Current Status of Fat Injections in Plastic Surgery

Fat injections have been extensively studied over the last 15 years, both for replacing lost volume, and also for potential stem cell therapy. Thus far, the results have been encouraging, yet there is also need to proceed with caution. While the concept of taking your own fat from an unwanted area of your body and putting it elsewhere to augment that area is an attractive option, the actual practice is quite complicated. I want to discuss this issue in two areas — the current status of fat injections for facial re-volumizing, and the use of harvested fat cells for stem cell therapy.

Loss of volume in the face

The primary cause of facial skin aging is sun damage, but a close second is loss of volume in the face due to bone and soft tissue regression. A metaphor is a balloon. When you let air out of a balloon, the resulting balloon is less firm and even floppy. The same happens to our skin as we age. It seems like a simple concept to inject fat or filler under the skin to, in effect, re-inflate your face, but the procedure requires a great deal of finesse on the part of the injector. We have excellent fillers such as Restylane, Juvéderm, Sculptra, and Voluma to do this safely, as long as the injector follows appropriate anatomic guidelines. Unfortunately, we are beginning to see puffy faces and abnormalities due to over-utilization of injectable agents of all kinds by untrained, un-artistic, or amateur injectors.

Fat injections

In regards to fat injections, there are two problems. First, the fat can absorb back into the body and leave the patient with an expensive bill and no significant results. Second, the fat can be placed into incorrect areas, causing visible, unsightly bulges and other irregularities. If the fat has been placed in clumps instead of fine strands, scarring on the skin can occur. We have seen several cases performed at other facilities where fat was injected around the eye, especially in the groove below the eye, only to create horrendous-looking lumps that need to be excised surgically.

A recent problem with fat grafts and weight gain was presented at the American Society of Aesthetic Plastic Surgery meeting in San Francisco, California. When patients gain significant weight, the grafted areas of fat become abnormally enlarged and create an unusual appearance on the face. Therefore, patients who have facial fat transfers need to be conscientious about maintaining their body weight.

Dr. Core utilizes fat transfers during facial rejuvenation surgery and also in isolated cases of reconstructive and traumatic injuries to replace significant volume deficits. However, he feels it is safer and more precise to use soft tissue fillers such as Sculptra, Juvéderm, and Voluma in lieu of fat. In addition to increasing volume, these fillers also stimulate the body to grow new tissue.

The fallacy of Stem Cell Facelifts

The second issue about utilization of fat in plastic surgery has to do with stem cell therapy. Many surgeons, especially outside the U.S., have touted a “stem cell facelift,” which in reality is nothing more than fat being harvested from one place in the body and injected throughout the face in rather large volumes. Dr. Core feels this is an extremely unscientific and dangerous approach to facial rejuvenation and patients should be wary of “stem cell facelifts.” Stem cells have nothing to do with suctioning of fat and re-injecting it into the body. Stem cells are actually grown in laboratories utilizing fat tissue that has been harvested from patients. The process at this point holds great promise but is still experimental.

There is another misconception about stem cell therapy and fat transfers, in this case when addressing radiation therapy damage to the skin. For over a decade, dramatic improvements in radiated skin have been obtained simply by transferring fat in small thin strands throughout the radiated tissue. This fat transfer process is not experimental, having been replicated in clinical studies throughout Europe and the United States. Unfortunately, insurance companies have become confused and have integrated fat transfers with experimental stem cell therapy. They have taken the statement from the American Society of Plastic Surgery regarding the investigation of stem cell therapy and they have applied it to the clinical use of fat cell transfers. We hope this misperception can be reversed in the near future for the benefit of radiation therapy patients.

In summary, fat transfer is an exciting new field, which is beginning to have significant applications in both aesthetic and reconstructive surgery. But the procedure is complicated and requires clinical experience, so potential patients need to do their homework beforehand and speak at length with a qualified physician.