Dismissing Fat Grafting Myths

After speaking with patients who are vaguely familiar with fat grafting I have encountered a lot of misunderstanding about how fat grafting works and a lot of this misunderstanding comes from other surgeons who do not understand it.  Here are some of the top myths on fat grafting that I would like to dispel:

18 Months after a Single Session of Fat Transfer

1. Fat grafting does not last. This is perhaps one of the most vaunted claims by surgeons who have “tried it”.  There are several reasons why fat grafting may not last.  First, the surgeon has no idea what he is doing.  By mishandling the fat, the transplanted fat may not survive.  Second, the surgeon may not know that placing fat in areas of high mobility like the smile lines (nasolabial grooves) and lips will most likely fail.  I believe if fat grafting is done well it not only lasts but also improves over time as blood supply enriches the transferred fat so that results look the best over 1 to 2 years following a procedure.
2. Fat grafting is dangerous because it looks lumpy. This is again false if you are dealing with a very experienced surgeon.  Most times surgeons warn patients that it is dangerous to put it around the eyes because it will look bad, saying something to the effect:  “I have seen it look that way so don’t do it.”  That reason either comes from the fact that they tried it and had that outcome or they saw other people’s bad results.  Lumping of fat comes from bad technique either placing too much of it, not in the right plane, or in the wrong direction.  By placing fat only from a perpendicular approach to the orbital rim with small amounts (a fifth of a rice granule) very deeply in experienced hands, the chances of visible lumpiness is virtually zero.  Fat grafting is very smooth and soft when done right.
3. Fat grafting makes people look fat. This is another misconception about fat transfer.  When one gets older the lower outer face starts to get heavier looking either through weight gain or through relative hollowness of the upper face.  When the upper face and central lower face are filled with fat, one can actually look thinner after fat grafting.  Also, very little fat needs to be placed to have a great result.  Many times I see individuals way overfilled because the doctor has either no experience or no artistic eye to perform a fat transfer.  Fat grafting is as much of an art as a science.  The precise placement and distribution of fat based on an individual’s degree of aging and facial shape are what separate a beautiful result from a mediocre or poor one.
4. I don’t need fat grafting I need something to counteract gravity. I hear this all the time.  I would say the majority of individuals who think they need to be lifted do not need to be lifted for a few reasons. First, the areas that look like they have been affected by gravity have not been, as one surgeon friend of mine discovered comparing photographs of individuals in their 60s with rigorously matched photographs in their 20s.  Very little gravity exists except in the neck area.  Second, when one pulls back on the skin with one fingers to stretch out wrinkles and other flaws
5. I don’t need fat grafting because all I care about are the small lines around my mouth. What is interesting is that what bothers most people typically does not help them look better if I fix it.  This is a matter of perspective and experience.  Perspective involves typically a woman who stares at herself too closely at the mirror with magnification seeing only the minor flaws on her face.  By helping someone see the big picture, I can help them see what would make them truly look better, which I argue would involve looking more rested, youthful, fresh, balanced, and for women, more feminine and for men, more masculine.  All of that is possible with fat transfer.  The second reason that many patients who come to see me do not understand fat transfer is that they have been indoctrinated to look at the face as needing eyebags removed, brows lifted, folds filled, etc.  No one talks about buccal transition fills, anterior cheek augmentation, anterior chin filling, etc. (except for me).  These transitions of the face truly are what make a person look older and not as attractive, even more so in many cases than a deeper smile line or fine lines around the mouth.  The fact that I have spent years perfecting my ability to see the face helps you achieve the best that you can be even though you may not know exactly what you want to have done.

Fat transfer should be done by an experienced and artistic surgeon and in that context can be the cornerstone in the majority of patients who are interested in facial rejuvenation to looking better.  Like anything else, if it is done well the results can be amazing!

Samuel M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas. To learn more about Dr Lam’s fat grafting procedures please visit our website www.LamFacialPlastics.com or call 972.312.8105 to schedule a consultation.