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Fat grafting, also known as fat transfer, has been a procedure that has been around for over a century but has gained popularity over the past two decades. Dr. Lam, a pioneer in the field, not only wrote the most popular textbook in the world on the subject, Complementary Fat Grafting (Lippincott, Williams, & Wilkins, 2006), but also has lectured worldwide on the subject along with having written numerous book chapters and articles on fat grafting. Fat grafting, in short, involves harvesting fat from areas of excess like the thighs or belly using a handheld liposuction technique, which is then processed for purity, and then finally re-injected into the face in areas that would benefit from volume restoration, for example, the area around the eyes, cheeks, etc.
Unfortunately, fat grafting has gotten a bad rap for a few reasons, which are unjustified when performed by a technically excellent and artistic surgeon. The first negative comment is that it can lead to a “pillow face”, which is an unnatural, overfilled appearance. Dr. Lam selectively avoids areas that appear fake like the anterior cheek, which looks distorted when people smile. Instead, his goal is to cover areas of bony prominences and soften the exposure of the underlying skull, which leads to a natural, refreshed appearance. Second, the belief that fat grafting is only temporary is false. Yes, a portion of fat does not survive but the vast majority lasts to provide a permanent result minus the effects of further aging. This concept will be explored more in-depth on this page and during a consultation with Dr. Lam. Finally, a complaint is that fat grafting around the eyes is unsafe due to lumpiness and irregularities, but this is far from the truth. In experienced hands, Dr. Lam has an incredible safety record and has taught how to safely inject fat around the eyes to minimize/avoid these issues.
With issues of filler migration around the eyes, fat grafting has become Dr. Lam’s best method to rejuvenate the eye area oftentimes in tandem with eyebag removal, light laser, upper eyelid skin removal, and less commonly browlift. Fat grafting is not good to try to lift jawlines or to fill in folds around the mouth, where a facelift and fillers, respectively, are better methods to address those problems. Nevertheless, fat grafting is a critical part of Dr. Lam’s methods to achieve excellent facial rejuvenation with or without face and neck lifting depending on the patient’s desires, budget, degree of aging, etc.
What is Facial Fat Grafting?
Facial fat grafting began in 1893 when Gustav Neuber harvested a lump of fat to be used to reconstruct a breast. However, that fat did not survive well because a large ball of fat simply would not have the blood supply that microfat would have. An early pioneer of modern fat grafting is Sid Coleman of New York who championed microdroplets of fat grafting into the face for long-term survival. Unfortunately, as a pioneer, many of his patients appear overfilled due to an overzealous desire to augment the face with fat. Dr. Lam wrote the most popular textbook on fat grafting in 2006, Complementary Fat Grafting, and has lectured around the world on his technique that combines artistic skill and technical precision allowing natural and long-term results that withstand the test of time.
Fat grafting today involves three steps: harvesting, processing, and injection. These three steps are explained with greater detail below. In summary, fat is harvested from the thighs or belly using a liposuction cannula done by hand; then the fat is processed through washing and filtration (Dr. Lam uses PureGraft), and then finally infiltrated with tiny droplets into the face in an artistic and skilled fashion. Unlike traditional cosmetic facial surgery, fat grafting as a standalone procedure does not involve any sutures, cutting, bandages, or drains and usually can be completed in 1-2 hours of operative time. It can and should be combined with other surgical methods like upper and lower blepharoplasty and/or facelift and non-surgical methods like laser, Botox, and fillers for optimal results when indicated based on your degree of aging, your anatomy, budget, recovery time, etc.
Benefits of Facial Fat Grafting:
Facial fat grafting has many benefits, some limitations, and some risks, all of which should be explained to the individual considering having the procedure performed. The main benefit of fat grafting is that it offers natural-appearing, long-lasting results much more globally than individual fillers can offer (which can be quite costly given the number of syringes needed and the number of sessions required to achieve a long-lasting result) not to mention that fillers around the eyes can migrate over time, which fat does not do. Generally, in a single session of fat grafting, you should be able to attain a very good result that should last years minus the effects of further aging.
Fat grafting is intended to soften features, cover exposed bone of aging, and to provide an appearance of a younger, rejuvenated face. The best way that Dr. Lam describes these benefits is in terms of what he calls “Right Brain Results”, meaning that you should look more youthful, attractive, rested, and balanced. However, “Left Brain Results” are unachievable, meaning elimination of a fold, perfect symmetry, etc. By understanding those elements, you will understand how fat grafting can have benefits without misunderstanding the limitations.
