Aging is a fact of life, but looking one’s age is not. The holy grail of plastic surgery seeks to reverse the
ravages of aging and bring the patient to his or her previous youthful glory.
As we age, our skin loses its elasticity and becomes saggy. Generally, there will be a noticeable volume deflation in our face due to the resorption of our bone, fat and soft tissue over time. Like a deflating balloon, the face loses its suppleness and roundness. Usually, such “deflation” is especially obvious over the temples, peri-orbital (eye) region, mid cheek and chin.
Previously, the common solution for volume replacement was through the use of filler injections or “liquid facelift”. However, the effects of filler injections are temporary (most lasts only 9 to 12 months) and too many injections lead to the infamous Hollywood “pillow face” or worse still “cat face” as the over-filled cheek presses on the eyelids making the eyes look smaller and slanted.
Fat injection in itself is not a new technique. However, in older injection techniques, up to 70 or 80% of the fat
will disappear as surgeons used to inject the fat as large clumps. As a result, only the peripheral fat in contact
with surrounding blood vessels survive while the innermost fat dies off. In recent years, with the invention of
slimmer cannula for fat harvesting and fat deposition, the concept of micro fat grafting has become increasingly
Essentially, micro fat grafting entails careful harvesting of fat using low-vacuum cannula, purification of the fat and then injecting them into the face in tiny aliquots over multiple passes. This avoids the previous problems of fibrosis, cyst and nodule formation. This technique is very operator-dependent and involves a rather steep learning curve on part of the surgeon in getting it right. Under the hands of a skillful plastic surgeon, it is a very rewarding procedure both for the patient as well as for the surgeon.
The advantages of fat versus filler injection are many, but most importantly is the prolonged survival of fat. It is postulated that injected fat can easily survive for 10 years or more. In addition, because it comes from the patient’s own body, there is no risk of adverse immune reactions to the injected fat. Due to the mesenchymal stem cells contained in fat, the injected fat has been shown to improve the overlying skin texture and quality. For patients who need large volume augmentation, fat injection is actually more economically viable compared with using multiple syringes of filler.
It is also common for patients to do this procedure alongside a conventional liposuction to get rid of excess fat over their abdomen and love handles. So, patients wake up from these “two-in-one” surgeries with a slimmer body contour and a fuller more rejuvenated face.
This technique is very useful for the correction of sunken, hollow eyes. It is also very useful for correcting dark
eye circles which are caused by a combination of fat loss around the eyes and sagging of the upper cheeks. By
filling in the shadow within the tear trough under the eyes, fat grafting can make an extraordinary difference in
rejuvenating the look around the eyes. It is also useful for the laugh lines around the face as well as the
hollowing over the chin as well as temple. The same technique can also be used for volume augmentation of
hypo-plastic and saggy breasts. For the body, fat grafting can also be used to rehabilitate patients with scarring
from previous accidents or deformities caused by previous surgeries including liposuction deformities, previous
over-zealous eyelid surgery or flattening of the mid cheek from previous facelift surgeries. It is also useful for
depressed or atrophic scars around the body.
Micro fat grafting of the face is usually performed under local anaesthesia. The fat is harvested via two or three small stab incisions over the thigh or abdomen. The harvested fat is first centrifuged to separate the pure fat from the blood and serum. This also helps to concentrate the fat and associated stem cells. Then, using a 18 Gauge needle, small needle puncture marks are made in the face and the fat is injected into the face using blunt-tip cannula. The key to success lies in careful deposition of tiny aliquots of fat near the facial muscles. The rich blood supply from the facial muscles will ensure the continued survival of these fat cells. Post-operatively, there may be bruising which will last for 1-2 weeks. There are no stitches involved as the tiny puncture marks will heal spontaneously.
In summary, micro fat grafting is an exciting new technique which has resulted in a paradigm shift in our approach towards facial rejuvenation. Under trained hands, it is safe and promises long lasting results for patients.