Have you looked at your new driverb�s license or passport and noticed a difference in your face?B Do you see that your eyes are more hollow and sunken in appearance, along with the loss of your youthful cheekbones.B Do you see smokerb�s lines around your mouth, along withB smaller lips that donb�t have as much show as before?B If your answer to these questions is yes, than you have lost volume in your face and should consider having fat grafting to the face.

As we age we loss volume from our face, along with muscle thinning and bone loss. This contributes to sagging and wrinkling of facial structures associated with the aging process. Global fat grafting to the face will replace the lost volume and restore the natural contours of the face to give one a more youthful appearance.B Volume loss can occur early and young patients can have volume deficiency also.B The tear trough area is a common area that these patientsb�sB can have, and it makes them makesB look tired.

How the procedure is done.B

Patients are given light sedation to relax them.B The fat is usually harvested from diet resistant areas suck has the hips, thighs, knees or abdomen.B The area filledB first with a numbing fluid called a tumescent solution.B The fat is usually harvested by hand with small cannulas through tiny incisions that heal in a few days.B The fat is spun and the oil and fluid is decanted off.B There will be a small reddish pellet at the bottom of the syringe that has stem cells in it.B This is usually mixed with spun fat in another syringe.B The harvested fat can be mixed with PRP or platelet rich plasma.B PRP is concentrated platelets with growth factors thatB been shown to decrease inflammation and speed up the recovery phase.B A certain growth factor calledB endothelial vascular growth factorB helps stimulate the production of new vessels, which is one reason we think the fat lives.B In order for the fat to live, it needs to be grafted in multiple planes and with small aliquots.B B I like to transfer deep on top of bone or in muscle. It is believed that the pre-adipocytesB or cells that will differentiate into fat cells are the cells that eventually survive and are responsible for the results seen.B The typical life span of a adipocyte is usually 7 years.B Results are predicable and last 1-7 years depending on the area grafted and on the patient.

When I graft spun fat in the face, I usually place about 30-60 cc for effective rejuvenation.B I like to correct the face globally for better results. The upper, midface and lower face will have fat grafted.

We now know that stem cells are present in fat.B These can be separated into what is called Stromal Vascular Fraction.B These are now used in regenerative medicine and can also be used for cosmetic purposes.B These cells might develop into blood vessels, collagen and other support structures.B We usually an improved texture to the face when fat grafting is done we think due to the effect of the stem cells.

When I do fat grafting I like to also do a Micro-needling procedure at the same time.B The Micro-needling is a microneedling procedure that helps rejuvenate the face.B I wrote about it in a previous blog, but basically it uniquely produces a growth factor called transforming growth factor beta 3. This growth factor is responsible for scarless healing and it is not produced with ablative laser treatments or chemical peels.B There is no coagulative necrosis durning the healing phase since there is no heat produced and there is no risk of pigment loss.B Collagen formation is the same as with most refractive lasers.B I really like the results when fat grafting is combined with a Micro-needling treatment.

fat grafting before and after to face