Enhance Your Look with Professional Fat Grafting

How is fat grafting performed?

As mentioned, there are three phases to a fat graft procedure: harvesting, processing, and injection. As a comparison, liposuction may remove 3 to 5 liters of fat (3,000 to 5,000 ml) whereas with Dr. Lam’s method of fat harvesting, he may remove 50 to 150 ml of fat. As you can see, it is far less than with traditional liposuction. Although he works with a body plastic surgeon who can simultaneously perform formal liposuction for body contour problems, his method only focuses on harvesting the fat for re-implantation.

Next, the fat is then processed to remove any of the impurities that would compromise longevity of the result. In the past, Dr. Lam used to use centrifugation but has found that an ultrafiltration method using PureGraft is better in terms of graft survival in his patients. Finally, the last phase of fat grafting is re-injection of the fat. He has been asked whether fat is removed as a solid, and no it is actually suctioned and re-injected like a liquid. Dr. Lam is very skilled with 20 years of experience injecting fat to achieve safe, long-lasting, and natural results that should age well for you over time.

Does fat last? How long does it last?

A question that patients always ask Dr. Lam is how long fat will last. In short, forever. However, this answer must be qualified and explained further. Initially, fat will look too full due to swelling and that may last 1 to 2 weeks and may even be slightly too full beyond that time. At a month or so, a patient may love the fact that the fat looks perfect but fat will be somewhat absorbed over time. Whatever survives (which is a very good percentage with Dr. Lam’s method) after the first 6 months will be permanent minus further aging. For example, if you have an identical twin sister (or brother) or has the same lifestyle (job, spouse, stress, sun exposure, diet, exercise), you should always look significantly younger than he or she does but both of you will continue to age. If your genetics and lifestyle are favorable, you should be able to look better hopefully for many years. Dr. Lam does see his patients come back after a decade or so to perform another fat transfer in those who desire to do so. He has heard that fat “only lasts a year”, which makes no sense, since it is a graft and once it has blood supply (after 6 months) it cannot disappear thereafter. Of course, if you lose major weight after the procedure, your fat cells can shrink in size.

I have heard not to inject fat around the eyes due to the risk of lumpiness?

This is a very common complaint on the internet. Dr. Lam not only has written the book on fat grafting and lectured on his method to perform safe fat grafting around the eyes for 15 plus years but he also achieves very safe results with smooth outcomes in almost all of his patients. He believes that fat grafting around the eyes is not only safe but also truly important to achieve excellent results in facial rejuvenation. The technique to attain consistent and safe outcomes is completely based on technique and experience, which Dr. Lam’s textbook, Complementary Fat Grafting, that he wrote in 2006, addresses. He has had the pleasure of teaching his method worldwide to scores of students who have adopted his method to perform safe and effective fat grafting around the eyes and in the entire face.

I do not want to look overfilled like a so-called “pillow face”? How does Dr. Lam avoid that problem?

This is a real problem that has plagued the industry and put a stain on plastic surgery. 30 years ago people were overlifted and now they are both overlifted and overfilled. Dr. Lam has looked back at his results over the past 20 years and noticed that long-term he encountered one area that has not aged as well with fat grafting, which is the anterior cheek. In a few of his patients, he has had to go back to perform microliposuction to correct it. Fortunately, he has not injected fat into the anterior cheek in more than a decade, but, unfortunately, the vast majority of surgeons who perform fat grafting love to inject it exactly into this area. Dr. Lam performs low volume fat grafting in areas that should not look “cheeky” when you smile and he does so simply by avoiding the anterior cheek and buccal recess, which are the two areas that are most susceptible to this problem.

Can I combine fat grafting with other procedures?

Fat grafting can be easily combined with other procedures like upper- and lower-eyelid procedures, lasers, facelift, chin augmentation, etc. Dr. Lam believes that the aging that occurs in the eyelid area is mainly volume loss, so he may remove a little bit of upper eyelid skin or remove a little bit of lower eyelid fat but the principal method by which he rejuvenates the eyelids is by adding volume. Please see the section on Blepharoplasty for a more complete understanding on this subject.

Will fat grafting eliminate all of my wrinkles?

Not at all. Even though Dr. Lam does see that after a year or years later fat can make the skin look better, he would like to emphasize some major limitations with fat grafting. Fat is an amazing and natural way to restore lost facial volume. However, it does little to nothing for managing wrinkles. He likes to say there are three components to the aging process: gravity, volume, and skin/wrinkles. Fat only manages one of these three problems, namely volume. Gravity needs to be managed with other methods like blepharoplasty and/or facelifting, for example. Do not think fat will manage wrinkles though. This limitation is important to emphasize. Dr. Lam has many advanced methods of managing facial wrinkles but fat is not one of them.

Will it lift my jawline up? Do I still need a facelift?

No, fat does not lift the jawline up. Unfortunately, many dermatologists try to convince patients that deeply placed fillers in the cheeks will lift up the jawline. That simply does not happen and will not happen. If your jawline is sagging, you really need a facelift, which Dr. Lam performs oftentimes in combination with a fat graft procedure. However, for those who do not want a facelift can undergo a full-face fat transfer in which he places some fat along the jawline and may perform microliposuction of the jowls to improve the jawline, but do not expect that fat transfer will look anywhere as good as a formal facelift. He can counsel you as to the pros and cons of each procedure as it applies to your face. In any case, a fat transfer will definitely not elevate your neck tissue no matter how much fat is placed.

