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At this point, you’re likely familiar with the idea of dermal fillers. Not to be confused with [neurotoxins like Botox®](https://aedit.com/aedition/comparing-neurotoxin-botulinum-type-a-injections-botox-dysport-jeuveau-xeomin) that temporarily reduce the appearance of lines and wrinkles by paralyzing the muscle responsible for movement, fillers are used to contour the face by restoring volume to areas that show signs of aging or reshaping certain features (think: nose and lips). 

Depending on the type of filler used, touch ups may be needed as frequently as every six months. For patients seeking a longer lasting solution that doesn’t involve a foreign substance, fat grafting offers similar facial rejuvenation without the risk of rejection.

So, what are the pros and cons of each procedure? And which one might be best for you? A board certified dermatologist and two patients weigh in on how dermal fillers and facial fat grafting work.

## **What Are Dermal Fillers?**
[Dermal fillers](https://aedit.com/aedition/everything-you-need-to-know-about-dermal-fillers) or ‘fillers’ as they’re commonly known, are substances that are injected into the skin to restore volume or reshape a particular area. “Fillers require no surgical procedures, and you can just come in and do the injection,” says [Samer Jaber, MD](https://aedit.com/provider/samer-jaber-md-3882), a board certified dermatologist in New York City. “Most fillers can be dissolved. So, if you don't like the results or have an unusual reaction, it can be removed.”

Made of hyaluronic acid (HA), calcium hydroxylapatite (CaHA), and poly-l-lactic acid (PLLA) to name a few, fillers have varying degrees of permanence. While HA fillers like Juvederm® and Restylane® need to be touched up every six to 12 months, semi-permanent options like Sculptra® (a PLLA filler) Radiesse® (a CaHA alternative) can deliver results for upwards of two years or more.  

### **What Are Fillers Used For?**
Fillers are used to rejuvenate areas of the face that have lost volume due to the natural aging process. Commonly used to [plump the lips](https://aedit.com/procedure/temporary-lip-fillers), volumize the cheeks, and minimize the appearance of [under eye bags](https://aedit.com/procedure/under-eye-filler), filler can also be used to alter refine the shape of the nose (a.k.a. [liquid rhinoplasty](https://aedit.com/aedition/what-you-need-to-know-about-liquid-rhinoplasty)) and define the jawline. For patients with atrophic (read: depressed) scarring, a small amount of filler may be injected to smooth the skin. 

### **What Is the Procedure and Recovery Process?**
Downtime after fillers is minimal. Normal activity can be resumed immediately (though you may be told to refrain from working out for 24 hours). Patients are often able to schedule the procedure during their lunch break, but it should be noted that swelling and bruising at the injection site is possible and usually resolves over the course of five to seven days. Unlike neurotoxin injections that take a week or more to kick in, filler results are immediate. 

### **How Much Do Dermal Fillers Cost?**
The cost for fillers varies greatly depending on which product is used and how many units is required. Generally speaking, cost varies between $250 and $1,500 per syringe. 

## **What Is Facial Fat Grafting?**
Also known as lipoinjection and autologous fat transfer, [facial fat grafting](https://aedit.com/aedition/what-its-really-like-to-get-facial-fat-grafting) offers an alternative to dermal filler. Rather than having a forgeign substance injected into the face (like the ones described above), fat grafting involves the injection of a patient’s own fat cells to plump areas of the face that show signs of aging. As such, there is no risk of your body rejecting the graft. 

Unlike the immediacy of fillers, the final results of fat grafting can take three to six months to reveal themselves. This is the length of time it takes for the graft to become established in its new location. During that time, the body re-absorbs a percentage of the fat (30 to 50 percent) that was injected, which is why providers often ‘overfill’ the area to start. Once the process is over, the graft is permanent, though revision procedures may be considered down the line. 

### **What Is It Used For?**
Fat grafting is used for facial rejuvenation, including volumizing the cheeks, plumping the lips, filling in the under eye area, reshaping the nose, defining the jaw, and even [augmenting the breasts](https://aedit.com/aedition/hybrid-breast-augmentation-with-implants-fat-transfer). 

### **What Is the Procedure and Recovery Process?**
Lipoinjection is a two-part process. First, fat cells must be surgically harvested from one part of the body, so they can then be purified and then injected into the face. Fat is generally collected from the hips, thighs, or stomach. Both of these procedures can be carried out as outpatient surgery under local anesthesia (some providers and patients may prefer general anesthesia to control pain).

