an aged face appearing shriveled, as a raisin would appear. In a youthful face, the transitions between anatomic subunits are smooth and seamless. As we age, the above changes take place, leaving the face with folds, grooves, and bulging which make the facial subunits appear separate and distinct with the development of dark shadows at their transitions. This is seen in the transition from the forehead to the cheek (temporal hollowing), loss of upper cheek volume while the lower cheek volume becomes more full, and around the eyes, as the bony orbital rims appear more prominent and the upper cheek volume descends, the tear troughs become more noticeable.
Skin changes, depending on the severity, can be prevented/treated with Botox/Dysport, medical grade skin care, chemical peels, and or laser resurfacing. Descent of the facial tissues and redundant skin can be treated with a facelift. So, what options do we have to replenish the volume of an aging face? Fillers and autologous fat grafting.
Autologous fat grafting is a procedure where fat is harvested from one area of a patient’s body (preferably the lower abdomen, flanks, outer thigh), processed, and then carefully transferred using blunt cannulas to the areas of the face that require volume restoration. Taking fat from one area of the body and placing it in another area of the body is called a free graft. This means the blood supply to the donor fat is disrupted and the fat transferred to the face will need a new blood supply to survive.
Fat grafting is indicated when there is an inadequate volume reserve to reposition in the midface and periorbital regions, and in areas where volume loss is the primary aging process occurring such as in the temples and bony loss around the nose and mouth leading to deepened nasolabial and mentolabial creases. Fat grafting works best in a field of tight facial tissues. When fat is injected into a patient with significant facial ptosis who has not had a facelift, the fat will weigh down the face. However, when performed with surgical correction of drooping tissues, fat grafting creates a beautiful, natural, re-volumization of the face and diminishes the sharp transitions from different areas of the face as well as shadows.
There is between 1-3 weeks of social downtime associated with autologous fat grafting and final results are visible closer to 6 months, and for this reason, as well as working best in a field of tight tissue, fat grafting is usually offered to patients who are undergoing other surgical facial rejuvenation procedures with similar downtimes.
Autologous fat transfer has several Pros, which include:
- Procedure utilizes the patient’s own fat, so there is no risk of allergic reaction and is natural
- Stem cells present in fat cells can stimulate new collagen production and improve skin texture
- The longest lasting option to reverse volume loss in the face which means less visits to the office and can be more cost effective than maintaining dermal fillers.
Dermal fillers are a great option for younger patients who only desire small amounts of volume changes, those that want to see the result more quickly, and for those who do not have social downtime of 10 days to 3 weeks.