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    The future of fat


    Fat and The Face

    Dr. Johnson says she performs fat transfer in almost every facelift.

    “… replacement of lost facial fat is truly rejuvenating, as it not only adds volume but appears to improve skin quality and texture,” Dr. Johnson says.

    Dr. Johnson also uses fat transfer in her cleft patients, to fill in lips that are asymmetric after lip repairs and to augment the posterior pharynx to reduce velopharyngeal incompetence, or hyper-nasal speech, after palate repair.

    Dr. TaleiBeverly Hills facial plastic surgeon Ben Talei, M.D., says that he uses fat transfer, judiciously — especially when using it as a primary modality for cosmetic rejuvenation.

    “The reason I am so cautious is because of the poor predictability in survival of fat and how it will act once transplanted. Fat has a survival rate of zero to 100%, in my opinion, when you look at each person as an individual. The fact that it has an overall survival of 60 to 70% in a cohort of patients means nothing to me when I treat an individual patient who should expect nothing less than 100% predictability for a cosmetic intervention.”

    When he uses fat for cosmetic rejuvenation, Dr. Talei says he’s conservative. Rather than injecting 10 mL of fat all over each side of the upper and lower face, he tends to use a smaller volume, of 4mL to 5mL. And he’ll likely inject it in the mid face and upper mid face in a deep location, where irregularities would have no effect if they were to occur. He tells patients that more than one treatment might be necessary to achieve the intended goal.

    “Most of the time I am using fat as an ancillary procedure rather than a primary procedure. It's a very nice adjunct to many facelifts, as long as it is done conservatively,” Dr. Talei says. “Overall, I avoid fat grafting into the lower face and superficially under the skin for many, many reasons.”

    Female patient shown before and after AuraLyft and eyelid rejuvenation with a small amount of conservative fat grafting for added cheek accents. She received an upper eyelid lift and lower eyelid tightening with fat repositioning and canthopexy to tighten the rounded lower eyelid. Photos courtesy Dr. Ben Talei.

    NEXT: Promises and Precautions

    Lisette Hilton
    Lisette Hilton, president of Words Come Alive, has written about health care, the science and business of medicine, fitness and wellness ...


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