Bruising and swelling can be expected at both the donor *and* recipient sites, and advice on how to manage this will be explained during preoperative consultations. “Both [filler and fat grafting] have minimal pain and discomfort during the injection, which can be easily managed with topical numbing gel,” Dr. Jaber says. “You may be slightly more swollen for a few days with fat transfer, and both procedures can result in mild bruising.”

### **How Much Does Fat Grafting Cost?**
The average cost of a facial fat transfer is $5,000, though this varies depending on the area being treated.

## **Patient Perspective**
Here, two patients share their experience with facial fat grafting. In one case, the treatment replaced a high-maintenance filler habit. In the other, it delayed the need for a more invasive facelift.

### **Mila, 35, New York, NY**
*Mila started her facial contouring journey with HA-based Juvederm® fillers. As time went on, she decided she would like a longer term solution and opted for facial fat grafting about a year ago.*

<Dialogue>
  <Question party={The AEDITION}>
    How did your filler experience differ from fat grafting?
  </Question>
  <Response party={Mila}>
    I started getting fillers when I was 25, so I spent close to 10 years getting injections topped off every eight months or so. The procedure for getting fillers is very straightforward. I used to have them during my lunch hour at work! With fat grafting, the process is somewhat more involved. They have to collect the cells, which is a procedure in itself, and then inject them. The collection procedure was new to me, but it was straightforward and painless. I would say the fat injections were a little more painful than fillers, but still absolutely manageable.
  </Response>
  <Question party={The AEDITION}>
    How did you find the fat grafting process, from the procedure to recovery?
  </Question>
  <Response party={Mila}>
    Both parts of the procedure went very smoothly for me. I had local anesthesia for both parts. There was some discomfort, but I didn’t feel any pain whatsoever. In terms of recovery, I found that I felt quite tired for the first couple of days. It could have been stress from the lead up to the procedure or the actual surgery. I’m not sure. I had a fair amount of bruising but not too much pain. I followed my surgeon’s directions regarding pain management, and it worked very well for me.
  </Response>
  <Question party={The AEDITION}>
    In terms of results, how were they different for each treatment?
  </Question>
  <Response party={Mila}>
    I have found the results from the graft to be softer than the results achieved from fillers. It could simply be because I went to a different practitioner though. The main drawback for me was the length of time between the procedure and being able to see the final results. I had to wait a good few months for the area to completely settle, which is a contrast to quick-fix fillers.
  </Response>
</Dialogue>

### **Sonia, 43, Long Island, NY**
*Sonia opted for fat grafting after discussing rejuvenation options with a plastic surgeon. As she noticed her face beginning to lose volume as she aged, she thought it was time for a [facelift](https://aedit.com/aedition/popularity-of-facelift-cosmetic-surgery-for-aging-sagging-neck), but the injections have so far offered the results she was looking for.*

<Dialogue>
  <Question party={The AEDITION}>
    What led you to consider facial fat grafting?
  </Question>
  <Response party={Sonia}>
    I found myself becoming increasingly bothered when I looked at my face in the mirror. I was seeing deeper and deeper wrinkles, my skin had lost its youthful appearance, and I was generally looking for a do-over. My cheeks had previously been very plump and were a real trademark for me when I was younger. Not seeing them when I looked in the mirror anymore was pretty disheartening.
  </Response>
  <Question party={The AEDITION}>
    How did you find the experience of having the procedure?
  </Question>
  <Response party={Sonia}>
    I had initially been considering having a facelift, so, by comparison, this was a real walk in the park! Both parts of the procedure were straightforward, and I was taken care of very well by my surgeon and his team. I opted for local anesthesia, which allowed me to have a somewhat quicker recovery than I would have had with general anesthetic involved. The process is painless, and I can’t even say I was uncomfortable at any point. I was asked continuously if I was in any pain, so the team was very careful to take care of that.
  </Response>
  <Question party={The AEDITION}>
    Are you pleased with the results?
  </Question>
  <Response party={Sonia}>
    I really am. For me, it was the perfect solution for what I was looking for. It’s a treatment that will tide me over until I have a facelift when the time is right. The results make me look better than I could have imagined — better than I did in my younger days even! The fact that they will stay like this for some time is a relief and having my next procedure in mind for whenever I am no longer satisfied with the results from this one is very reassuring.
  </Response>
</Dialogue>

## **The Takeaway**
Dermal fillers and fat grafting both offer facial rejuvenation and contouring results in an injectable form. While filler provides an immediate result, it requires regular maintenance. Fat grafting is a slightly more involved procedure because it is a two-step process and results take three to six months to take effect. Once the graft becomes established, it is permanent (though touch ups may be needed down the line). Consulting with a board certified dermatologist or plastic surgeon will ensure you receive the best treatment for your aesthetic goals. 

