how not to f*ck up your face

Is a Fat Transfer the Best Facial Filler?

Photo-Illustration: by The Cut; Photo: Getty Images

Q: I’m 68 and have been considering fat grafting for my rather gaunt face. I’m no stranger to fillers, having sampled most of them in the past 20 years.
What are your thoughts on fat grafting? Does it really last longer than other fillers? How much downtime should I expect? Is it worth the discomfort and expense? (Also, I’ve been slathering on sunscreen since I was 30, so despite tanning throughout my misspent youth, my skin looks healthy.)

A: First, congratulations on your consistent use of sunscreen, which has evidently paid off in the quality of your skin health. As for what you’re calling “fat grafting,” I take it to mean you’re referring to the procedure, also called lipofilling and fat transfer, of injecting autologous fat (i.e., fat harvested from your own body) into areas of your face that have lost volume.

Many years ago when I was just starting out as a beauty editor, a popular dermatologist shocked me at a routine visit with what sounded like an extraordinary suggestion. “I can do something very nice for you,” she began. What is it about that declaration that always invites suspicion? Anyway, I was curious.

“I can take some fat from your buttocks and inject it into your face,” said the doctor.

“Fat from my bottom into my face?” I remember saying, repeating her words as if that would magically clarify my confusion.

Yes, she said, and she might even have offered to do it for free. I left the office promising to think about it.

That night, I asked my husband for his advice. “Fat from your ass?” he said. “In your face?” He looked at me as if trying to decide if I was pulling his leg. “Well,” he said finally, “do you want fat from your ass in your face?”

No, I decided, I did not.

That was, as I said, many years ago, and though I have yet to succumb to it, fat transfer has become increasingly popular, according to the Aesthetic Plastic Surgery National Databank. If you’re in the market for a bit of plumping up, there are a number of reasons you may want to choose your own stuffing rather than get something off-the-shelf.

Because the filler is autologous, you can’t be allergic to it, so you won’t suffer an allergic reaction, said dermatologist Lisa Donofrio, M.D. Unlike hyaluronic-acid fillers, fat doesn’t absorb water over time, which is the reason some HA fillers can make you look puffy. Because fat is opaque (instead of clear, like HA fillers, which can refract light and look blue under thin skin), it’s also a good choice for treating dark circles under the eyes. And since many doctors charge by the syringe, if you’re looking to augment more than one area, fat transfer can be a more economic option, Donofrio said.

Are you considering some overall remodeling? Then you may enjoy the effect of transferring some of the fat in your butt or midsection, where you might like it reduced, to your midface, temples, or the area around your eyes, where you might like it refilled, pointed out HNTFUYF DermDiva Heidi Waldorf, M.D. A twofer!

As for the downsides, because fat transfer involves a couple of procedures (the fat harvesting with liposuction and the injections), your doctor — you’ll notice I’m not using the word provider here, as a physician should be treating you — must be experienced with the liposuction treatment. And very important, they must be experienced in the placement of the cannulae (the needlelike tubes that deliver the fat), which is different from the needle placement used with other kinds of fillers, Donofrio said. Don’t assume the person who has delivered your off-the-shelf filler will necessarily have the expertise needed to shoot up your fat. Also, fat transfer often requires preoperative blood work and antibiotics. So: not a walk in the park!

And speaking of not walking in the park, the downtime could last around a week depending on the extent of the bruising and swelling, said Donofrio. As for the cost, you can expect to shell out at least $5,500 for your reupholstery.

Now, the $5,500-dollar question is, How long do the results last? Donofrio has observed that sequential fat transfers with small volume do much better in terms of retention. Most people take three-to-five total sessions. According to experts, the midface/cheek and the area around the eyes retain fat the best. Donofrio said it’s common in her practice to see a patient who had the procedure 15 or 20 years ago with very good retention of the fat today.

But there are a couple of issues, dear reader, that could make your decision moot. The people who may benefit the most from added facial volume are often the ones with too little fat on their body to harvest, said Donofrio. Even if you can scrape together enough, it might be too fibrous to use, added dermatologist Mary Lupo. And at 68, you may be coming too late to the fat-transfer party, said Donofrio, because fat thrives in existing fat, which means that your (as you describe it) gaunt face is probably too fat deficient to support the growth of the transplanted stuff. Better to invest your hard-earned cash elsewhere.

Valerie Monroe was beauty director at O, The Oprah Magazine, where she wrote the monthly “Ask Val” column for nearly 16 years. Now, she writes the weekly newsletter How Not to F*ck Up Your Face. Her goal continues to be to shift our thinking in the beauty arena from self-criticism to self-compassion and to learn how to be loving witnesses to ourselves and one another as we age.

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Is a Fat Transfer the Best Facial Filler?