Fat Grafting FAQs

How does Dr. Lam use Fat Grafting to rejuvenate my face?

Dr. Lam believes almost categorically that lifting the cheek and brow are outdated modes of rejuvenation that do not reflect how a person looked in youth. Using old photographs, Dr. Lam focuses on preserving identity rather than altering it unfavorably.His principal method of rejuvenation today for the face is facial fat transfer that permits a seamless and natural cosmetic rejuvenation of the face, all done without a single incision. In fact, there are no knives, sutures, or bandages following the procedure. The only part of the face that he believes in lifting today is the neck and jawline and only when needed. (Please see his facelift section).

Why Fat Grafting?

Besides avoiding incisions, fat transfer permits the most natural results for the face and matches one’s own identity in youth rather than creating an arbitrary result that the surgeon believes is youthful. There are two principal goals with fat transfer: framing the eye and restoring the facial shape of youth. Let’s explore each concept more thoroughly.
This patient underwent corrective plastic surgery to return her identity back to when she was young. Using old photographs as a blueprint can be an effective way to ensure that an individual does not look like different person following a cosmetic procedure.

What Does Framing the Eye Mean with Fat Grafting?

Perhaps framing the eye is one of the most important ideas to understand and also one of the most difficult to appreciate. Why? Because it is counterintuitive and exactly the opposite of traditional cosmetic eyelid surgery. When we look at another individual, we are very focused on their eyes because that is the central point of attention during any conversation. It also reveals whether one is tired, angry or sad or rather unrejuvenated eyes can falsely make someone appear tired when he or she is not. Interestingly, many women are more focused on their mouth because they think that is what ages them more, even fine lines that may not be entirely perceptible to another individual. Looking at the face with an artistic eye is very important when Dr. Lam performs a consultation with you to decide which areas are the most important to remedy.
When looking at a youthful eyelid, there is naturally a fullness of the eyelid contour and a low (not high) brow. When looking at an older individual who has had a browlift, that is when you see a high brow that looks nothing like the person in youth. Don’t believe it? Go back and look at your old photographs before you decide.

Traditional cosmetic eyelid surgery removes the youthful frame of the eye, further hollowing it and at times aging someone more but even worse altering unnaturally one’s identity. If you review your old photographs, you will be perhaps greatly taken aback to discover you actually had a low brow that was fuller than where it is today. If you have had a browlift, you will see that your brow is unnaturally higher than when you were younger. These are real problems. Without understanding identity and youth, we take away both instead of improving someone.
As we become older, we lose fat around the eyes. That is exactly what traditional eyelid surgery accomplishes, i.e., it makes you look even older. What would you cut or lift in the woman photographed? Obviously, the answer is nothing. She needs fat grafting to replenish the lost frame to the eye. If you have had a browlift or eyelid procedure, compare yourself now with your old photographs. You will probably notice you have a higher eyelid crease and a higher brow than when you were young, i.e., your identity has been unfavorably altered.

What is an ideal facial shape of youth?

Interestingly, many men and women are not thrilled with how full their faces were in their twenties owing to the “baby fat” that was present. Many women prefer a slightly thinner look of the early 30s, which gives way to the beginning of a gaunt, more tired expression in the late 30s, which in turn becomes progressively hollower thereafter. Men may like their faces slightly later than the early 30s (but that opinion varies), as men oftentimes look better slightly hollower than women. So what is the ideal shape for women? In general, a triangle, where the cheeks are fuller and the chin is fuller to restore the heart-shaped face of youth. Sometimes, as women get older the lower outer face begins to dominate. In those cases, fat transfer to the central chin can actually make someone look thinner, which can be surprising. If there is a significant jowl and neck hang, then a facelift may be required. For men, the recipe is not so straightforward. Oftentimes, the outer cheek should be strengthened to create a more masculine shaped face. Balance and proportion are the keys to an excellent result.This woman exhibits the inverted triangle of aging which has been restored to the youthful heart-shaped face or right-side up triangle of youth. Notice that the patient actually looks slimmer with fat added to the face (and without a facelift or liposuction). This is the mistake of thinking you will look fat after fat transfer. This is why the artistry that Dr. Lam exercises is as important as his technical skill.

Does Fat Grafting Last?

Absolutely, if done by the right hands. Dr. Lam performs safe, effective and permanent results that only further aging will erode. If your surgeon says fat transfer does not last, that is only because he can’t make it last. Dr. Lam has written two textbooks on fat grafting and is the world expert on this technique. Combining artistry and technical skill, he is able to create a balanced result that not only lasts but improves over time. How is that possible? After 6 months, the fat transfer result begins to improve as the blood supply to the fat is literally “connected.” Where other surgeons’ fat grafting results begin to disappear at this point, Dr. Lam’s results begin to improve. View case studies of Dr. Lam’s improving fat grafting.

