The popularity of fat injections has risen and fallen, and appears to be on the rise again. The realization that many of the facial changes of aging are due to the loss of volume of both soft tissue and bone, has dramatically increased the use of fillers. Because the commercially available fillers are relatively expensive, fat grafting has been attractive as a relatively inexpensive source of a large volume of filler material, material that is native to the patient and should not cause allergic reactions.
However, there are significant problems associated with fat injections. When large volumes of fat are injected into the face there is considerable swelling and bruising, usually requiring about two weeks of downtime. The uptake of fat can be highly variable, and the fact that equal volumes of fat are put in opposite sides of the face does not guarantee that there will be even take on both sides.
If a person gains weight after fat injections, the implanted fat can enlarge as well. This can result in a strange or unnatural appearance. Filler is frequently placed under the lower lids, since this is a frequent and noticeable area of volume loss. This is a treacherous area for fat injection. In fact, overall fat injections have a high complication rate according to Dr. Val Lambros, a highly respected plastic surgeon who has done pioneering work on the nature of facial aging. He also reports that injected fat does not age well as the face gets older.
My conclusion, speaking as one who has considered taking up fat injections but has not yet done so, is that fat injections are not yet ready for prime time, and may never be so. Fat injections are more popular with plastic and facioplastic surgeons than with dermatologists. Unless there are further improvements that address the current problems with fat injections, I'll continue to use synthetic fillers and hope for the prices to fall further.
Gerald N. Bock MD
Stockton & Lodi, CA