Facial fat grafting

Facial fat grafting (lipofilling), the transfer of the patient's own fat to the face, is a procedure in which the patient's fat is used to restore volume to certain areas of the face. The fat is harvested by fine liposuction, usually from the abdomen, flanks or thighs, processed and then reinjected in small amounts where volume has been lost or where a more harmonious contour is desired.

The areas most often treated are the cheekbones, temples, nasolabial folds, under-eye area and chin, which can be moderately enlarged with the patient's own fat. At Detalii Med, in Baia Mare, the procedure is performed by Dr Marius Pruna and Dr Valeria Pruna.

Facial fat grafting may be considered in situations such as:

• loss of facial volume with age, with flattened cheekbones or hollow temples;
• pronounced nasolabial folds;
• a hollow under-eye area that looks tired;
• a small or slightly receding chin for which moderate enlargement is desired;
• mild facial asymmetry.

The patient should be in good general health and have enough fat in a donor area. Smoking, some chronic illnesses and large weight fluctuations can affect the result and are discussed at the consultation.

The procedure can restore volume, smooth transitions, for example between the lower eyelid and the cheek, and improve the contour of the cheekbones or chin. Because the patient's own tissue is used, the result usually looks and feels natural.

Fat grafting does not lift sagging skin and does not replace a facelift when there is a significant excess of skin. It does not treat fine surface wrinkles and does not correct pigmentation marks. In addition, the amount of fat that takes cannot be predicted exactly: some of it is reabsorbed in the first months, which is why a touch-up session is sometimes needed.

At the consultation, the doctor assesses the proportions of the face, the areas that have lost volume and the quality of the skin, and discusses with the patient what they would like to change. The area from which fat can be harvested is also assessed.

The medical history, medication (especially blood thinners), allergies, smoking and any previous procedures or injections in the face are discussed. The doctor explains that some of the fat is reabsorbed and that, depending on the case, a touch-up may be needed. The type of anaesthesia and the preparation before the procedure are also agreed at this stage.

The procedure has three stages:

• Harvesting: through very small incisions, fat is suctioned with fine cannulas from a donor area, usually the abdomen, flanks or thighs.
• Processing: the fat is purified to separate the fat cells from fluids and other unwanted material.
• Reinjection: the fat is injected with thin cannulas, in small amounts and in several layers, for even distribution.

As a guide, the procedure takes about one to two hours, depending on the number of areas treated. The incisions are small and are usually closed with a single stitch or adhesive strips.

The type of anaesthesia is agreed at the consultation, depending on the number of areas treated and the patient's situation. For limited treatments, local anaesthetic may be used, possibly combined with sedation; for more extensive procedures or those combined with other procedures, general anaesthesia may be recommended. When sedation or general anaesthesia is needed, the patient is assessed beforehand by the anaesthetist.

After the procedure, the face is usually swollen, and bruising may appear in the treated areas and in the donor area. Swelling is most noticeable in the first few days and gradually goes down over one to two weeks, sometimes more slowly around the eyes.

• In the first few days, cold compresses and sleeping with the head slightly raised are recommended.
• Massage or pressure on the treated areas is avoided, unless the doctor advises otherwise.
• A compression garment may be recommended for the donor area for a period of time.
• Strenuous exercise, saunas and strong sun exposure are avoided for a few weeks.

Many patients return to their usual activities after about a week, depending on how visible the swelling is.

Facial fat grafting is generally well tolerated, but it carries risks that patients should be aware of:

• swelling and bruising that are more pronounced or last longer than usual;
• reabsorption of a larger proportion of the fat, requiring a touch-up;
• asymmetry or small contour irregularities;
• nodules or oil cysts, which sometimes need treatment;
• infection, bleeding or temporary changes in sensation;
• irregularities in the donor area.

Rarely, injecting fat into the face can lead to serious vascular complications. The doctor uses techniques intended to reduce this risk and explains at the consultation the warning signs that require urgent medical attention.

Immediately after the procedure, the face may look fuller than the final result because of swelling. Over the first months, some of the transferred fat is reabsorbed, and the fat that remains becomes integrated into the tissues. The result is usually assessed after about three to six months.

Fat that has taken can last in the long term, but the face continues to age naturally, and large changes in weight can alter the volumes. If needed, a touch-up is usually carried out after a few months, once the result has stabilised.

Facial fat grafting uses the patient's own fat to restore volume to the cheekbones, temples, folds, under-eye area or chin. The result usually looks natural, but some of the fat is reabsorbed, and a touch-up is sometimes needed. The suitable areas, the type of anaesthesia and realistic expectations are agreed at the consultation, at Detalii Med, in Baia Mare.