Structural Fat Grafting: permanently restoring youthful facial contours

A number of 'soft tissue fillers' are available for temporarily improving facial areas that have lost volume or have developed deep lines and creases. Probably the most popular fillers currently are hyaluronic acid products like Restylane, which can be used to plump up thin lips and to fill out nasolabial folds (lines that run from beside the nostrils to the area beside the corners of the mouth) and marionette lines (lines that run from the corners of the mouth towards the jawline). The improvement generally lasts four to six months.

Some synthetic materials are available which can be used in an attempt to produce a permanent soft tissue augmentation. Unfortunately, the body treats such materials as foreign objects, and as a result the placement of synthetic materials may lead to inflammation, infection, migration and granuloma formation. In general, synthetic materials are less likely to produce a result that looks and feels natural.

For patients seeking permanent enhancement of soft tissue volume, the ideal material to use would obviously be something that is naturally-occurring and not rejected by the body or treated by the immune system as a foreign material. Whether the goal is to restore volume to an area such as the lips or the cheeks, or to fill in a crease or depression such as the nasolabial folds or marionette lines, the ideal material is quite clearly the material that one wishes was there in greater abundance in the first place: YOUR OWN FAT.

The grafting of autologous (your own) fat to reliably restore or improve facial volume is now possible. The fat is harvested from the abdomen, thighs, hips or buttocks using specially-designed instruments and a specialized technique, processed (by centrifugation, which eliminates all components of the harvested material which is not viable fat), and meticulously injected into the facial areas to be enhanced.

Fat grafting has been performed by plastic surgeons for decades. There is no question that fat is the ideal material for soft tissue augmentation, and that the results obtained with fat grafting are the most natural-appearing. However, one problem with this procedure in years past has been resorption (breakdown) of the grafted fat, so that the resulting improvement is not permanent. The grafted fat must gain its own blood supply in its new location in order to persist long-term, and this generally is not possible when large amounts are injected at once and when specialized instrumentation and techniques are not employed.

A relatively new technique has been developed called structural fat grafting, in which small amounts (less than 0.1 cc at a time) of fat are carefully microinjected in a series of discrete layers to gradually 'build' new soft tissue structure. As there is space between each microinjection, new blood vessels are able to grow into the grafted fat, allowing it to persist. If this process of blood vessel ingrowth (neovascularization) does not occur, then the injected tissue cannot truly be considered a 'graft' and is instead just another 'soft tissue filler' of limited duration.

This is a procedure that requires specialized training and specialized surgical instruments, as well as patience and attention to detail on the part of the surgeon. When performed properly, permanent improvements in facial contours are possible. If enough fat resorption occurs following a fat grafting procedure such that the desired result is not achieved, a second 'touch-up' procedure can easily be performed to augment the result obtained from the first injection.

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