What is the role of facial fat grafting?

Facial fat grafting has become the cornerstone in Dr. Lam’s strategy for management of the aging face. Although the initial mention of putting fat in one’s face may sound unappealing, understanding its benefits requires an education process that can be quite enlightening. Fat grafting is intended to address one component of the aging face that is oftentimes overlooked, the loss of volume and the hollowing that occurs in the face, particularly around the eyes, the cheeks, and the front of the jawline. Dr. Lam believes that too many facelifts and blepharoplasty (cosmetic eyelid surgery) are performed in people who really may benefit more ideally from fat grafting, especially in the younger individual in his or her thirties and forties who may be too early for a facelift or other such procedure.
During the mid-thirties and beyond, the area around the eyes and at times the front of the jawline become hollower and deflated. What may appear to be extra skin that develops around the eyes and some loosening of the jawline really may be better interpreted as mild to moderate degree of emptying or hollowing in this area. Selective fat grafting in these areas can provide improved balance and harmony of the face and thereby rejuvenate the face more naturally.
The best way to understand the importance of facial fat grafting is to review one’s own old photographs in his or her twenties, thirties, and beyond. This self-education process can help every individual truly understand this very important part of the aging process. Bringing your old photographs in to Dr. Lam can also help establish improved dialogue about when you thought your face appeared to be the best.There are two major objectives when undertaking facial fat grafting: “framing the eye” and creating a more youthful “volume and shape”. “Framing the eye” means supporting the hollowing and deflating eye and cheek that occurs with aging. As mentioned, Dr. Lam performs selective blepharoplasty in combination with fat grafting as needed to achieve the ideal results based on an individualized and tailored approach. The aging process tends to deflate and hollow the eyes, which can oftentimes be exacerbated with the principle of strictly removing tissue undertaken in traditional blepharoplasty (or cosmetic eyelid procedure). Adding a lost frame around the eye can be a critical component to achieving a natural rejuvenation in which your identity is preserved and enhanced rather than removed or unfavorably changed. The second very important concept is understanding the importance of overall facial “volume and shape”. In youth, the face can have more of a heart-shaped or triangular shape, especially in the female, which over time begins to dissipate in one’s thirties. Interestingly, some women believe that their faces are too full in their twenties owing to the presence of “baby fat”. Accordingly, using your old photographs to show Dr. Lam where you thought your face was the best can help establish mutually aligned aesthetic objectives.Many times, women in particular evaluate their face under the close scrutiny of a mirror magnified to 8x or 10x and bright illumination, as that is the way that they apply make up. Instead, what Dr. Lam tries to have you do to understand the impact that his procedure can provide is for you to step back 5 feet away and evaluate your face with normal overhead lights, as this distance most closely resembles social encounters and how others perceive your youth and attractiveness. At this distance, what takes precedence is the overall volume and shape of your face.As we get older, our face changes from a more youthful and vibrant triangle into a square, as the cheeks and chin deflate and the jowls become more prominent. A younger individual (in his/her 30’s or 40’s) may only need to volume enhance his or her cheeks and chin, whereas an older person may require both volume enhancement and a lifting procedure to return the face to an overall more youthful shape. Again, the reason that volume and shape of the face play such a critical role in achieving a youthful face is that is the first and enduring impression that you make to an observer at any social distance of 2 feet, 3 feet, 7 feet, and even 20 feet. Retraining one’s eyes away from just filling smile lines (which Dr. Lam can do) is the first start in understanding the power of what volume contouring can deliver.

Does Dr. Lam perform facial fat grafting differently for men?

Absolutely, Dr. Lam performs a very customized plan of fat grafting in every case. In men, the anterior cheek should not be overly enhanced otherwise the face can be feminized. Conversely, the lateral cheek can be a more masculine feature to be subtly enhanced. The lateral (outer) jawline can also be a region to enhance to arrive at a more masculine or youthful jawline. Dr. Lam tailors his approach for every patient. Generally, Dr. Lam is more conservative with volumes in the male face depending on one’s age. Again, using old photographs can be the definitive guide in communicating what facial shape is the most desirable.

Are there any areas that fat is not as good for in facial filling?