A natural question is whether fat grafting survives since the Internet is replete with surgeons and patients claiming that fat grafting is only temporary in nature. Dr. Lam performs facial fat grafting in his own surgery center in Plano, Texas (north of Dallas, Texas) almost every week and has done so for 20 years. He would not be performing this procedure if he did not believe his results were long-term and amazing. He describes fat grafting phases postoperatively to help people understand the difference between swelling and graft survival. The first phase postoperatively in the first couple weeks of fat grafting represents swelling where you may think too much fat was placed but it is just swelling. At 4 to 8 weeks you may think that your result is perfect, but this may also represent some residual swelling and absolutely does not reflect a long-term result. After several months the fat will diminish and the portion that survives will persist. Usually, Dr. Lam believes whatever survives after 6 months is permanent in nature minus further aging. When the fat graft diminishes a bit at this time, he encourages you to review photographs to show that the result still looks substantially better from a right-brain perspective rather than a perfect left-brain result (see above for explanation).
Who is a Candidate for Facial Fat Grafting?
The ideal candidate for fat grafting is an individual with some signs of aging, especially around the eyes where they have lost volume and where possibly Dr. Lam may combine an upper and/or lower blepharoplasty (cosmetic eyelid procedure) to improve fat grafting results. Look at the blepharoplasty page for details of how Dr. Lam combines these techniques. Dr. Lam prefers someone over the age of 40 years if possible who has relatively stable weight and realistic expectations.
In general, he does not prefer to do fat grafting on extremely young individuals like teenager or 20 somethings because their future weight profile is unclear, that is, they may gain a lot of weight making the fat look fuller over time. Grafted fat is truly live fat and with significant weight gain or loss there can be some changes to the size of the fat graft. Usually “holiday weight” does not cause major issues in most individuals. By staying away from the anterior cheek, Dr. Lam has seen fewer issues of weight gain following fat grafting. In general, if you are planning to lose some weight, Dr. Lam prefers but does not insist on performing fat grafting when the weight profile is slightly higher, as he believes it is safer and more ideal to do the fat grafting allowing for possible weight regain over time. He can discuss that point with you more specifically during a live or virtual consultation to have you understand more about his philosophy and strategy that is applicable to you personally.
A few other limitations with fat grafting should be stated, mostly due to Internet misinformation. There are many physicians, especially cosmetic injectors, who argue that filling a face full enough will allow the neck and jawline to lift upwards. Dr. Lam condemns this comment and does not believe that fat or fillers can lift a face. He only believes a face and neck lift can lift tissues sufficiently to deliver a reasonable cosmetic outcome. Secondly, fat grafting should not be used to eliminate folds around the mouth or wrinkles around the eyes. Fat is placed too deeply and it is too soft a product to work on these lines. Instead, Dr. Lam uses fillers, lasers, and Botox to manage these conditions rather than fat. Finally, as mentioned, fat grafting is not a great option to try to make a face symmetric since no face will ever achieve any reasonable level of symmetry.
The Facial Fat Grafting Procedure:
Facial fat grafting involves harvesting fat from the body, purifying the fat from impurities, and then re-injecting the fat into the face and/or hands to rejuvenate lost volume. Let’s break down each part of the procedure. Harvesting of fat uses liposuction cannulas where Dr. Lam gently suctions the fat out using handheld syringes rather than a liposuction machine. The reason is that harvesting fat at high pressures like in mechanical liposuction can damage delicate fat cells, which would compromise fat-cell survival. Instead, handheld harvesting is the way to go. He typically chooses areas of the body that has the highest stores of quality fat like the belly or thighs and in rare cases in extremely thin individuals he will decide to harvest from the buttocks. People oftentimes ask if there will be an improvement in the contour of their thighs and abdomen. Generally, the answer is no because the amount of fat that Dr. Lam removes is very little when compared with mechanical/machine liposuction. For example, a very obese patient may take 1 to 5 L (1,000 to 5,000 ml) of fat off of their body for body liposuction, whereas Dr. Lam will remove 50 ml of fat in general to be transplanted, where about half of that fat does not make it to the processing step but represents lysed (broken) fat cells. Accordingly, the amount of fat removed is very small. Ideally, if you are contemplating liposuction, for you not to do that procedure first so that Dr. Lam has his choice of the most ideal fat for facial fat grafting. Another question oftentimes asked is whether you can decide where Dr. Lam chooses the fat. Generally, this is not ideal because Dr. Lam’s extensive experience with fat grafting will help guide him to choose the ideal donor site, especially considering that most likely you should not see a cosmetic improvement in the area he harvests from it is far better to let him decide where he will plan his harvest. Finally, lipoharvesting does not require any incisions but small needle sticks usually at the groin or in the belly button (umbilicus) for harvesting.