AEDITION expert perspective-min

Patient Perspective Collection | The AEDITION

Patient Perspective

Facial rejuvenation and contouring is possible with both dermal fillers and autologous fat transfer. So, which injectable solution is best for you?

Comparing Dermal Fillers And Fat Grafting For Facial Rejuvenation And Contouring

Dermal Fillers vs. Fat Grafting: What’s Best For You?

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Before I reached a certain age (let’s just say, it rhymes with “sporty”), I’d only ever cared about what I considered to be an excess of body fat. I had, admittedly, never given much thought to the fat in my face — until it started to disappear. It hardly seemed fair: Did I really have to choose between a slim physique and a smooth face?

To see if I could bring back a bit of my baby face, I met with board certified UCLA plastic surgeon [Jason Roostaeian, MD](https://aedit.com/provider/jason-roostaeian-md-449). He explained to me that [facial aging](https://aedit.com/aedition/how-your-phone-might-be-aging-you) isn’t just caused by gravity, but also by the redistribution and loss of fat throughout the face. The result: wrinkling and irregularities. 

[Fillers](https://aedit.com/procedure/temporary-lip-fillers), he explained, can restore some of that lost facial volume and refresh the youthful contour temporarily. After discussing all of the risks, I decided to give it a try — peppering Dr. Jason with questions as he thoughtfully examined my face, injecting hyaluronic acid filler into my tear troughs and cheeks.

I tried not to wince as I wondered aloud: How often am I going to have to do this? “It varies from patient to patient,” Dr. Jason told me. “But plan on dermal fillers lasting about six months to a year.” 

While I’d never been stellar at mental math, it seemed obvious that, as a sporty-something-year-old, this was going to get pretty pricey by my golden years. “Once you get older, you’re better off getting a facelift with fat grafting,” explained Dr. Jason, “which will take care of the skin laxity and the volume loss at the same time.”

He had me at “[fat grafting](https://aedit.com/aedition/why-everyone-is-talking-about-fat-grafting).”

## **The Technique Used In Facial Fat Grafting** 

Sure, I’d heard about the [Brazillian Butt Lift](https://aedit.com/procedure/brazilian-butt-lift) (during which plastic surgeons transfer [liposuctioned](https://aedit.com/procedure/power-assisted-liposuction) fat from the belly and flanks to bulk up the booty), but I had no idea that similar fat injection techniques were being used to permanently plump up cheeks, lips, under eyes — basically, anywhere that [facial fillers](https://aedit.com/aedition/everything-you-need-to-know-about-dermal-fillers) were gaining fame. 

I needed to know: Why isn’t everyone doing this? “First off, it’s a surgical procedure that includes all of the associated risks and recovery time,” Dr. Jason explained. “Secondly, because fat is a living tissue, it’s less predictable — though, at the end of the day, using your body’s own fat as filler is always going to be the gold standard.”

When pressed for more details, Dr. Jason told me that although some doctors perform facial fat transfer procedures under local anesthesia, he prefers to use general to ensure patient safety and comfort. “We have to be very careful with our technique,” Dr. Jason told me. “Imagine we’re taking tiny seeds of purified fat and dispersing them throughout the area to give them the best chance to grow and survive, while providing a smooth, even result over time.” He said that plastic surgeons generally overfill areas of the face during a fat grafting procedure because it is not unusual to lose about 30 (or even as much as 50) percent of the transferred fat cells over time.

When I asked about possible complications associated with facial fat grafting, Dr. Jason pointed out that because a patient’s fat is their own tissue (known as “autologous fat”), there’s no risk of adverse reaction — though swelling and bruising are typical and may be quite pronounced. “Because we’re distributing the fat throughout a given area through a very small incision, we end up affecting a lot of tiny blood vessels, which is bound to cause bruising,” he shared.