Yes, Dr. Lam believes that fat is not an ideal filler for lips and facial lines. The fat tends not to persist in the lips very well and can also make the recovery time quite long and deforming, which is unacceptable to him. He has many alternative strategies for lip enhancement, both temporary and permanent, that do not require any incisions and are discussed in the Lip Enhancement and Dermal Fillers FAQ sections. Dr. Lam does place fat along deeper facial lines like the smile lines and the so-called “puppet” or marionette lines that extend just below on either side of the lips. However, he believes that you will most likely be disappointed in your result with fat grafting in this area. Fat grafting to fill a line simply has not yielded consistently excellent results. The reason that Dr. Lam still places some fat into these facial lines during fat grafting is that he wants to ensure a softer transition between augmented cheeks and the unaugmented upper lip. If this explanation is confusing to you, he can explain these principles more clearly during a personalized consultation. Please be sure to bring questions with you to your consultation.

If my chin is very weak, can I just have fat grafting there instead of a chin implant?

Yes and no. Dr. Lam almost always places some fat along the anterior jawline and chin area, since we lose some dimension in this area as we become older. However, if you have a very weak chin (see Facial Enhancement with Chin Implants FAQ section), you may still benefit more from a chin implant instead or in combination with fat grafting. A chin implant provides more assured projection (i.e., how far the chin sticks out) than fat grafting can. Nevertheless, in most circumstances, fat grafting alone can provide wonderful and consistent results in the chin area. Conversely, if you have only subtle loss of volume in the chin area from aging and only require a little enhancement in this area, a chin implant can make you look different and is simply unnecessary in most cases. A consultation with Dr. Lam will help establish which method would be ideal for you.

How does Dr. Lam perform facial fat grafting?

Fat grafting is an entirely incisionless procedure that requires no cutting, sutures, or bandages. It is performed with anesthesia by an M.D. anesthesiologist in Dr. Lam’s surgery center in about an hour and a half. The process begins with sterile (clean) harvesting of fat from the area where you have the most fat on your body. For some women, it may be the belly and for others the thighs. For most men, the extra fat is only distributed in the truncal area (belly and love handles). Dr. Lam does not use a liposuction machine to harvest the fat. Instead, all the fat is gently harvested with a handheld syringe so that the fat cells are not traumatized or damaged during the harvesting process.
The fat is then centrifuged to remove the unwanted impurities (like blood, lidocaine,and lysed fat cells). The fat is transferred into tiny 1-mL syringes that are used to insert the fat using a 1-mm blunt cannula. A cannula is a device that is blunt and soft at the tip so that the underlying facial tissues are not harmed in any way.
Dr. Lam carefully places about a fifth of a rice granule of fat per pass of the cannula with thousands of little passes to rebuild the entire face. This micro-droplet technique provides the absolutely smoothest results and the best longevity since there is rich blood supply that supplies and surrounds each tiny parcel of fat.

Will I then need liposuction for my body afterwards?

Harvesting of fat from the body only takes very small amounts of fat away and generally will not result in a body contouring benefit except in the very thin individual. If you require liposuction, you will still require this procedure by a plastic surgeon who performs body plastic surgery, as Dr. Lam does not perform any body procedures. Dr. Lam highly recommends you defer having your body liposuctioning until he has completed his facial fat grafting procedure so that he has access to your “best fat”, the fat that is hardest for you to lose no matter how much dieting you do. This fat tends to be the most ideal for facial fat grafting.

Will I look fatter after fat grafting?

No! No! No! This is perhaps one of the greatest concerns that patients express early on, as the procedure simply does not make intuitive sense. Dr. Lam only places fat along areas of hollowness like around the eyes, the cheeks, and the anterior chin. Placing fat into the jowls and neck would make you look fatter, which Dr. Lam does not do. Also, if you are slightly heavier in the neck and jowls, fat grafting into the other facial areas can actually make you look slimmer since the augmented areas now make the other heavier areas look proportionately smaller. The best way to understand this principle is to think of a glass of water. If you put a very large glass of water next to it, the original glass of water looks very small. If you put a very tiny glass of water next to the original glass of water, the original glass of water appears large. This is the principle of harmony (to be discussed below) that Dr. Lam exercises when rejuvenating your face.

What if I gain or lose weight?

All of us tend to gain some weight as we age, which is natural and to be expected. Surprisingly, we also lose some volume in our faces at the same time. Generally speaking, gaining and losing approximately 20 pounds or so will not make a difference in your face in most cases. However, patients who are grossly overweight or who have a wildly fluctuating weight may not be ideal candidates for fat grafting. Discussing these concerns with Dr. Lam will help you decide what are your best options.

What if I have areas of my face like my jowls that appear heavier?

Placing fat near the jowl can make the jowl appear smaller based on the above principle. Also, the jowl itself if it is prominent enough cannot be entirely addressed with fat grafting but requires a facelift to improve this condition. Dr. Lam will also address the jowl and other areas of the face that appear heavier with a process known as microliposuction to reduce areas of heaviness. As we get older, we not only lose volume in some parts of our face, we also gain volume in areas that we don’t desire.