After the fat has been harvested, the fat must undergo purification so that only viable, quality fat cells are transplanted to minimize inflammation and to maximize survival. There are many ways to purify fat, including but not limited to centrifugation, washing, along with systems that filter fat. In the past, Dr. Lam used a centrifugation method for many years but believes today that the level of purity he can achieve with a closed system like PureGraft has revolutionized his results. PureGraft involves placing the harvested fat into a closed filtration bag where the fat is washed and filtered of contaminants. He has seen far better survival with this method than his prior method. The fat, after it has been washed and filtered, is transferred sterilely into individual syringes for injection into the face.
The final phase of fat grafting is the infiltration of fat into the face. Dr. Lam uses exclusively 1.2 mm Tulip-brand cannulas, which he believes provides the ultimate in gentle infiltration, safety, and survival benefits. He has used this brand now for close to 20 years. A cannula, if this is unclear, is a needle with a blunt end. The cannula is inserted through the skin using a tiny needle stick but is blunt to minimize bruising, to allow for safe injection (to avoid injection into a vessel), and to allow tactile feedback (where Dr. Lam uses his non-dominant hand to guide placement during procedure). Infiltration is truly an art. Fat grafting does not require any physical incisions, bandages, etc., that are associated with traditional facial cosmetic surgery. The entire process is done in about 1 to 2 hours in Dr. Lam’s state-of-the-art surgical facility (accredited by the Joint Commission) in Plano, Texas, just north of Dallas, which is part of his office space.
Common Treatment Areas:
The most common area of treatment for Dr. Lam for facial fat grafting is the periorbital area, that is, around the eyes. There are many reasons for this being the case. First, Dr. Lam today does not believe that fillers can be safely injected around the eyes because he has seen issues of migration of “temporary” fillers like hyaluronic acid even years afterwards. In short, temporary fillers are not really temporary. Second, the aging around the eyes really should be of paramount importance because we relate to each other by looking into one another’s eyes and the eyes are what makes someone look tired, sad, or older. Third, areas like the lips can be easily done with fillers rather than fat (although Dr. Lam does perform lip enhancement when performing fat elsewhere on the face). It’s just so much easier to perform fillers in the lips rather than needing anesthesia if that is the only thing someone is wanting. Fourth, areas like the folds (nasolabial groove/fold/smiles lines) really are not easily improved with fat grafting and are also so easily and better improved with fillers. Finally, fat grafting really will not lift a jawline (despite popular myths to the contrary) so a face and neck lift are far better for this problem. All that being said, Dr. Lam believes in injecting fat into various areas of the face because he believes a little bit of fat in multiple areas really can transform a face beautifully like the upper and lower eyelids, temples, outer cheek, lips, earlobes, etc.
Recovery and Aftercare:
Following a fat grafting procedure, there is typically very little discomfort. The areas where fat was harvested can be a bit sore for a week but far less compared to traditional liposuction or body plastic surgery. We recommend a light compressive garment for the body for the first week if there is any soreness in order to improve that feeling. Generally, the face has minimal to no discomfort even if a blepharoplasty is performed at the same time. With a face and neck lift there can occasionally be some soreness but Dr. Lam has invented a revolutionary way to manage that discomfort instantly with dilute Botox.
The hardest part of the fat grafting recovery is looking too swollen for the first couple of weeks. He usually says this mantra to have you understand most likely your psychological perspective: “No one likes it at a week; others will probably like it at two weeks; and it may take you three weeks to like the result.” Of course, everyone is different in terms of how they react to the result and to recover. Staying with a good diet and reducing your stress can help expedite healing along with avoiding any exercise for a week following the procedure. Thereafter, it is recommended for the second week to minimize exercise like straining or bending over in order to speed up resolution of swelling even though these types of activities in general should not impair the result in any way.
There is otherwise very little after care following a standard fat grafting. Since there are no incisions, there is no direct aftercare. Ice packs 20 minutes on the face and 20 minutes off the face can help reduce swelling for the first week but good rest, elevation, and diet will do most of the work. If other procedures are performed, then after care will vary. For example, if an upper blepharoplasty was also performed, then cleaning and ointment will be advised. If a lower blepharoplasty was undertaken, then eye drops may help with eyelid lubrication for the first week. These details will be discussed with you during your preoperative visit and tailored to the procedures you will be having.
