Cosmetic surgery has traditionally worked by removing excess tissue, but in the realm of ‘rejuvenation,’ it’s just the opposite. That’s more about replacing what is lost. ‘In terms of recreating the smooth, rounded contours of our youth, the answer may be no farther away than our abdomens,” says Dr. John Holds of Ophthalmic Plastic and Cosmetic Surgery. Harvesting fat from the abdomen or thighs, where we don’t want, and injecting it in the face, where we do, is becoming the gold standard. “We could use injectable filler, but I can inject more fat for one-fifth the cost of filler,” Holds says.

    And people like the idea of using their own body tissue instead of artificial filler, he adds. When harvested fat is injected, it more likely becomes a permanent part of the body, while filler is gradually absorbed and has to be replaced. “We also know that fat cells have some stem cell activity and may actually be good for the skin and tissue,” Holds says. The downside of fat transfer, sometimes calls liposculpture, is that some of the fat doesn’t take, and some sites are not predicable, particularly areas like the lips, where there is a lot of movement.

    “In many ways, fat transfer is a complementary treatment to other cosmetic procedures,” Holds explains. “I often use it as an adjunct to surgery to achieve a more balanced look. We characterize a youthful face as having fullness, convexity and highlights. An aging face is defined by bumps, sagging and shadows. Restoring those contours with fat augmentation is a great tool.”   

    Doctor David Caplin of Parkcrest Plastic Surgery says fat transfer, or grafting, is the hottest thing. “I’ve been doing it for 10 years, and the majority of my facelifts and other procedures involve fat grafting. It also can be done as a stand-alone procedure, and its newest use is in breasts to even-out rippling from implants, plump-up defects after lumpectomy, or to treat post-liposuction deformities.”

    In the face, a great deal of aging is from lost volume, Caplin explains. “Tightening the skin by itself won’t give as good a look as if we also replace lost volume,” he says. And Caplin now does chin augmentation with fat grafts instead of implants because it is integrated into the body instead of introducing a foreign appliance. “Fat grafting has totally changed the way I do faces.”

    When Dr. Michael Nayak of Nayak Plastic Surgery is asked about fat grafting, he just says, “I love it, and I use it frequently.” But, he notes, the results are not always dependable. “The techniques have improved a lot, but it still remains somewhat unpredictable. It’s like transplanting bushes from one side of your yard to the other. Some of them will survive and others won’t, because they have been stressed. It also depends on the conditions where you plant them. Rose bushes do best in sunny areas; fat grafts do best in the eye areas and cheeks.”   

    But let’s not forget the most obvious advantage of using fat, Nayak says: You’re taking it from someplace you don’t want it. “If I’m doing liposuction, I’m taking out cups of fat. In the face, a couple teaspoons (added) will have a dramatic effect. For fat grafting purposes, we pretty much have an unlimited supply. It’s much cheaper than filler, and it’s our own tissue, which appeals to people emotionally.”

    The downside is that you need two or more sessions to ensure a good result. He says he balances the resulting lumps and bumps with multiple sessions. It’s also a surgical procedure because it’s injected with a cannula, not with a needle like filler. “I almost always use it as a complementary procedure to other therapies, like eyelid surgery (blepharoplasty),” Nayak says. “I remove excess skin and then use fat to fill in the dark circles in the tear troughs and other indentations.”