I have heard that fat grafting can lead to a lumpy result or that it does not last and is only temporary?

Dr. Lam achieves uniformly smooth results with his fat grafting, as this is his specialty. He has literally written the book on the subject, Complementary Fat Grafting. He has yet to encounter a situation where he has had to remove any of his own grafted fat. With the absolutely precise micro-parcels of fat that he delivers in every case, he achieves the most seamlessly natural results. Also, fat grafting is a permanent solution with a couple of caveats. As you get older, you will lose some fat naturally but less so than if you never had fat grafting to begin with. A simple analogy will be explanatory. If you had a twin who has not only the same genetic makeup as you do but also controlling for all external factors (diet, stress, smoking, sleep, etc.), you will also look substantially younger than your twin. Not only are Dr. Lam’s fat grafts permanent, but also his patients often look significantly better at a year than they do at a month following the procedure. This is a very common observation. Fat grafting is a graft so it must have enough blood supply for an optimal outcome. In the majority of individuals between 35 and 60 years of age, fat grafting rarely requires a touch up. In a smoker or someone older than 60 years of age, occasionally, Dr. Lam needs to put some additional fat at 6 months to a year following the procedure. However, Dr. Lam’s touch up rate is about 5% overall, and a touch up is extremely easy to perform and requires little less than an hour with a much shorter, sometimes a weekend, recovery time.

Will a facelift or a fat graft take care of the lines around my mouth?

Unfortunately, no. Dr. Lam has seen many patients from other surgeons who have come to him dissatisfied and disillusioned with fat grafting or a facelift because they were promised that either method would correct folds around the mouth. Dr. Lam believes that there is no long-term correction of the folds around the mouth with fat grafting or a facelift. These lines must be addressed through office-based (non-surgical) methods as outlined in the Skin Rejuvenation and Dermal Fillers FAQs sections.

Does Dr. Lam use fat grafting to plump up lips?

No. Although Dr. Lam performs numerous fat grafts, he believes that fat grafting is not an ideal method to enhance one’s lips for three reasons. First, fat in the lips most often simply will not last. With the use of silicone, Dr. Lam can achieve a natural, permanent, soft, and non-surgical enhancement of one’s lips. Second, the swelling/deformity with fat grafting in the lips is both protracted and can be quite alarming. For the results that you eventually obtain with fat grafting in the lips, Dr. Lam does not believe that it is worth it. Third, the ability to sculpt natural looking lips with fat grafting is harder than with silicone or Restylane in Dr. Lam’s opinion so he will not use fat in the lips.

What is the recovery for facial fat grafting?

Although facial fat grafting does not require any incisions or bandages, there still will be some recovery time necessary. Generally speaking, the first week following the procedure you will look swollen to the point that you will most likely not be socially acceptable. The second week following fat grafting will be much better but you will still be moderately too swollen. By the end of the second week, most observers looking at you may actually begin to see more improvement than deformity. It oftentimes takes up to 3 weeks before you begin to like your result. Nevertheless, most people return to work after 7 to 10 days following their procedure and you should allow that much time off from your work schedule. Wearing dark sunglasses for the first couple of weeks can make it much easier to camouflage your swelling, as most of the noticeable swelling occurs around the eyes. If you have been to other fat grafting websites and noticed that the recovery can be much worse and longer, you should not be dismayed. Many other surgeons overfill the face which, in Dr. Lam’s opinion, not only makes your recovery time unnecessarily long but also your results can appear unnatural.

Are there any precautions that I need to follow after fat grafting?

Dr. Lam will review with you all the details about what you should and should not do in his instructions that he will give you. However, in summary, it is a good idea to reduce your dietary salt for the week following your fat grafting to minimize swelling. Also, you should refrain from a lot of household busywork or bending over, which can make you more swollen. Periodic icing of the treated areas will also help reduce swelling more quickly. As there are no incisions or bandages, you will not have to clean or take care of any incision lines. There is in fact very little postoperative care.

What will I feel like after fat grafting?

You will feel surprisingly very good. The areas from which the fat are harvested will feel a bit sore, as if you worked them out the day before. That mild discomfort should last typically only several days. The face will feel somewhat tight and a bit flushed for several days with only very minimal discomfort if any.

Are there any changes to my skin after fat grafting?

Surprisingly, fat grafting oftentimes can make the skin appear much softer and smoother afterwards. However, if this change should occur, it will often take 6 months to a year before it is evident. Dr. Lam has seen even wrinkles soften and uneven color and texture improve. Somehow (which is not all together understood right now), fat grafting affects the skin in an impressive way to help rejuvenate the skin. In some studies, the skin texture and tone looks better 10 years after fat grafting than it does even one year afterward. There is almost a reversal in the aging process.

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