Do I need a blepharoplasty with my fat grafting around my eyes?

Only a formal consultation with Dr. Lam will help you decide whether you would benefit from cosmetic eyelid surgery at the same time. Please watch his virtual consultations on upper blepharoplasty and lower blepharoplasty to understand more precisely when that would be appropriate. In short, if you have a visible eyebag (not just hollowness), then Dr. Lam will almost definitely remove some fat (using his no-incision method known as transconjunctival) at the same time he adds fat to the lower eyelid lower down along the orbital rim of the eyelid. For the upper eyelid, he usually believes that the problem is not just sagging skin but also volume loss. Think of it like a balloon that deflates. When the upper eyelid deflates, part of the issue is usually the need for volume restoration with fat grafting. Again, Dr. Lam will discuss with you what methods including fat grafting, laser resurfacing, upper and lower eyelid blepharoplasty, and/or browlifting would be helpful in your situation for your eyelid aging.

Dr. Lam’s approach to fat grafting

Facial volume loss is one of the major components of facial aging. Dr. Lam wrote the definitive textbook on the subject, Complementary Fat Grafting in 2006, and the book sold out for 15 years after its publication. Volume loss is only one component of aging and a surgeon with a good aesthetic eye should avoid the overfilled looks that have turned many people away from fat grafting and/or fillers. Dr. Lam will evaluate your aging face and tailor the right program for you to achieve your desired outcome based on your desires, anatomy, degree of aging, budgets, and recovery time. What is more important than the technical methods described above that outline how Dr. Lam performs fat grafting is the artistic eye that Dr. Lam applies to the procedure. The reason that his patients look balanced and not overfilled is that he has a great understanding of how to make a face look attractive in a natural not overdone way whether that involves fat grafting and/or other procedures.

What are the benefits of fat grafting?

Fat grafting provides a global volumization strategy for the face that can be far less expensive than the alternative, injectable fillers. Also, Dr. Lam truly believes now that fat grafting is the preferred method to achieve volume restoration around the eyes. He has now seen over time that even temporary fillers like Restylane can lead to visible migration even years later, which does not happen with fat grafting. Accordingly, he believes that hollowness around the eyes is best treated with fat grafting. Fat also provides a more economical approach when restoring a lot of lost volume, especially when compared to the price of office-based fillers. That being said, for wrinkles, folds, and creases, Dr. Lam still believes that fillers are preferred. Also, if you are planning to have a blepharoplasty and/or facelift, then a fat graft can be easily performed at the same time as these procedures.

What is the nature of the recovery?

The major problem after fat grafting is typically not significant discomfort. Instead, the major problem is that you may feel that your identity is altered for the first week or longer. This can be disconcerting even if you are prepared that it may occur. This is why Dr. Lam shows recovery videos on his website to prepare you (at least in part) that your eyes in particular will be swollen and temporarily change your identity. This problem will resolve over a period of 1 to 2 weeks. In a few cases it may take up to 3 weeks for you to like the result but in almost every case most people looking at you will probably feel you look pretty good at 2 weeks. This is due to the fact that we have a much harsher self-perception than what others hold of us. The areas where the fat is harvested (the belly and thighs) can be bruised quite a bit but fortunately these areas are coverable with clothing. The donor areas can also be a bit sore and when you work out feel as if you have worked them out too much. You can wear a light compressive dressing (which our nurses can counsel you on) to help minimize discomfort. You should try to avoid strenuous workouts for a week but then can slowly return after a week. Just avoid swimming and dirty water exposure (although you can shower after the first day) for the first 3 weeks if possible.

What are the risks of fat grafting?

Fat grafting has some known downsides. First, there is some variable absorption even though a high percentage is retained. Second, if one is prone to gain and lose a lot of weight, the volume of fat grafting may fluctuate in the face since it is a live graft. Third, if one is very young (<30 years of age, he or she may not be as good a candidate because one’s history of weight stability may not be as established. Third, even though it is permanent, there will be ongoing aging, so fat does not stop aging. Fourth, fat works poorly to manage surface defects like acne scars or linear scars. Fifth, fat works poorly for lines of the face like wrinkles and smile lines. If one appreciates the limitations of fat grafting, then Dr. Lam can leverage the advantages of fat grafting in that an individual can look remarkably rejuvenated for less cost all at once.

Will Fat Grafting work on my hands?

Besides the face, hand fat grafting can provide remarkable rejuvenation for the hands. Many times individuals overlook the importance that hands make to the overall appearance. Dr. Lam says that the only two areas that are not covered by clothing are the hands and the face/neck region. Hands can definitely give away one’s aging. The goal of fat grafting for the hands is not to eliminate wrinkles. Fat grafting does a poor job towards that end. Instead, fat grafting is intended to partially (but not entirely) cover exposed veins and bones of the hand that are associated with aging. Even though fat may not entirely cover all veins and bony landmarks or efface wrinkles, the appearance of the hands after fat grafting can truly look incredibly younger to an onlooker. This could be particularly important for public speakers or for those who use their hands a lot socially on a daily basis. For wrinkles, Dr. Lam uses fractionated lasers that can help improve the quality of skin but because hands cannot tolerate high doses of lasers not all wrinkles will be improved or eliminated. Using all-natural bleaching skin care products and photofacials should also be used in moderate to significant cases of sun damage to the hands.

Get Informed with Our Fat Grafting FAQs