Fat Grafting Dallas

Facial volume loss is one of the major components of facial aging. Dr. Lam wrote the definitive textbook on the subject, Complementary Fat Grafting in 2006, and the book continues to sell out over a decade after its publication. Volume loss is only one component of aging and a surgeon with a good aesthetic eye should avoid the overfilled looks that have turned many people away from fat grafting and/or fillers. Dr. Lam will evaluate your aging face and tailor the right program for you to achieve your desired outcome based on your desires, anatomy, degree of aging, budgets, and recovery time.

Key Points:

1. Fat grafting provides a global volumization strategy for the face that can be far less expensive than the alternative, injectable fillers. However, fat grafting has some known downsides. First, there is some variable absorption even though a high percentage is retained. Second, if one is prone to gain and lose a lot of weight, the volume of fat grafting may fluctuate in the face since it is a live graft. Third, if one is very young (<35 years of age, he or she may not be as good a candidate because one’s history of weight stability may not be as established and because he or she may not require that much volume (so fillers may be more suitable). Third, even though fat grafting is permanent, there will be ongoing aging, so fat does not stop aging. Dr. Lam recommends to perform some fillers on an annual basis to maintain against further aging (although this is not mandatory). Fourth, fat works poorly to manage surface defects like acne scars or linear scars. Fifth, fat works poorly for filling lips and also lines of the face like wrinkles and smile lines. If one appreciates the limitations of fat grafting, then Dr. Lam can leverage the advantages of fat grafting in that an individual can look remarkably rejuvenated for less cost all at once.
2. Fat grafting can be easily combined with other procedures like upper- and lower-eyelid procedures, lasers, facelift, chin augmentation, etc. Dr. Lam believes that the aging that occurs in the eyelid area is mainly volume loss, so he may remove a little bit of upper eyelid skin or remove a little bit of lower eyelid fat but the principal method by which he rejuvenates the eyelids is by adding volume. Please see the section on Blepharoplasty for a more complete understanding on this subject.
3. With the advent of microcannulas (short, blunt-tipped instruments), Dr. Lam can achieve remarkable outcomes in the office using fillers. Fillers, however, take many more rounds of treatments to have a similar longevity to fat grafting. Accordingly, if someone is over 45 years of age (for example) with moderate to significant volume loss, he recommends one to consider fat grafting over the use of fillers. However, for those with a smaller, starting budget or those that do not prefer a surgical procedure (even though fat grafting involves no incisions), then fillers may be the preferred method. Deciding between fat grafting and fillers is a daily conversation that Dr. Lam has with his prospective patients, and he can weigh with you the pros and cons in your case to help make the right decision for you.

Besides the face, hand fat grafting can provide remarkable rejuvenation for the hands. Many times individuals overlook the importance that hands make to the overall appearance. Dr. Lam says that the only two areas that are not covered by clothing are the hands and the face/neck region. Hands can definitely give away one’s aging. The goal of fat grafting for the hands is not to eliminate wrinkles. Fat grafting does a poor job towards that end. Instead, fat grafting is intended to partially (but not entirely) cover exposed veins and bones of the hand that are associated with aging. Even though fat may not entirely cover all veins and bony landmarks or efface wrinkles, the appearance of the hands after fat grafting can truly look incredibly younger to an onlooker. This could be particularly important for public speakers or for those who use their hands a lot socially on a daily basis. For wrinkles, Dr. Lam uses fractionated lasers that can help improve the quality of skin but because hands cannot tolerate high doses of lasers not all wrinkles will be improved or eliminated. Using all-natural bleaching skin care products should also be used in moderate to significant cases of sun damage to the hands.

FAQs

Does Dr. Lam do touch ups for fat grafting?

No. Fat grafting should provide a very good outcome after a single treatment. There are several reasons Dr. Lam does not do fat grafting touch ups. First, fat grafting is a live graft and touching up a result can lead to overfilling the area, which would be a worse outcome. Second, fat is only good for general contours and not for surface problems, so fat will fail again if used for that purpose. Further, if one tries to make things perfect with fat grafting, you will have one of two outcomes: being overfilled or disappointed that the surface problem you wanted fix was not. Dr. Lam uses fillers in the office at a year or so to touch up a fat graft result (which is charged at an extra expense) but even fillers cannot accomplish perfect outcomes. He likes to say that fat improves the “mattress” or foundation/structure of the face, whereas fillers and Botox are used to manage more superficial facial problems.

What is the nature of the recovery process?

