Facelift with Blepharoplasty + Face Fat Grafting
WHAT ARE FAT INJECTIONS?
The fat transfer, also known as fat graft or fat injections, is a surgical intervention that aims to improve the appearance of the face through the transplantation of autologous adipose cells (the patient’s own fat).
As we age, the skin loses elasticity and volume in some areas and the facial contour is less defined. Wrinkles become more pronounced and jowls can develop along the jaw line.
Fat transfer is an effective facial rejuvenation treatment to restore the lost volume of some areas of the face, as well as to treat wrinkles, preventing them from becoming deeper. The procedure uses the patient’s own body fat, removed through liposuction (usually from the stomach, flanks, buttocks or inner thighs) to strategically graft the areas of the face that have lost volume or have more pronounced wrinkles. The harvested fat is purified before being injected into the face, and because it is the patient’s own fat, the risk of rejection is minimal.
FOR WHOM ARE
FAT INJECTIONS TO THE FACE INDICATED?
Good candidates for a fat transfer to the face usually have the following characteristics:
- Cheekbones with little volume or sagging
- Pronounced nasolabial folds
- Wrinkles and creases on the face
- Deep Dark Circles
- Jowls along the jaw line
- Good general health
- Non-smokers
- Psychologically stable patients, with realistic expectations regarding the results of the surgery.
FAT TRANSFER
SURGICAL PROCEDURE
YOUR FAT TRANSFER MEDICAL APPOINTMENT
Consultation
The first step of your medical appointment regarding fat transfer to the face is to share with the plastic surgeon what bothers you, the expectations you have for the surgery and the degree of rejuvenation you want to achieve;
Treatment plan
Depending on the initial state of the face and the desired result, a treatment plan will be outlined for a rejuvenated and natural appearance;
Detailed explanation
During the medical appointment, all the risks of the fat transfer procedure will be explained, as well as the pre and postoperative care;
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After the medical diagnosis, you will be presented with an exact price for the fat transfer according to the surgical plan outlined, and you will be able to schedule a date for your surgery. The price will depend on the initial condition of the face, the amount of fat to be removed and injected and the combination of procedures.
WHERE CAN FAT BE HARVESTED FROM?
Fat can be harvested from any area of the body where it is available. The most common areas are:
- Stomach;
- Flanks;
- Back;
- Hips;
- Inner thighs.
IN WHICH FACE AREAS
CAN IT BE INJECTED?
Fat can be injected into areas of the face that have lost volume and contour over the years. The most common areas are:
- Cheekbones;
- Dark circles;
- Temples;
- Nasolabial folds;
- Lips;
- Facial folds, wrinkles and creases.
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FAT VS HYALURONIC ACID: ADVANTAGES AND DISADVANTAGES
A common feature of skin aging is the lack of volume and contour due to the gradual loss of fat on the face. When the goal is to improve the appearance of wrinkles and achieve a denser face with better defined contours, there are different treatment options, surgical and non-surgical, to achieve the desired result.
Two of the most used techniques are fat injections and hyaluronic acid fillers. Both approaches can provide excellent results, if performed by a certified reconstructive and aesthetic plastic surgeon or by a physician specialized in aesthetic medicine (in the case of hyaluronic acid fillers), however, it is crucial that you understand the difference between the two procedures so you can make a conscious decision.
So, let’s explore the pros and cons of fat transfer and dermal filler treatment with hyaluronic acid.
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ADVANTAGES AND DISADVANTAGES
OF FAT TRANSFER TO THE FACE
Benefits
- Body fat is the safest and most natural filling substanceavailable. As it is fat from your own body, the risk of rejection is minimal;
- Fat does not only restore lost volume. There is some evidence that the stem cells from fat injections provide a rejuvenating effect on the skin area where the fat is injected;
- The fat that survives the transfer process becomes living tissue providing a long lasting effect that cannot be obtained with other fillers;
- As the fat is usually harvested from your own body, this procedure enables an overall improved body contour, removing fat from areas where it is deposited;
- The long-term costs associated with maintaining the results are lower with fat transfers than with dermal filler treatment with hyaluronic acid, as this requires maintenance every 9-12 months;
Disadvantages
- Fat transfer involves surgery with anesthesia and associated risks;
- The initial cost is higher than the dermal filler treatment with hyaluronic acid;
- It implies a recovery time of 3 to 7 days;
- Fat transfer requires surgical intervention in other parts of the body as well, therefore bearing the same risks as liposuction, albeit minimal.
