As we age, the lost volume in our face results in an older and more tired look. Much like a balloon is smooth and wrinkle free when full of air, the appearance and texture is much different when deflated. The first areas to show these changes are the cheeks and the lower eyelids. In these particular areas, which is called the mid-face, the reabsorption of fat from the cheeks and the inferior orbital rim, i.e., the inferior border of the orbit, create a “step” between the cheeks and the lower lids that is medically referred to as a “tear trough,” and gives people the appearance of a tired face. Even if a classic facelift is performed, the loss of fat in those areas needs to be replaced in order to rejuvenate the face. To that end, in the recent years, injections of fat in the area (which is called mid-facial and tear-trough fat grafting), have been developed, and have been popularized secondary to the natural results achieved and the great improvement in appearance.
The replenishment of fat can also be performed on the forehead, the temples, the mandibular borders and even the upper and lower lips. The procedure performed by itself, without any surgical approach, gives the patient sufficient rejuvenation of the mid-face to be utilized these days as a stand-alone procedure for facial rejuvenation for those who are not ready, don’t want or don’t have time to undergo more invasive traditional surgery. In recent times, since the discovery of the presence of a large amount of stem cells in the fatty tissue, the technique has noticeably improved. Scientists have discovered that a large number of stem cells can be isolated from the patient’s own fatty tissue. the process has been refined to the point that now, with the proper equipment and technique, these cells that constitute what is called “stromal vascular fraction” (SVF) of the fat tissue can be harvested from the patient’s own fat in our state-of-the-art in-house laboratory. By using the patient’s own fat, the results can be permanent, with no risk of adverse reaction. The procedure is safe, minimally invasive, with minimal down-time and discomfort, and provides the patient with a permanent natural result. With this technique, the patient will also have the chance to improve the quality of the skin due to the presence of the stem cells in the injected and replenished facial fat tissue promising role of PRP in fat transplantation.
The procedure is usually performed with local anesthesia, and if the patient prefers, some light sedation can be provided. The first part of the procedure consists of a small liposuction, generally of the abdomen, where 60 cc of fat is harvested to isolate the stromal vascular fraction that contains the stem cells. Another equal amount of fat will be harvested in order to perform the grafting, at which time the stem cells will be added to the mix. These adult stem cells are called “adipose-derived stem cells” (or ADSCs). These ADSCs have potential in the sense that they have the ability to differentiate into a variety of different tissues, including, but not limited to, new fat tissue and also blood vessels. This very angiogenic nature of stem cells gives them the ability to differentiate and grow new vessels, which will help assure permanent stability of the fat grafting. The skin quality should also improve because of the presence of these stem cells just being in contact with the patient’s own skin. We use a developed and validated method for harvesting and isolating stem cells from fat for therapeutic use. Our clinic utilizes materials that are produced according to GOOD MANUFACTURING PRACTICES (GMP) set by the FDA. We are collecting approximately 1 million cells per cc of fat extracted. This procedure consistently produces predetermined acceptance criteria, making it easy to duplicate in an office setting, and it has been validated via reproducibility and robustness analysis. Obtaining a cellular product that is capable of proliferating and differentiating requires detailed analysis. This is critical to ensure reliable patient outcomes. In our clinic, the fat has been grafted, usually from the abdomen, and combined with the isolated stem cells. The product is injected through small cannulae in the areas of the face where it is needed.
The position and fullness of the brows have an enormous impact on facial expression. We offer fat grafting to the brows in order to elevate the eyebrows as well as to replenish the fat that has been absorbed from the forehead. This is an ideal procedure for patients seeking eyebrow rejuvenation, for whom botulinum toxin is not an option because they are resistant to it, or because they don’t like the idea of being injected 3 times a year and/or don’t like to have foreign substances or botulinum toxin injected into the body.
As we age, the fat in the cheeks dissolves, causing them to fall and increasing the depth in the lines alongside our mouths and contributing to formation of so-called “tear-troughs,” which is the area of orbital rim between the lower eyelid and the cheek. Augmentation of the cheeks, the tear troughs and the lines alongside the mouth is an excellent treatment to improve facial aging, and can be successfully achieved in a permanent way with this proposed procedure.
Other areas of augmentation include the temples, the chin creases, the jowls and the neck lift liposuction deformities.
After the procedure is done, you go home. The pain and discomfort following surgery can be controlled with oral medication. While absolute bed-rest is unnecessary, limited activity is advised for the first 48-72 hours. While there will likely be minimal swelling, which might persist for a week, most patients can return to light-duty work in 3-4 days. Patients should refrain from vigorous activity for 4-6 weeks after the procedure to help the swelling resolve more quickly.
Given this technique and the precise handling of the graft, we can accurately predict the fat absorption depending in the local of the injection. Typically, most patients are over- injected in anticipation of some resorption. Any effect that persists 6-8 weeks after the procedure is usually permanent.