Fat Grafting – the future is here

Face-lifts and liposuction come to mind when most people think of cosmetic surgery. But the latest trend is to add volume to the face with fat removed from other parts of the body.

Plastic surgeon Rafael Diaz-Garcia of the Allegheny Health Network credits the fame of celebrities such as Angelina Jolie and Kim Kardashian, who have fuller lips or are more shapely than stars of the past such as Twiggy and Kate Moss.

But it’s not always about looking like a TV or movie star. Some people just want to look more like their former youthful selves. One 64-year-old Westmoreland County woman consulted with Leo McCafferty, a Pittsburgh plastic surgeon, about the sagging skin around her eyes but went on to talk about how her face had thinned over the years.

“He said he wanted to see some pictures of me when I was younger, and you don’t realize [the difference]. Sure everyone sees the wrinkles, but you miss [features] like the rosy cheeks,” she said.

Dr. McCafferty used fat grafting to add fat from her stomach to her cheeks and upper lip. Fat grafting for the face is most common for people in their late 40s up to 70s, he said. It’s more common in women than men, although both genders take advantage of the surgery.

“As we age, our faces change to a more rectangular shape. The fat is helping us to re-create [the heart shape] without making people look like they’ve had surgery or are relying on the pulled face-lift look,” he said.

Fat transfers to the face were the ninth most popular surgical procedure in 2015, according to the American Society for Aesthetic Plastic Surgery. This statistic likely includes fat transfers as part of other procedures, such as a face-lift, that are more common than fat grafting alone, Dr. McCafferty said.

After removing the fat, the surgeon “harvests” it, taking out debris, red blood cells, stem cells and oil so that only mature fat cells are injected in the face, Dr. Diaz-Garcia said. Fat is injected in a thin line of droplets so the new fat cells can feed off neighboring cells until a new blood supply grows to support them, he said.

“The whole premise of fat grafting is you take something, break it up into little pieces, inject it and allow your body to bring new blood supply to the little pieces,” he said.

For reasons that are still not entirely understood, about 75 percent of the cells successfully become “part of their new neighborhood,” but the other 25 percent do not, according to Dr. McCafferty. Because of this, surgeons must be careful not to “over-correct,” adding more fat cells than necessary. This can cause residual lumps. By using their own fat cells rather than alternative fillers, which are often synthetic, patients are less likely to experience infection, allergy or a high rate of rejection.

“It’s a procedure that’s easy on the patient, not exorbitant in terms of cost, [with] very little risk and very little downtime. It’s a magic combination and gives very nice, consistent results,” he said.

Fat grafting is also increasing in popularity for other uses. Peter Rubin, chairman of the department of plastic surgery at University of Pittsburgh Medical Center, uses a similar procedure for cranial-facial injuries in military and trauma victims, for breast reconstruction in cancer patients and to increase the comfort of prostheses for amputees.

Through research, Dr. Rubin and his team have determined that the fat stabilizes about three months after the procedure. In three-year follow-ups, the fat retained the same volume as it had at three months.

When done for cosmetic reasons, the procedure is not usually covered by insurance. Dr. McCafferty said its cost ranges from $900 to $2,500.

The Westmoreland County woman had fat grafting done simultaneously with a procedure for her eyes, so she was not conscious during surgery. Dr. McCafferty said fat grafting alone does not require the patient to be unconscious. Instead, he can numb the locations where the fat will be removed and where it will be added.

Consequently, the recovery period is shorter than with some other surgeries. Other than making sure not to rub the affected skin vigorously or disturb the area where the fat was added, patients go about their day-to-day lives. The Westmoreland County woman returned to her job as a teacher two weeks after her procedure.

The results, she said, were subtle enough that no one could pinpoint that she had had a cosmetic procedure. She did get a few comments such as, “Wow, you’re getting a lot of rest.”

For many people, the subtle effect is part of the appeal of a fat transfer. One 66-year-old woman from Butler said she had the procedure not to look younger but because she wanted to “look the best for my age.”

After having a face-lift in her early 50s, she returned to Dr. McCafferty eight years later for liposuction. He suggested using the fat removed from her stomach and inner thighs to fix the deep creases around her lips caused by pursing her lips behind a face mask while working as an orthopedic sales associate.

“It is a young person’s job, and I did it until I was 62,” she said. “[The surgery] helped me just to feel better about myself, not because I felt I had to look better to compete but it gave me the confidence.”

Because of the mouth’s mobility, the fat transfer held its appearance only for about a year. Now, she gets synthetic fillers added to the area around her mouth every six months. She credits the success of the fillers to the base layer of fat cells from the fat grafting a year earlier.

The Westmoreland County woman said she would not hesitate to have another fat transfer and recommends it to her friends.

“After I told them what I did, I know a couple of them are going to have it done,” she said.

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