ADVANTAGES AND DISADVANTAGES OF DERMAL FILLER TREATMENT
WITH HYALURONIC ACID
Benefits
- Hyaluronic acid fillers have an excellent track record in terms of patient safety;
- No surgery and no anesthesia. Only topical anesthesia is applied before the treatment, and it can be performed in the consultation room in a short amount of time;
- No recovery time;
- Initial treatment cost is lower than that of fat transfer;
- The effect is reversible, as hyaluronic acid can be dissolved very quickly and safely with a simple injection of another substance.
Disadvantages
- Although it is very rare, there is a risk of allergy or rejection;
- The result of dermal filler treatments with hyaluronic acid is temporary, thus requiring continuous maintenance over time – usually every 9 to 12 months;
- In the long run, the overall cost of dermal filler treatments with hyaluronic acid, especially in patients with very pronounced signs of aging, may be higher.
FAT TRANSFER TO THE AT SCARS
One of the great benefits of facial rejuvenation with fat grafting is that it leaves no visible scars. The scars are millimeter incisions located in the natural folds of the body, through which the liposuction cannula is inserted to harvest the fat. After being centrifuged, the fat is injected into the face, and this second process leaves no scars.
TYPE OF ANESTHESIA
Generally, the fat transfer to the face is performed with sedation and local anesthesia – it basically depends on the combination of procedures and the characteristics of each patient. It is for the anesthesiologist to decide the type of anesthesia for each individual patient.
WHAT RESULTS CAN I EXPECT
AFTER PERFORMING A FAT TRANSFER TO THE FACE?
A facial rejuvenation with a fat transfer will give you a more youthful and natural look, without looking like you have undergone surgery. The result of the fat graft is long-lasting, but no surgery guarantees lifelong results.
A surgical intervention does not stop the natural aging process and as it progresses, the sagging skin and the facial muscles relaxation continues.
You will naturally look better and have softer wrinkles than you would without the surgery. However, part of the fat that is transplanted is reabsorbed by the body. It is impossible to predict what exact percentage will be properly integrated into the tissues where it was injected (the expectation is 30% to 50%), which means more than one session might be necessary to get the results you want.
FAT TRANSFER
TO THE FACE STEP-BY-STEP
MARKING PATIENTS WHILE STANDING
Before administering the anesthesia, markings are made both on the patient’s face, and in the area where the fat will be harvested;
SEDATION
Sedation is administered intravenously by the Anesthesiologist who will be present throughout the whole surgery. The local anesthetics are then injected into the area to be treated so that the patient does not feel any pain during the surgery;
DISINFECTION AND DELIMITATION OF OPERATING FIELDS
Both the entire face and the fat harvesting area are cleansed and disinfected to reduce the risk of infection. Operative fields are placed to isolate the intervention areas from the external environment;
FAT HARVEST
The cannula is inserted in the area where the fat will be harvested. The liposuction cannula is connected to a vacuum aspiration pump that harvests the fat;
FAT PURIFICATION
The extracted fat is purified and the fat cells to be used are placed in syringes;
FAT INJECTION
The purified fat is injected into the designated face areas to restore lost volume and improve the contours;
POST-ANESTHESIA CARE
The patient is awakened by the anesthesiologist and is then transported to the recovery room where she/he remains under observation for a few hours before being discharged.
PREPARATION FOR SURGERY
Before surgery:
- Perform all medical examinations and blood tests, sending them at least one month in advance;
- Do not take aspirin or any anticoagulant medication in the two weeks prior to the surgery. You must inform the medical team of any medication you are on, and any medical condition you suffer from.
- Do not take any weight loss medication one month before the intervention;
- Do not smoke on the month preceding the surgery and while the healing process is underway. Tobacco compromises tissue oxygenation, hindering the healing process as well as the integration of fat with the face tissues;
- If you get a cold or feel ill in any way in the days prior to the surgery, the medical team should immediately be informed.
- Carefully read all the documentation provided, as some questions may arise before surgery day;
- Organize your routines in advance to be make sure you will be able to recover peacefully for at least 3 days;
- If you have any doubts regarding the fat transfer to the face, do not wait for the surgery day; ask all your questions beforehand.
Surgery Day
- The day before surgery you should have light meals only, in order to avoid indigestion. You should be fasting for 8 hours before the surgery - do not eat or drink any liquids including water.
- Shower with the prescribed antiseptic shower gel the day before and the day of surgery, to reduce infection risk.
- Do not wear jewelry or a watch, do not wear makeup or nail varnish.
