How long will fat grafting to the face last?

I am a bit intrigued with the idea of using fat grafting to address some wrinkles under my eyes. How does fat grafting compare to filler and/or botox? Which will last longer, and what price point will I be looking at?

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Wrinkles under the eyes are generally the result of poor quality skin or excess skin. Poor quality skin, which results from sun damage and aging, is best improved with skin care treatments such as lasers. Excess skin below the eyes is best treated with lower eyelid surgery (blepharoplasty). Botox can be used in skilled hands to minimize the wrinkles, mostly to the sides of the eyes (crow’s feet). Fillers are used to treat the hollow areas that result below your eyes from aging (tear troughs), and are best treated with thin fillers such as Belotero or juvederm. Fat grafting to the areas below the eyes is not a great idea. Fat is permanent, and it is a very thick as a filler.

As a general rule, fat grafting or fat transfer will last much longer than fillers. If you have fine lines on your face -- around the eyes, mouth area, etc. -- and want to add facial volume, than you can opt for fat injections. Fat is taken from other parts of your body, such as your abdomen, and deposited into these areas for a kind of facial rejuvenation.

Fat grafting is permanent, which means you won't have to come back to the plastic surgeon every six to 12 months or so for more dermal filler injections. The downside, however, is that it might be hard to find many board-certified plastic surgeons or dermatologists with experience in fat transferring.

The opposite is true of injectable fillers such as Restylane and Juvederm. While the results are not long-lasting (six and 12 months respectively), this type of "facelift" is performed far more often than fat transference. Typically, although the price differs by the location and experience of the cosmetic surgeon, filler treatments cost roughly $1,000 per session, give or take a few hundred dollars, while fat transfer procedures can be as expensive as $5000.

We’ve come across the question of fat grafting vs. filler on numerous occasions. We almost always recommend injectable fillers, especially for first timers. Fat transfer can work, but only when performed by a few very skilled plastic surgeons. It is particularly effective for areas extending from the nose down to the corners of the mouth (the dreaded marionette lines). Fat is grafted from certain areas of the body, such as the abdomen or buttocks, and filtered and prepared for injection into the target areas.

The more popular method of facial enhancement, albeit not permanent, is the use of injectable fillers to replace volume loss. The overwhelming majority of our patients go this route. Again, it isn’t permanent like facial fat transfers, but it is a good way of testing the waters to see if your face responds to fillers. Restylane and Juvederm, among others, are the preferred fillers. While they don’t provide long-lasting results, they will give a temporary lift to the areas you have in mind.

Both procedures will cause swelling and bruising and should only be performed by board-certified plastic surgeons or dermatologists. The cost of a fat transfer procedure is several times more expensive than filler injections. Depending on your location, a filler session can run anywhere between $500 and $1,200, while fat grafting can run well north of $5,000.

If this is your first time addressing volume loss in your face, I suggest that you look more closely at fillers.

Dr. Jonathan Heistein has 1 Fat Transfer before & after:

Fat Transfer before image performed by Dr. Jonathan HeisteinFat Transfer after image performed by Dr. Jonathan Heistein

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Fat grafting is an excellent option for adding volume to the face.  It is not a wrinkle treatment, however, and must be used judiciously or not at all under the eyes.  If the problem actually is wrinkles and not volume loss or a tear trough then the proper procedure would be skin resurfacing or, if severe skin laxity is present, a lower lid blepharoplasty.

Both fat transfer and facial fillers can minimize wrinkles in the face. Some types of wrinkles, such as those found in the brow and forehead, should be treated by another type of injectable known as a neuromodulator (BOTOX® Cosmetic). Fat transfer replaces what was there which is a more long lasting solution. If your problem is loss of fat (Deflation) then the treatment is fat transfer. If there is aging, deep nasolabial fold, jowles, etc then you need a face lift. Some people will benifit from both. It all depend on analyzing your face and the aging process. I highly suggest a consultation with a board certified plastic surgeon by the American Board of Plastic Surgery.

Fat grafting is a great option for filling out volume loss to the face.  It was the original filler used before the introduction of all the filler products.  Advances in fat grafting harvesting and injecting techniques have also made it a much more effective option.  Of the the fat that is injected, about 50% of it is expected to dissolve.  The remaining 50% lasts forever.  All that said, I would not inject fat into wrinkles below your eyes, nor would I inject it into the tear troughs or hollow areas below your eyes.  Fat is too thick to be injected into wrinkles or below the eyes.  There is a high risk of causing noticeable lumps when injected there.  For wrinkles below your eyes, generally a laser treatment to tighten the skin or a blepharoplasty to remove any excess skin would be required.  Thin fillers like juvederm or belotero are best to fill out wrinkles elsewhere on the face.  Botox is not a filler - it paralyzes the muscles - and should not be injected below the eyes as it may effect lid position and function.  It works very well in treating the crow's feet, which are the lines on the sides of the eyes.