Can fat injections replace injectable filler treatments?

Fat injections are excellent treatments.  But so are dermal fillers.  The question is:  "what you are trying to treat?"  If you have a crease or wrinkle engrained in the skin, you may need a filler placed in the skin to treat this.  Fat is not placed in the skin layers itself, but it is placed under the skin in multiple layers.

To treat an area like the nasolabial folds, if you have a sharp crease, you may be better off with a temporary dermal filler like Restylane, Juvederm, Perlane, or Radiesse.  I like using the only permanent FDA approved injectable filler, Artefill.  Unlike some of the other temporary dermal fillers, results continue to improve with time.  Unfortunately, Artes Medical (the company that owns the rights to Artefill) folded a few weeks ago.  It had nothing to do with the quality of Artefill, and it is very likely that another company will purchase this technology and it will be back on the market soon.

I think fat transfer works great in broad areas of depression or atrophy, and to try to lift the cheek to reduce the heaviness on the nasolabial fold.  It is your own material and there is no risk of rejection.  I use it in the temples, tear troughs, infraorbital rims, brows, cheeks, and jawline.  I tell all my patients that in my hands, 30-40% of the fat I inject stays for 2-5 years, and the other 60-70% is resorbed by the body within about one month postop.  So it will likely need to be repeated, but fortunately, most people have enough to give.

Part of the push for synthetic dermal fillers was because older methods oerefat "filling" was riddled with many risks and complications.  Anything that is a permanent procedure will naturally have more risks & potential complications than something that is non-permanent or temporary.  Newer techniques of fat grafting have allowed for more predictable results.  That being said, fat results will never be as reliable or predictable as dermal filler results.  The tradeoff being that if the fat survives, the results are permanent.  The nasolabial area tends to uptake fat quite well, especially if harvested from liposuction.  Additionally, should the fat be absorbed somewhat, you can always correct it a little with filler rather than having to use the entire syringe or more as before.

Autologous fat injections are a permanent natural alternative to facial fillers. They can have similar complications like irregularities, absorption, infection, etc.. I usually tell patients that they probably will require additional fat injection treatment because fat injections are not a perfect science, and they do not take a 100%. Therefore, additional treatments are often required to get the full desired effect.

Linda,

Fat grafting is a nice alternative to fillers.  It can achieve the same results as the fillers, but has the potential to last much longer and, possibly, permanently.  Make sure that you go to someone with extensive experience in fat grafting, since you want to get it done correctly the first time.  Basically, the fat is harvested from your abdomen or thigh with a mini-lipousuction technique.  The fat is then processed (we use a centrifuge in my office) to isolate or concentrate the fat cells.  The fat is then put into syringes and injected in a similar way as the off-the-shelf fillers.  You should expect a bit more temporary bruising and swelling with the fat grafting than with the fillers.  This is due to the fact that the fat should be injected into multiple levels and directions for a smooth, even look.  Additionally, this helps increase the chance of the fat lasting since it will be distributed closer to the micro blood supply of the skin and subcutaneous tissue.  If they are suggesting that you have fat grafting around your eyes, question them extensively about their experience and ask to see several before and after photos of their patients.  Injecting fat in the lips and nasolabial crease is fairly routine.  However, injections around the eyes can lead to big problems in inexperienced hands.  The fat grafting procedure usually costs a bit more than the fillers, but it has the potential to last much longer.  So, your cost savings in the long run is great.  In my office, the fat grafting procedures generally run between $2000 and $4000 depending on the areas grafted (nasolabial crease, lips, cheeks, periorbital, pre-jowel, etc).  Good luck with yoru procedure.

David Shafer, MD

Fat injections are considered by most doctors to have some permanent benefit.  In our practice, we have studied and presented another option which has given superior results, LiveFill.  Fat injection technique involves removal of fat cells from the body via liposuction.  The cells are then usually spun in a centrifuge.  They are then injected through a needle back into the face.  This process kills (depending on the study you read and the technique used for measuring viability) most to nearly all of the cells.  These dead cells cannot resurrect themselves.

LiveFill uses nontraumatized cells shaped into grafts which are then placed directly into hollow areas.  The percentage of dead cells is very low, 12% in our studies (vs. 75% dead cells for Coleman technique fat aspiration).  That means the number you are starting out with is higher, and your eventual success rate is higher as well.  We demonstrated this with 3-dimensional CT scans measuring volume, presented the results at ASAPS and ASPS meetings, and published the results in Plastic and Reconstructive Surgery.

So yes, LiveFill is an alternative to temporary fillers.

Having said that, in most 62-year-old patients, there are usually two primary problems going on:  loss of volume, and sagging of facial skin.  Sagging of the skin cannot be overcome with obtuse amounts of volume replacement, in my opinion.  Rather, a combination of a cleverly done facelift with volume restoration (with LiveFill grafts) gives the best long term results.

An old mentor of mine once said that if Plan A fails (i.e. temporary filler, temporary filler, temporary filler), make sure Plan B is not the same as Plan A (i.e. more temporary filler), but think of the problem differently.  In this case, consider whether a facelift is the most appropriate way to rejuvenate the face.