- Do not wear contact lenses;
- Bring comfortable clothes to wear when you are discharged - preferably with buttons or a zip;
- After discharge, you can neither drive nor go home unaccompanied. If you have no one to take you home, you must inform us in advance. You must be accompanied for at least 48 hours.
Recovery and postoperative care:
- You may experience discomfort during the first 3 days, but you are not expected to feel any pain;
- Rest and avoid any type of effort in the first 8 days;
- Do not massage the area where the fat was injected before being told you may do so;
- Do not drive for 8 days;
- Do not smoke;
- Do not get direct sun exposure;
- Do not lie down all the time – short walks are important to promote circulation;
- Sleep with your head on a high pillow;
- Use cold compresses to avoid edema;
- Attend all follow-up appointments.
- Drink plenty of water and follow a balanced diet;
- You can go back to work 3 to 7 days after the procedure.
BENEFITS OF FAT TRANSFER TO THE FACE
It improves skin quality: the harvested fat contains stem cells that provide growth factors which contribute to long-term facial rejuvenation.
It provides long-lasting results: The results of the fat transfer to the face usually last for several years, or may even be permanent, whereas the results obtained with the dermal fillers usually last 6 to 9 months.
It does not cause an allergic reaction: As the fat transfer uses the patient’s own fat, the immune system does not treat it as a threat when injected in the face.
It provides natural results: The fat transfer to the face produces very natural looking results, as it uses a body’s natural substance.
It enables a shorter recovery time: The fat transfer to the face has a shorter recovery time than surgical procedures such as a facelift.
It improves the contour of different problematic areas: fat transfer to the face gives you the chance to get rid of fat from body parts where it is often difficult to be eliminated.
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Specialist Doctors
About
Dr. Luísa Magalhães Ramos / Plastic Surgery
PORTUGUESE MEDICAL ASSOCIATION, Nr. 42810
Graduated by the Faculty of Medicine of the University of Porto, she specialized in plastic, reconstructive and aesthetic surgery, at Hospital de São José, in Lisbon.
Throughout her training, she subspecialized in aesthetic plastic surgery, having worked in world-renowned clinics.
Currently, she is mainly dedicated to face and breast aesthetic plastic surgery and to intimate female surgery.
About
Dr. Alice Varanda Pereira / Plastic Surgery
Member of The Portuguese Medical Association, Nr. 47051
Graduated by the Faculty of Medicine of the University of Lisbon, she completed her master’s degree in human sexuality and is currently developing her PhD at this same institution.
She joined the University faculty academic staff in 2008 as a lecturer of the Institute of Anatomy. It is in this unit that she produces most of her research projects, mainly in the area of surgical anatomy, whilst also supervising master’s thesis for undergraduate students.
About
Dr. Mariana da Rocha Martins / Plastic Surgery
Member of The Portuguese Medical Association – Nr. 55124
Graduated by the Abel Salazar Institute of Biomedical Sciences at the University of Porto and specialized in reconstructive and aesthetic plastic surgery at Hospital de São José, in Lisbon.
Throughout her specific training in plastic surgery, she worked in internationally renowned institutions such as Institut Kaplan (Barcelona), La Clinic (Montreux) and Great Ormond Street Hospital (London).
About
Dr. Marta Gouveia Duarte / Plastic Surgery
Member of The Portuguese Medical Association, Nº 57817
Graduated in Medicine from the School of Health Sciences of the University of Minho, where she completed her Master’s thesis in Human Aging.
She concluded her specialty in Plastic, Reconstructive, and Aesthetic Surgery at the Centro Hospitalar de Lisboa Central – Hospital de São José.
Collaborates in several research projects at NOVA Medical School.
About
Dr. Filipa Oliveira/ Plastic Surgery
PORTUGUESE MEDICAL ASSOCIATION: registration Nº. 59147, specialist in Reconstructive and Aesthetic Plastic Surgery.
Graduated in Medicine from the Faculty of Medicine of the University of Porto, where she completed her Master’s thesis on pediatric scars.
PhD in Medicine from the University of Münster in Germany.
After completing her specialty, she became a Senior Graduate Assistant (Oberärztin) at the Fachklinik Hornheide and the University of Münster. She is currently involved in various research projects at the University of Münster, where she is supervising doctoral students. She is also a regular correspondent for scientific and leisure magazines in Germany.
FAQ about
Fat Transfer to the Face – Lipofilling
IS FAT TRANSFER TO THE FACE A SAFE PROCEDURE?
