What It's Really Like To Get Facial Fat Grafting
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.
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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. He explained to me that facial aging isn’t just caused by gravity, but also by the redistribution and loss of fat throughout the face. The result: wrinkling and irregularities.
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.”
Sure, I’d heard about the Brazillian Butt Lift (during which plastic surgeons transfer liposuctioned 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 facial 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.
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.
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 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.
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 one hand, I was incredibly satisfied with my initial appearance, but 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 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 self was staring back at me, smiling.