Fat Grafting vs Dermal Fillers

Fat grafting and dermal fillers are both skin rejuvenation procedures used to reverse the natural signs of mild to moderate aging or improve skin irregularities such as acne scarring. As a person ages, the volume of fat within their face begins to decrease. In turn, this creates hollowness in areas like the cheeks, temples and under the eyes. This can cause a person to appear older, tired and gaunt. Furthermore, the loss of volume can create fine lines, wrinkles, folds and saggy skin. Fat grafting and fillers can improve these conditions. Fat grafting is also known as fat injections, autologous fat grafting or autologous fat transfer. It is a procedure that takes fat from another part of the patient’s body and transfers it to lacking areas through a series of injections. For the face, this procedure is most commonly performed with a face lift or neck lift procedures.  Fat can be used to add volume to the area of the temples, mid-face, lips or jawline. Dermal fillers are created in a laboratory but contain normal components of human soft tissues such as hyaluronic acid (which is naturally found in the body). For that reason, fillers are considered safe and biodegradable. Dermal fillers are non-surgical treatments and are simply injected into the treatment area.

Ideal Candidates

GOOD CANDIDATES for fat grafting include:

• Patients with a greater loss of facial volume and sagging soft tissue on the face and neck
• A patient who wants to enhance the face, breasts or buttocks
• Those looking for longer lasting results
• Patients who want to use their own natural fat rather than a filler material
• A patient whose body already rejected a filler
• Any patient with fat on another area of the body they wish to have removed

GOOD CANDIDATES for dermal fillers include:

• A patient looking for a quick and easy fix for most skin imperfections
• Patients looking for a non-surgical treatment with little to no recovery
• Thin patients who do not have enough fat for fat grafting
• A patient who wants a more predictable outcome than fat grafting

The following patients are NOT GOOD CANDIDATES for fat grafting or dermal fillers:

• A patient who suffers from a bleeding disorder or those who tend to scar easily
• Patients with cold sores or active herpes simplex virus
• Those who are prone to acne flare-ups since facial injections can cause an outbreak
• Patients with moderate to severe signs of aging may be better candidates for a facelift
• Patients not healthy enough for surgery are not ideal for fat grafting
• A patient looking for a “one time” treatment may not be a good candidate for filler treatments

Advantages of Fat Grafting

Fat grafting is performed in a surgical facility or hospital. Liposuction is used to harvest the fat from other portions of the body where fat may be unwanted such as the abdomen, thighs or buttocks. To gain enough fat for the transfer for procedures to augment the breast or buttocks, the surgeon may need to perform liposuction on several areas of the body. Once the fat is removed, it is rinsed and purified before being injected into the treatment area using a layered technique. This layered technique aids in an even distribution for a more natural look while also helping the injected fat integrate with the residing fat. The integration is important for the survival of the newly injected fat due to the need of forming an adequate blood flow to the living tissue. During the injections, the surgeon will massage the treatment area to create a smooth contour between the injected fat and the surface of the skin.

Advantages of Dermal Fillers

Dermal fillers are performed in a doctor’s office and, depending on the number of treatment areas, the entire procedure can be performed in 15 minutes to an hour. While dermal fillers are not painless, most patients tend to tolerate the discomfort well since the filler usually comes premixed with an anesthetic. The practitioner may also numb the treatment area with a topical anesthetic and use a skin chilling instrument to help with the discomfort of the injection. The practitioner will inject the gel-like filler under the skin with a very fine needle or blunt cannula which can reduce bruising. The treatment area is massaged and the doctor evaluates the results to determine if more filler is needed.

What are the Costs of Fat Grafting and Dermal Fillers?

The cost of fat grafting and dermal fillers depends on the extent of the treatment, type of anesthesia used, facility fees and the geographic location of the treatment. Fat injections for the face start at around $3000 but this can be a more permanent solution to restoring lost volume.  Dermal fillers are priced per syringe and the cost can range between $500 and $1000 per syringe. Most patients require more than one syringe of filler to restore lost facial volume.

