By Dr. Philip Solomon & Nancie Heiber
While new to many, fat grafting is not a new procedure; it is considered a secret weapon in facial aesthetic surgery. Dr. Philip Solomon has been using fat grafting for facial rejuvenation for over two decades. The first documented case of facial fat grafting dates back to 1893, when a German surgeon transferred fat from a patient’s arm to their orbital region. But it wasn’t until the 1990s that modern technology and new methods for transferring fat bolstered fat grafting into common usage. Fast forward to today, and fat grafting is at its peak of popularity thanks to its ability to provide amazing results when replenishing facial volume, augmenting facial structures and addressing facial scars as well. But what exactly is fat grafting and how can it be used to improve appearance? Why are doctors and patients turning to it as an alternative to filler? Dr. Philip Solomon MD, FRCSC, Otolaryngology, Head and Neck Surgeon, practising Facial Plastic Surgery in Toronto, answers our questions about the growing popularity of fat grafting.
Living Luxe (LL): Let’s start with the basics—what exactly is fat grafting?
Dr. Philip Solomon (PS): Facial fat grafting is a procedure in which fat is harvested from a donor site on the body, such as the abdomen, flanks or thighs, then purified to remove contaminants such as blood and oils, before being injected into areas of the face for volume restoration or augmentation.
LL: What is the difference between fat grafting and dermal filler injections?
PS: Both methods have their role in aesthetic medicine, offering excellent results as tissue volumizers. Fat grafting uses the patient’s own fat, making it completely natural with no risk of rejection. When transferring fat cells to areas like the orbit around the eyes, it can also improve skin quality and reduce discolouration. Many believe fat grafting yields a more natural-looking and longer-lasting result, with less long-term tissue swelling.
Dermal fillers are temporary and can be dissolved. They are ideal for younger patients who may not want a permanent change or who worry their aesthetic preferences could evolve. Dermal fillers provide immediate results. However, since they are synthetic, they may cause persistent swelling, particularly around the cheek-eye junction. They also produce a slightly different aesthetic compared to fat grafting, which can be desirable, such as achieving a bee-stung lip look some younger patients prefer.
Overall, dermal fillers remain a valuable tool in aesthetic medicine. Proper patient selection, the right product choice, and an experienced injector are key to optimal outcomes.
LL: What areas of the face does fat grafting address?
PS: Fat grafting can be used anywhere you can do dermal filler injections, such as the tear troughs, temples, cheeks, nasolabial folds, marionette lines and lips. Much like filler, patients may need more than one treatment to achieve their desired goal. Fat grafting has a variable reabsorption rate, which we account for when carrying out the procedure. We often get the outcome we want in the first treatment. However, in some cases, patients may need a secondary treatment to reach their ideal goal. We are extremely cautious not to overcorrect, as it is difficult to correct. It’s a bit of a Goldilocks scenario as we don’t want to add too little or too much fat. The goal is to get it just right.
LL: Who are the ideal candidates for fat grafting?
PS: Both men and women in their 30s can consider fat grafting for facial volumization to address various anatomical concerns. (We do occasionally see patients in their 20s whose genetic predisposition to hollowing or a lack of volume makes them suitable candidates as well.)
Common areas such as the tear troughs, lips and temples can benefit from fat grafting at virtually any age. For patients in their 40s and 50s, fat grafting is frequently used as part of a facial rejuvenation treatment plan either in isolation or combined with other surgical procedures.
It’s important to carefully assess the treatment options, including whether facelift surgery may be appropriate, either in conjunction with fat grafting or as a staged procedure at a later date. We want to avoid adding volume to areas of the face that could be altered by the repositioning involved in facelift surgery. Having utilized fat grafting extensively throughout my career, I’m particularly partial to its versatility—especially when combined with a deep plane facelift as it has the ability to considerably elevate a patient’s outcome.