The loss and downward descent of the cheek fat pads lead to a whole host of facial changes that we associate with facial aging. Beyond the obvious flattened cheeks, dark circles and hollows under the eyes, tear troughs and eye bags develop. Deepening nasolabial folds, marionette lines, jowls and looseness of the neck can all be traced backed in part to the atrophy and descent of cheek fat pads.
Although the illusion of rejuvenation can be accomplished with commercially available fillers, cheek implants, or underlying soft tissue repositioning and suspension maneuvers of a facelift, no other aesthetic procedure so truly actually rejuvenates as does structural fat grafting. Literally hundreds of tiny spheres of living fat are carefully and strategically returned to the apples of the cheeks, hollows around the eyes and temples and the jawline in multiple layers from just above bones to just below the dermis. Remarkably, the fat chosen for these grafts retains the cellular messengers of the fat from where it came – this phenomenon is called donor dominance. The fat of the lower abdomen and thigh is ideal for this purpose, for it retains its “fat fullness” our whole lives, thus it is the perfect filler material. Another plus of using lower abdominal or thigh fat is that almost none of us would complain if we had to sacrifice a little belly and/or thigh fat, which makes it a double win. Lastly, the truly remarkable and frankly unexpected benefit of structural fat grafting is skin rejuvenation that fat grafting imparts to the overlying skin. This “stem cell” action is stimulated by the microinjected donor fat. The cellular messengers of the microinjected fat grafts orchestrate neovascularization (new blood vessel ingrowth) to support the newly placed fat grafts. This stem cell action stimulates the overlying skin to take on tighter, thicker, smoother, more youthful skin characteristics.
The procedure entails careful, low-pressure liposuction harvesting techniques so as not to damage the tiny fat grafts. This special fat is then carefully microinjected in a layering fashion to leave a discreet graft-recipient-site space or environment around each tiny globule of grafted fat, so that it can more easily commandeer new blood vessel ingrowth to sustain its survival and persistence.
Structural fat grafts have a multitude of advantages over commercial fillers. Foremost perhaps is that fat grafts are permanent. Initial survival of structural fat grafts to the face is about 75%. Whatever survives that first week or so is permanent. Contrast that with off-the-shelf hyaluronic acid fillers, which require replacement every 6-24 months. There is nothing “artificial” about fat grafts – they come directly from our own living body. Although structural fat grafting is certainly much more of a labor-intense procedure than using off-the-shelf fillers, the cost savings may also be substantial. And lastly, the stem cell action of the placed fat grafting confers a more youthful quality to the overlying skin – an unexpected and most welcomed bonus.