Recovery and Downtime

There is little to no RECOVERY for dermal fillers and patients can return to most activities immediately after any injections. There may be some redness, tenderness, slight swelling and bruising at the injection site. This will subside within a few days to a week. Patients can use ice packs to minimize discomfort and makeup to conceal these side effects. Patients should have a DOWNTIME from intense physical activities, of 24 hours, to help minimize swelling and bruising. The fat injection site has similar side effects of redness, tenderness, bruising and swelling.

A fat injection procedure may require 7 to 10 days of RECOVERY due to the liposuction portion. Patients will experience some discomfort in the area where the fat was harvested but pain medications may be prescribed to minimize the pain. There will be some activity DOWNTIME due to the liposuction portion of the procedure. Patients are encouraged to walk around the house regularly to help speed healing and minimize the risk of blood clots. A compression garment will be worn for several weeks on the liposuction area. This garment will minimize swelling and help the skin retract to the body’s new contour. Patients can resume normal activities within a week or two.

Results

Patients will be able to see immediate results after fat grafting and dermal fillers. However, the swelling can obscure some results.

Most patients will only need one fat grafting treatment to gain the desired results. However, a percentage of the fat will not survive the transplantation process and will be naturally eliminated from the body within 6 weeks. The remaining effects of fat grafting are considered permanent since they become a living, breathing tissue. Final results for fat injections can be seen at 3 to 6 months post-op since it takes time for the transplanted fat to settle. As a person continues to age, the volume of fat will begin to naturally fade away and touch-up treatments may be needed to maintain the results.

Dermal filler results are temporary but will last several months, to years, depending on the type of filler used and where it is injected. Results in high motion areas, such as the lips, tend to fade faster than areas of less motion. Over time, the filler material will begin to degrade and become naturally absorbed by the body. Repeat injections, performed before the filler is fully absorbed, are needed to sustain a lasting outcome. This can increase the longevity of the filler since many of them can build on themselves.

To maintain longer lasting results with fat grafting and dermal fillers, patients should uphold a good skin care routine and always apply sunscreen when going outdoors. Patients should not smoke or drink excessively since these lifestyle habits can rapidly age the face.

Limitations of Fat Grafting

The limitations of fat grafting include:

• The results can be unpredictable since a percentage of the fat may not survive the transfer
• The amount of fat that can be harvested at one time and injected into a specific treatment area
• The amount of available fat for harvesting on a thin patient

Limitations of Dermal Fillers

The limitations of dermal filers include:

• The results are not permanent so there will need to be follow-up treatments
• The number of syringes needed to obtain the desired results, with dermal fillers, can be a limitation since the cost will increase
• Some patients might have an allergic reaction to some types of fillers

Risks of Fat Grafting

The risks associated with fat grafting include:

• Asymmetry with the results
• Infection at the injection site
• Lumps or bumps
• Over, or under, correction
• Skin necrosis or tissue death
• Skin rash with itching
• Blindness or death if injected into a vessel and migration occurs
• Scarring

Risks of Dermal Fillers

The risks associated with dermal fillers include:

• Allergic reaction
• Swelling at the injection site
• Bruising at the injection site
• Palpability of the filler under the skin’s surface
• Over, or under, filling of the treatment area

Choosing Between Fat Grafting and Dermal Fillers

Fat grafting and dermal fillers are both excellent choices for adding volume to a lacking area of the face. Both treatments can improve skin abnormalities, correct aging issues and provide a more youthful appearance. Fat grafting can also be used to restore volume in the breasts or enhance the shape of the buttocks. Patients who do not want surgery, or those who do not have enough fat to harvest, are better candidates for dermal fillers. Dermal fillers can be administered for immediate results but the outcome is temporary. While fat grafting requires a recovery time, only one treatment is usually needed. When considering either option, a patient should consult with a board-certified doctor. A skilled doctor can discuss the advantages and disadvantages of fat grafting and dermal fillers in order to help patients choose the most appropriate treatment to meet their needs.

Written by Cosmetic Town Editorial Team - MA

Based on an exclusive interview with Dr. Rocco Piazza in Austin, TX