The Fine Art behind Facial Fat Transfer
Facial lipoaugmentation or fat transfer is the art and science of restoring volume and contour of the human face using autologous fat. The popularity of facial fat transfer seemed relatively new, but the concept is not. Free fat graft was pioneered in 1893 by Franz Neuber who transferred a small piece of fat from the upper arm to fill a soft tissue defect of the face. Its use to correct deficits of the cheek and chin areas was further reported as early as 1909.
The Inverted Triangle of Youth
The Young Brow Line
Complications of Facial Fat Transfer
The advent of liposuction in the 1980s spurred the move toward modern fat grafting. Dr. Ilouz reported the transfer of liposuction aspirate in 1984, and Dr. Ellenbogen, a Beverly Hills plastic surgeon, reported the use of fat autografts in atrophic and posttraumatic facial defects in 1986.
So Is There an Art Behind Facial Fat Transfer?
The Inverted Triangle of Youth
The young face typically has an inverted triangular
appearance. Having more volume in the cheeks and a soft angle of the
jaw suggests a youthful appearance. As one ages, this inverted triangle
of youth becomes more rectangular as one develops jowls and as the
malar fat pad (cheek) descends. Thus, facelift/neck lift procedures,
along with selected fat transfer to the face, revivify this inverted
triangle of youth.
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| Inverted Triangle of Youth (Photograph courtesy of industrial-sourcing-news.blogspot.com; AP Photo/Damian Dovarganes) |
The Ideal Beautiful Cheek
One of the secrets to a beautiful face is a pronounced cheek bone with narrow cheeks. The ideal
beautiful cheek has been found to be oval, not round. It is also angled
which extends from the angle of the mouth to the base of the helix of
the ear. Fat transfer to the aged face into the ideal cheek area may beautify the face in selected patients. Cheek augmentation that deviates from this "ideal" may result in a less attractive and unnatural facial appearance.
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| Angelina Jolie's Beautiful Cheeks (Photograph courtesy of 640pixels.com) |
Recently, aesthetic plastic surgeons have recognized that
young attractive female models have a brow line that is low lying with anterior
projection of the brow. Hollowness
around the eyes may suggest advancing age. Atrophy of the fat underneath the brows may cause a tired
aged appearance. Thus,
re-establishing the contour of the brow line, such as a fat transfer (as
suggested by Ellenbogen), may restore some youthfulness as well as can visually
make the eyes bigger.
This powerful technique, especially in combination with other facial rejuvenation procedures, may only be applied in very select cases, such as the presence of a hollowed eye appearance.
What are the Indications for Fat Transfer?
- Depressed scars of the face & body
- Aging skin with loss of supportive tissue, such as the dorsal hand, hollow cheeks & eyes, upper lip and nasolabial folds.
- Facial Reshaping for the gaunt/thin face
- Cheek augmentation
- Buttock augmentation, such as the Brazilian Butt Lift
- Chin augmentation
- Hemifacial atrophy
- Flattened upper lip
- Fat resorption is the most common problem encountered.
- Bruising
- Fat embolism, very rare.
- Blindness, extremely rare.
- Iatrogenic injuries, such as vessels & nerves. Thus, it is important to select a plastic surgeon to perform this procedure.
- Asymmetry may occur due to multiple factors, such as the variable nature of the viability of the fat grafted/transferred and pre-existing asymmetry of the face.
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| The Golden Ratio of Angelina Jolie (Photograph Courtesy of Digitallywright.com by Brandon Wright) |
Ellenbogen R. Free autogenous pearl grafts in the face: a preliminary report of a rediscovered technique. Annals of Plastic Surgery. 1986;16:179-19
Illouz YG. L'avenir de la reutilization de la graisse apres liposuccion. Rev Chir Esthet Lang Franc. 1984;9:36
Neuber F. Fat transplantation. Chir Kongr Verhandl Dsch
Gesellch Chir 1893;20:66
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