Facial Fat Grafting
Contemporary facial fat grafting is utilized to volumize the face, correct asymmetries, and balance the face that has suffered trauma with resultant fat loss or has gone through an ablative procedure for a tumor. By harvesting, preparing, and transplanting fat as intact tissue it can be selectively used to enhance body contour and improve facial balance. Facial Plastic Surgeon Dr. Jose Barrera, MD, has published peer reviewed articles on Facial Fat Grafting, refining his technique for facial fat grafting over numerous years.
Follow our patient on her journey after Deep Plane Facelift, Pretricophytic Browlift and Facial Fat Grafting.
The goal in facial fat grafting for facial rejuvenation is to restore youthful fullness to the upper Face by sculpting the cheek bone and providing fullness to the cheek mound. Dr. Jose Barrera, MD has published on the position and dynamic movement of the malar fat pad and the cheek mound in JAMA Facial Plastic Surgery (Figure). Restoring position and volume to the malar fat pad enhances volume and fills the nasojugal and tear trough deformity that is apparent with facial fat descent and deflation associated with aging. By filling above the boney layer of the midface, a full lower eyelid is reestablished. In addition, a straight jawline can be achieved by facial fat grafting to establish an attractive, straight shadow under the mandible with a well-shaped chin. Adding support to the midface and lower eyelids rather than excising and suspending structures results in a much more natural rejuvenation and enhancement.
Fat grafts are also used in skull base surgery to obliterate relatively small well-contained cavities and restore lost soft tissue bulk. Fat grafts are harvested from the anterior abdominal wall or hip region. Fat grafts can be combined with other autologous materials to obliterate a large defect or in patients who present for revision surgery or have been previously treated with radiation therapy.
Fat has been demonstrated to be a well-vascularized tissue with high metabolic activity. Fat has numerous functions including its structural role and serving as a reservoir for energy storage. The number of fat cells is generally stable after the completion of adolescent growth. Changes in the volume of fatty tissue relate to the size of cells and their overall lipid content. Cells removed by liposuction or other surgical procedures do not regenerate. Cells shrink with overall weight loss and in fact may dedifferentiate. However, subsequent weight gain causes redifferentiation of the cells with an increase in volume.
Fat cells have thin cell membranes enmeshed in a fibrous network. Without the supporting fibers, the cells tend to collapse. Connective tissue creates structure to lobules of fat. Harvesting fat while maintaining as much supporting structure as possible preserves structural integrity of the tissue and helps the tissue retain bulk in the transplanted site. Almost any site can be used for harvesting; the abdomen and hip region are easily accessible, therefore preferred.
Our technique in facial fat grafting involves three separate procedures: (1) harvesting the graft, (2) transferring the graft, and (3) placing the graft.
Fat is commonly harvested from the anterior abdominal wall using a small 2 mm incision inside the umbilicus or belly button. Alternatively, placement of the incision on the left side avoids possible confusion as to whether an appendectomy had been performed. An alternative site is to utilize the hip region. Particularly in women, a deposition of fat can usually be found.
Transferring and storing adipose during surgery should avoid desiccation. Once the fat graft has been harvested, it is placed in a receptacle filled with bacitracin saline solution.
Facial Fat grafts are either injected using a lipocanula system for facial augmentation or the fat graft can be placed directly into a facial, head or neck defect.
59 year old female with left parotidectomy for parotid tumor removal. Deep Plane Facelift, Pretrichophytic Browlift, and Facial Fat Grafting was performed.
55 year old female with infratemporal fossa defect after tumor resection. Facial Fat Grafting to right temple and zygoma was performed.