Results and Expectations:
Fat grafting if done by Dr. Lam’s artistic eye and careful surgical technique should yield natural, long-lasting results for facial rejuvenation. Even though there will be some absorption of fat over the first few months, the overall result should appeal to the “right brain”, as mentioned, that is, you should look younger and more attractive without someone being able to know why that is the case. A gentle coverage of bony landmarks will yield a softer appearance to the face and diminish the hard transitions lines of aging. To make any one area of the face perfect with fat grafting is impossible, but to soften multiple features can make a face appealing in a way that is undetectable and natural.
Once blood supply is formally in place for the fat graft, approximately 6 months or longer after the procedure, the result can be considered “permanent”. The best way to understand permanence is that the result is permanent minus further aging. Dr. Lam likens your face to a glass of water with a tiny hole at the bottom. The water is the fat in your face, which gradually diminishes over time like a glass of water gradually losing water because of the tiny hole. Dr. Lam refills the glass of water but gradually it continues to go down. Hopefully, even a decade later you should still look better if you take care of yourself with good diet, avoid excessive sun exposure, minimize stress, etc. If you have two identical twins, one of whom has a fat graft procedure and the other does not and you can control for lifestyle (same sun exposure, diet, stress, exercise, etc.), then the identical twin who had the fat graft should still look much younger than the identical twin who did not have the fat transfer, but both still would have aged 10 years since fat grafting does not arrest the aging process. A second fat graft procedure would be done years later only if you so desire or have experienced sufficient aging to make it worthwhile.
Risks and Considerations:
In general, fat grafting is a very safe procedure with consistently excellent cosmetic results if all of the above limitations are well understood. Dr. Lam performs very safe fat grafting with consistent and natural outcomes so long as you keep all of the points mentioned in this section and those discussed during a consultation in mind. Contour deformities, that is, lumps are incredibly rare in Dr. Lam’s hands and typically resolve over a few weeks to months or rarely need to be excised, which Dr. Lam has only had to do once or twice in 20 years’ time despite performing this procedure almost every week. Dr. Lam has not seen any necrosis, tissue compromise, or other major risks with this procedure and finds it to be very safe in his hands. He will address with you any of your concerns that you may have during a formal consultation with him.
FAQs
Does Dr. Lam perform Nanofat or Microfat procedure?
Can Dr. Lam use fat grafting for reconstructive purposes like to fill a defect or hole?
Does Dr. Lam perform fat grafting elsewhere in the body other than the face?
Does Dr. Lam inject fat into my neck area?
Can Dr. Lam perform fat grafting to fix acne scarring?
Does Dr. Lam use fat grafting as a reconstructive tool to fix facial defects from accidents, etc.?
Will Dr. Lam just put fat in my lips?
Does fat grafting work well for smile lines?
Will Dr. Lam put fat into my earlobes?
Does Dr. Lam perform partial fat grafts?
If I am on Ozempic (semaglutide, Mounjaro, or other GLP1 agonists) , can I do a fat transfer?
If Dr. Lam puts enough fat grafting in my face, will that lift my neck or stretch out my wrinkles?
Facial fat grafting in Dr. Lam’s hands is uniquely different in his artistic vision and technical execution. Fat grafting cannot fix skin problems or lift sagging tissues. Fat transfer is intended to soften hollow areas, especially around the eyes, to make a face appear more rested and youthful. The procedure is a good complement to traditional blepharoplasty, cosmetic eyelid surgery, and face and neck lifting. Dr. Lam is a world authority on fat grafting and has many patients who fly into Dallas, Texas, for him to treat them.
Your Cosmetic Surgery Procedures will be performed by Dr. Lam's surgery center located in Plano, TX.
Dr Lam has helped me with fat transfer, botox, and fillers. He is an amazing person with a great personality. I would trust Dr Sam Lam with any Plastic, Reconstructive, or Cosmetic Surgeon procedure. His office runs like a well oiled machine and his staff are super friendly!
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Schedule a Facial Fat Grafting Consultation
If you are interested in learning more about how fat grafting, or facial fat transfer, can be helpful as part of your rejuvenative goals, please reach out to us for a personal consultation with Dr. Lam at his clinic. You can call 972-312-8188 or email us at info@lamfacialplastics.com.