## **The Facial Fat Grafting Procedure**   

Full disclosure: I don’t think I was totally listening at this point. Instead, I was already fantasizing about the fate of my face and whether it was possible to tack on this fat transfer treatment to an unrelated procedure I had coming up. Since I was going under anesthesia anyway, why not wake up looking younger? Dr. Jason told me that the facial fat grafting would add about 45 minutes to my existing surgery and that the recovery typically takes about two weeks. I decided to give it a go.

Right before my fat grafting surgery, I came face-to-face with Dr. Jason and his purple surgical marker. He sat in front of me, considering the peaks and valleys of my face before tracing a pattern along my contours. We then discussed possible donor sites during an informal body fat analysis (which I can only liken to swimsuit shopping with a stranger) to determine exactly where Dr. Jason would be harvesting the filler for my face. 

He planned to make a total of four small incisions: one in each thigh to collect the fat and then one in each cheek about halfway between my mouth and nose. It’s through the latter that he’d inject the fat after purifying it in the operating room.

## **Recovery After Facial Fat Grafting**

The next thing I knew I was lying in recovery with a surgical glove filled with ice water splayed across my face. I was too groggy to even wonder about my results. After about an hour, the nurse cleared me to leave, sending me and my husband home with instructions to apply cold packs consisting of gauze soaked in ice water for the first 48 hours and to sleep as upright as possible to prevent swelling.

Standing before my bathroom mirror, I looked like I’d passed out after a fraternity hazing: bloated, a little bruised, and covered in Sharpie babble. But my skin was so smooth, plump, wrinkle-free, and refreshed. Though Dr. Jason had told me that the initial swelling from the procedure would obscure the final result, I was already pleased.

For the first 48 hours, I was totally unproductive. The cold packs made reading or even watching TV too challenging, but, after a couple of days, I was able to be up and about around the house — albeit with soreness in my cheeks and at the donor site. I’d also developed moon-shaped magenta bruises across each tear trough that seemed to be growing larger and darker daily. 

I realized that not being equipped with the proper concealer was going to be problematic. I threw on a baseball cap, pulled the brim down extra low, and ran to CVS to grab a tube of a color corrector. I dabbed the makeup over the bruises, took a step back, and saw a woman with purplish-green shiners staring back at me. But, man, she looked so young.

## **The Results After Facial Fat Grafting**

Over the subsequent weeks, I became pretty adept at camouflaging my ever-changing bruises as they morphed and shrank unevenly from red to purple to blue, green, and yellow before finally fading away. If anyone noticed my technicolor transformations, they didn’t let on (with the exception of my mother-in-law, who deadpanned, “You look like you’ve got two black eyes”). 

When I asked Dr. Jason whether or not it was typical for patients to have lingering bruising, he said it generally “clears up completely within 10 days or so. But every patient is different.” For me, caking on the concealer for a few weeks seemed a small price to pay in exchange for a positive, permanent result.

Dr. Jason also told me that it would take about three months for the swelling to subside completely and the surviving fat to become established. With the passing weeks, every sign that appeared from my “old” face made me wonder: Would I end up looking happily refreshed or disappointingly unchanged? 

I felt strangely conflicted. On the one hand, I was incredibly satisfied with my initial appearance, but on the other, I was equally reluctant to invest too much in the outcome. Notes from my journal about one-month post-op capture the conundrum: “Woke up this a.m. and the left smile wrinkle was back. Ugh. Yesterday went shopping without any concealer — felt amazing.”

By the time I saw Dr. Jason for my three-month follow-up, the soreness in my cheeks and thighs (initially akin to a pulled muscle), and small red scars from the incision sites had completely resolved. Much of the fullness in my cheeks and the evenness under my eyes remained. As Dr. Jason evaluated the outcome, I held the hand mirror and saw no apparent signs of plastic surgery other than a slightly younger selfstaring back at me, smiling.

After growing weary of the price and upkeep associated with dermal fillers, one writer decided it was time to try something a bit more permanent.

What It's Really Like To Get Facial Fat Grafting 

shutterstock 650888758-min

If you’ve thought to yourself, I wish I could take some of the fat [here](https://aedit.com/procedure/thigh-lift) (gesturing to your thighs) and put it in up [here](https://aedit.com/procedure/breast-augmentation-with-fat-transfer) (gesturing to your breasts), well, you can. And while you’re at it, you can even put some of that flab under your eyes and into your [cheeks](https://aedit.com/procedure/cheek-augmentation-with-fat-transfer) — or whatever area of the body you could use some extra volume. The appeal of getting rid of fat where you don’t want it and adding it to where you do is why fat transfer procedures (also referred to as fat grafting or fat injection) are on the rise. In fact, a survey of plastic surgeons conducted by the [American Society of Plastic Surgeons](https://www.surgery.org/sites/default/files/ASAPS-Stats2017.pdf) showed that fat transfer to the face was up by 22 percent in 2017.