The major problem after fat grafting is typically not significant discomfort. Instead the major problem is that you may feel that your identity is altered for the first week. This can be disconcerting even if you are prepared that it may occur. This is why Dr. Lam shows recovery videos on his website to prepare you (at least in part) that your eyes in particular will be swollen and temporarily change your identity. This problem will resolve over a period of 1 to 2 weeks. In a few cases it may take up to 3 weeks for you to like the result but in almost every case most people looking at you will probably feel you look pretty good at 2 weeks. This is due to the fact that we have a much harsher self-perception than what others hold of us. The areas where the fat is harvested (the belly and thighs) can be bruised quite a bit but fortunately these areas are coverable with clothing. The donor areas can also be a bit sore and when you work out feel as if you have worked them out too much. You should try to avoid strenuous workouts for a week but then can slowly return after a week. Just avoid swimming and dirty water exposure (although you can shower after the first day) for the first 3 weeks if possible.

Should I do fat grafting or fillers for my face?

This is always the major decision process for each patient. As a general rule, for younger patients with early signs of hollowness, fillers are preferred and more than adequate. For someone in their 40s or older, especially someone who has not had fillers before, fat may be more of a universal and cost-effective solution. Even though fat grafting may cost less for a global fill, you may have a tighter initial budget. Fillers offer a less expensive option than fat grafting when targeting just a few select areas of the face that are of critical importance. Dr. Lam is very good at counseling you on which procedure would be better for you based on numerous factors, some of which have been outlined above.

Does Dr. Lam believe that I should do fillers or fat grafting for my hands?

In general, if there is moderate to significant aging, hand fat grafting is definitely Dr. Lam’s preferred method. Hand fat grafting can give you the most “bang for your buck” since it can take quite a bit of fillers to even approximate a hand fat graft result (except for the younger patient with early hand hollowness.) With hand fat grafting he is able to fill even the knuckles and the fingers for a global fill. It should be noted that the recovery with hand fat grafting can be longer, lasting 2 to 3 weeks where the hands may look swollen and bronzed (reddish-brown discoloration). However, fortunately, most individuals really don’t notice hands being swollen and usually it is not as unsightly as one thinks.

Comparison Chart between Fat Grafting vs. Fillers

There are two principal ways to restore facial volume: fat grafting and facial fillers. This is oftentimes a confusing decision for many patients. The following table lists the pros and cons of each method based on Dr. Lam’s experience. Even though this table outlines some of the basic pros and cons of each method, only a consultation with Dr. Lam can help establish with you which method would be better in your case.

	Fat Grafting	Fillers
Type of Procedure	Surgical (but no incisions)	Office-Based
Ideal Age	Over 35 years old (with enough facial volume loss to justify the procedure, relatively stable weight, and healthy to tolerate anesthesia)	Any Age
Short-Term (Initial) Cost	Higher	Lower
Long-Term Cost	Lower	Higher
Recovery	7-10 days: You will not look socially acceptable during the first week but typically have very little discomfort during that time. You should take at least a week off from work.	Typically, mild swelling for a day or so but if there is bruising, that could last in rare cases over a week to two. Ideally, you should give two weeks before major events, a week before minor events, but many return to work the same day or the next day if they are willing to accept some mild swelling and possibly some minor bruising.
Benefits	Can provide the most cost-effective solution for an individual with moderate to significant volume loss Permanent solution minus some initial resorption and also further aging Can provide improvement in the quality of skin over time (‘stem cell’ effect)	Can be tailored to one’s budget (small, moderate, or more) Typically, very little recovery Can be effective to treat areas that fat does not fix well like lips and folds Office-based without need for anesthesia Not weight dependent Can last many years after a few rounds Reversible, dissolvable
Limitations	More recovery time than fillers (see above) Some initial resorption of fat Does not effectively manage smile lines or lips Fat is dependent on weight, with too much weight loss the fat can look partially resorbed, or worse with weight gain the face can look too full	Can be costlier over time when trying to simulate a fat transfer Can take multiple rounds of fillers to achieve longevity so multiple smaller rounds of recovery can exceed the one larger recovery time of fat transfer Very low risk (but still possible) of infection since it is not one’s own tissue

Videos:

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Photos:

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All fat grafting procedures are performed by Dr Lam personally, at his Cosmetic Surgery center in Dallas Texas. To schedule a fat grafting consultation call 1-888-866-3388 or email us. The details of your fat grafting procedure (both the limitations and the benefits in your particular situation) will be explained to you during your consultation with Dr. Lam and his team.