Restoring lost facial volume with your own fat.
Facial fat transfer (fat grafting) restores volume that has hollowed with aging by relocating your own fat, most often from the abdomen, into the face. The grafted fat is living tissue that integrates with the surrounding structures and becomes a natural part of the face.
Facial aging isn't only about sagging skin — it's also a loss of the soft, round fullness that gives a youthful face its shape.
The midface contains several fat compartments, lying in different layers and locations beneath the skin. A thin fibrous wall, which tethers the skin to the deeper tissue, divides each compartment from its neighbors. In youth the compartments are evenly full, creating a smooth, youthful contour. With age they begin to deflate independently, some more than others; the deep fat of the inner cheek (deep medial cheek fat) is one example. Because each compartment loses volume to a different degree, the cheek flattens and then hollows, in a pattern unique to each person.
The fibrous walls between the compartments are anchored to the skin above and the bone below (retaining ligaments), and they hold their position better than the fat between them. An orange shows the same effect: each slice of pulp is separated by a thin wall, and as the pulp dries and shrinks, the wall of each slice becomes more prominent beneath the peel. In the face, the skin is held in at each fibrous wall as the fat between them deflates, forming the tear trough (nasojugal groove), the cheek crease (mid-cheek groove) and the fold beside the nose and mouth (nasolabial fold). Because these creases follow the support beneath the skin, treating the skin alone does not address their cause.
As the fat of the upper cheek deflates, the cheek pad (malar fat pad) loses its prominence and settles lower on the face. The skin and the rest of the soft tissue follow, because the deflated fat no longer holds them up. The fullness that remains collects lower in the cheek, leaving the upper cheek flat.
Hollowing, creases and descent come from one change in the same structure, the uneven deflation of the fat compartments. Together they give the face a tired look that no longer matches how a person feels.
Autologous fat is harvested by gentle liposuction, most often from the abdomen. It is then processed to remove excess fluid and isolate healthy fat cells (adipocytes). Using a micro-cannula, we place the fat in small portions, in multiple layers and mainly in the deeper planes of the face.
A portion of the transferred fat does not survive and is absorbed by the body. The fat cells that do survive go through a shock phase while new blood vessels grow into the graft. We therefore place slightly more fat than the final volume requires. Once the swelling has resolved and the graft has settled, a touch-up session can be added if more volume is wanted.
Fat that survives continues to behave like fat elsewhere in the body, so it can enlarge modestly with weight gain and shrink modestly with weight loss. The surviving fat cells remain in the midface, giving the cheek a net gain of fat cells compared with before treatment. Maintaining a stable weight keeps the result consistent.
Transferred fat carries adipose-derived stem cells (repair cells found in fat tissue) together with other supporting cells. In an early clinical study of six patients, skin injected with fat and its stromal vascular fraction (the stem cell-rich portion of fat) showed less elastosis (damage to the skin's elastic fibers), new elastic fibers and a richer network of small blood vessels at three months. These findings suggest a possible improvement in skin quality over the grafted area.
Synthetic and biosynthetic fillers (hyaluronic acid, calcium hydroxylapatite and poly-L-lactic acid) are placed in the office without downtime. Their effect is temporary, ranging from several months to about two years, and the cost rises with the volume used. Autologous fat comes from a plentiful donor supply and allows a larger volume, often 20 cc or more, to be placed across several areas in one session. Because it is the patient's own tissue, it does not cause the foreign-body reactions that can occur with synthetic material. Fat that survives the first months tends to last longer than a filler.
Facial fat transfer is a minimally invasive procedure that typically takes about half an hour, with minimal twilight sedation and a short recovery. For patients who prefer a less extensive approach, it is an introductory procedure for facial rejuvenation, and it combines readily with full face laser resurfacing or blepharoplasty. Many patients having a face and neck lift add fat transfer to the same operation, which addresses the descent and the volume loss of the aging face with a single recovery. At consultation, Dr. Kim reviews whether fat transfer alone or as part of a broader plan best fits each patient's goals and anatomy.
Swelling is expected at the injection sites, largely from the numbing medication and saline used during the transfer. Bruising can occur in the face and at the donor site.
Most patients resume daily routines within a few days, avoiding strenuous activity at first. During this period the face often looks fuller than the final result because of swelling, which gradually resolves along with the bruising.
Around the first month, as the swelling resolves, the grafted areas can appear deflated, and this may continue for several months. During this time the surviving fat cells recover from the shock phase and re-establish their blood supply. The graft then gradually rebuilds volume (revolumization), and the final result becomes apparent over the months that follow. Patients who would like additional volume can discuss a secondary fat graft after about one year.
Facial fat transfer restores volume using your own living tissue, which integrates with surrounding structures and carries no risk of allergic reaction. Dermal fillers use synthetic materials that are temporary, requiring ongoing maintenance visits. Fat transfer can offer more permanent results that age naturally along with the rest of your face.
Some of the transferred fat is naturally reabsorbed by the body, but a significant portion establishes a blood supply and remains long-term. Results typically stabilize within a few months. In some cases, a second, smaller session is planned to achieve the desired level of volume once initial healing has settled.
Most patients experience swelling and mild bruising at both the donor site and the face for one to two weeks. Strenuous activity should be avoided initially, though normal daily routines can usually resume within a few days. Because fat is injected in a deep plane in small increments, the risk of visible lumps is minimized.
Yes — fat transfer is frequently performed alongside a facelift, neck lift, or eyelid surgery in the same operation, sharing a single recovery period for a more comprehensive rejuvenation.
Shown with patient consent. Individual results vary by anatomy, technique, and healing.
"I've had two surgeries with him. The 1st was a body fat transfer to my cheeks, after having weight loss surgery I felt I needed some volume in my cheeks — I was very happy with the way that turned out."
"Dr. Kim's staff is nothing short of AMAZING! They absolutely go above and beyond for their patients; they are so caring. Dr. Kim is truly at the top of his field in Facial Plastic Surgery."
"Absolutely love Natural Face Clinics — Dr. Kim is amazing. He is professional, knowledgeable and the staff are fabulous! I would never go anywhere else."
Consultations are available at our Rochester and Manhattan offices. This procedure is performed in Syracuse, New York, at our accredited surgical suite, and patients travel to Syracuse for the procedure.
Patients from New York City return home after the procedure and are seen for the one-week visit at our Manhattan office. Patients from Rochester stay at a local hotel the first night and then return home.