Any surgery has associated risks and fat transfer is no exception. For the surgery to be performed safely, it is very important to choose a reconstructive and aesthetic plastic surgeon enrolled in the Portuguese Medica Association and with several years of proven experience in performing fat transfers and facial surgeries.
HOW MUCH DOES A FAT TRANSFER TO THE FACE COST IN LISBON?
The price for a fat transfer to the face will depend on the skin’s aging degree, the amount of fat to be harvested and injected and the combination of procedures. The fat transfer is often combined with other facial rejuvenation surgeries such as upper and/or lower blepharoplasty, eyebrow lift, face or neck lift, peelings and CO2 laser. The exact price will be shared with you during the medical appointment, after diagnosis.
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WHAT TYPE OF ANESTHESIA IS USED?
The anesthesia to be administered will depend on the patient and the combination of procedures, but the fat transfer is usually performed with sedation and local anesthesia.
WHAT IS THE IDEAL AGE FOR UNDERGOING A FAT TRANSFER TO THE FACE?
There is no specific age to perform a fat transfer to the face. Surgery is indicated when there are visible changes in the face that bother the patient, ideally before there is a very pronounced and visible aging (between 45 and 55 years old). The sooner you perform the surgery, the less drastic the change and the more natural the result.
ARE THERE NON-SURGICAL ALTERNATIVES TO FAT TRANSFER?
If your goal is to replace lost facial volume but prefer to avoid surgery, LMR Cirurgia Plástica offers alternative minimally invasive alternatives. Dermal fillers with hyaluronic acid can add volume to the cheekbones, lips, dark circles, wrinkles and creases, depending on what you want to improve. Although the effects are not permanent and usually last between 9 to 12 months, these fillers can help to minimize the effects of aging in the face without being subject to the risks of a surgery. Our team can suggest an ideal treatment plan based on your needs and concerns.
DOES A FAT TRANSFER LOOK ARTIFICIAL?
No. One of the great benefits of a fat transfer is that it provides a natural result, both to sight and touch. As it uses the body’s own fat, the result will resemble a natural, denser and younger face.
WILL I GET A "SWOLLEN FACE" LOOK?
Right after the fat transfer you will notice your face is swollen, but you need not to worry as this does not correspond to the end result. The visible swelling during the month following surgery is mostly due to post-operative edema. It will decrease over time, resulting in a denser, but very natural result. It is important to understand that in the months following the surgery, your body will absorb 30 to 50% of the injected fat, providing an even more natural look.
HOW LONG WILL THE RESULTS FROM A FAT TRANSFER TO THE FACE LAST?
It is not known for sure how long the fat transfer results last. During the first few months, between 30% and 50% of the injected fat is reabsorbed. The remaining fat generally remains for several years or even permanently. The longevity of the injected fat will depend on the used technique and the place where it was injected. There is greater longevity in the cheekbones and lower eyelid areas, and less longevity in more mobile areas, such as the perioral area.
CAN WEIGHT FLUCTUATIONS AFTER THE FAT TRANSFER COMPROMISE THE END RESULT?
As we get older we tend to gain some weight, as we lose some facial volume at the same time. This is natural and expected. Losing or gaining around 10 kg will not make a difference in most cases.
However, patients with excessive weight or strong weight fluctuations may not be ideal candidates for fat transfer.
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CAN MY BODY REJECT THE TRANSPLANTED FAT?
One of the main advantages of this surgery is that, because the fat comes from your own body, the risk of rejection, allergies and adverse effects is very low.
WHAT IS THE RECOVERY TIME AND WHEN CAN I RETURN TO WORK?
Depending on the treatment plan, most patients can return to their day to day activity within 3 to 7 days. Some bruising and mild swelling is common in the liposuction area, but these dissipate a few weeks after the procedure. You can use make-up to hide the bruises so you get back to work more comfortably.
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IS THE POST-OPERATIVE VERY PAINFUL?
In the postoperative period you may experience mild discomfort, but pain is not to be expected. Moderate swelling, bruising and numbness may occur, but these are transient symptoms that disappear after a few days.
WHAT ARE THE RISKS OF SURGERY AND ANESTHESIA?
Fat transfer to the face is a safe surgery, but, like any surgical procedure, it is not without risks and complications. Some of the complications of the fat transfer are: infection, prolonged or unsightly scarring, changes in skin sensitivity, irregularities in the contour, asymmetry, reabsorption of fat, etc. The risks and complications of surgery will be explained in detail during your medical appointment.