## **How Does A Fat Transfer Work?**

A fat transfer works with the surgeon performing [liposuction](https://aedit.com/procedure/power-assisted-liposuction) on a "donor site" — usually the stomach or thighs — to extract fat through a small incision and using a cannula. “You don’t need to be particularly heavy to have this done,” says [Michael Frederick, MD](https://aedit.com/provider/michael-frederick-md-643), a board certified plastic surgeon in Palm Beach, FL. “There are very few people I can’t get any fat out of.” Then, the doctor rinses the fat to remove broken fat cells, oils, and other things that might be mucking it up. (There are a few different rinsing techniques; [Jason Bloom, MD](https://aedit.com/provider/jason-bloom-md-2248), a board certified facial plastic surgeon at the Main Line Center for Laser Surgery in Ardmore, PA, uses Puregraft, which resembles an IV bag with filters in it.) The doctor injects the rinsed fat into areas of the body that you’d like to be a little fuller, like your [butt](https://aedit.com/procedure/brazilian-butt-lift), breasts, or face. This may sound intense, but as cosmetic procedures go, it's pretty straightforward and done under local anesthesia. You might experience some soreness and swelling in the area where fat was extracted, but it will only last for a few days.

## **What Are The Perks Of Fat Grafting?** 

The first major perk of fat grafting is that you’re getting a two-for-one deal here: reducing body fat in one area and enhancing another, all in one appointment. You can even have your harvested fat injected into more than one part of the body at a time. Patients also like that it’s a natural way to create volume; instead of having a foreign substance inserted into your body (like silicone [breast implants](https://aedit.com/procedure/breast-augmentation-with-implants) or synthetic [facial filler](https://aedit.com/procedure/under-eye-filler), you’re using your own fat. This reduces the chances of rejection or allergic reaction and can produce more natural-looking (and feeling) results. Plus, the results are permanent, as opposed to synthetic fillers that only last a few months. “There is retention of 70 to 75 percent after five years,” says Dr. Bloom.

Fat grafting procedures can also help rejuvenate the skin, although it’s a slightly different type of fat transfer than the method used simply to increase volume. “Nanofat grafting involves harvesting fat and then passing it through a series of screens or meshes to grate down the fat cells to stem cells, which can revitalize the skin,” says Bloom. [Research]( https://www.ncbi.nlm.nih.gov/pubmed/23783059) shows remarkable improvements in skin quality and facial rejuvenation six months post-operation. However, this method doesn’t really increase volume, so Dr. Bloom sometimes uses a combination of both types to give a patient fullness while also revitalizing the skin.  

## **What To Keep In Mind About Fat Grafting**

Experts say fat transfer procedures are an effective way to add volume to the face and body, but as with all surgical procedures, there are a few side effects to keep in mind. For one, “it’s somewhat unpredictable,” says Dr. Frederick. While [fat grafting](https://aedit.com/aedition/what-its-really-like-to-get-facial-fat-grafting ) is great at creating volume, it doesn’t work as well for contouring and fine-tuning. This is why Dr. Bloom uses the fat grafting technique in some areas of the face, like under the eyes, in the cheeks, and along the jawline, but not others, like in the lips, which require precise shaping. The same issue applies to fat transfers to the breasts. “While it can increase the size of your breasts, it doesn’t create shape,” says Frederick, who sometimes uses a combination of implants and fat grafting to create natural-looking breast augmentation. Another potential downside to transferring fat to the breasts is that it can sometimes cause benign cysts referred to as fat necrosis. If the fat is not dispersed properly, “it won’t get the blood supply that it needs, which causes the fat cells to die. And you could wind up with areas of hardened fat,” says Dr. Frederick.

Lastly, fat can get homesick. “Fat acts the same way, no matter where you put it,” says Dr. Frederick. For example, if you tend to gain weight in your stomach, and you have fat removed from your lower abdomen and injected into your butt or your boobs, you’ll now be more prone to weight gain in those areas. But, hey, if big boobs or a big butt is your goal, consider this an added perk.

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The biggest trend in cosmetic surgery is fat grafting, which takes fat from one place to plump another. Here's why.

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