Filling soft tissue deficits such as wrinkles, laugh lines, sunken areas around the eyes, and cheeks has been a frustrating problem. This frustration has been shared by both plastic surgeons and their patients who want something that works well and lasts. Many substances have been used. Some have been successful but last only a short time such as collagen. Others are permanent but are hard to the touch and have an unnatural feel like silicone implants. Still, others have been fraught with infection and lumpiness like liquid silicone. We have not come up with the perfect soft tissue filler yet. There is an amazing work being done in the field of stem cell research. In the future we will be able to take your own blood and grow your own collagen which will be permanent. That day is at least 20 years away and the cost will be very high.

Recently, fat transplantation has become very close to what could be considered the ideal soft tissue filler. Many pioneers in plastic surgeons are using it with outstanding results. After all, it is your own fat that is being used. The benefit of fat transplantation is that the majority of the fat transplanted lives forever. Meaning, the result is permanent. This is a major step forward. Also, the touch and feel of fat is perfect because it is your own tissue.

The idea of fat transplantation is not a new one. It has been attempted since the early '70s but the results were not reliable. The reason for this was because the adipocytes, or fat cells, were destroyed when the fat was harvested during liposuction. With newer techniques such as gentle handling, filtering, and chemical alteration it has been found that the majority of adipocytes can and do survive.

For decades, plastic surgeons have been actively looking for something to act as a soft tissue filler. Until these new techniques were devised, the search included such substances as silicone, fascia, tendon, bone, and many other artificial foreign bodies. None could provide the soft, squeezable feel that one's own tissue has. Fat is the best soft tissue filler that we currently have available.

The importance of fat transplantation was not thoroughly recognized until plastic surgeons started seriously evaluating what causes facial aging. It was once thought that aging was caused by stretching of the skin. With more recent developments it is clear that this is only a small part of facial aging. The majority of facial aging can be attributed to fat and muscle descent as well as loss of facial fat. With the advent of successful fat transplantation, significant strides have been made in recapturing one's youthful appearance. This is done by replacing the fat, which has been lost with age, or has fallen down the face leaving sunken eyes with circles, deep cheek folds, etc.

The importance of facial fat can be best seen in that of a baby. Look at the cheeks of an infant. You will see a tremendous amount of fat. When you look at successful models, all of them have high cheekbones with a lot of fat within the cheeks. As we age the fat either falls downward or goes away exposing an aged, sunken in appearance. By replacing this fat a more youthful appearance can be obtained without even making incisions. This is a very attractive idea to most people, and this is why fat transplantation has become so popular among experienced plastic surgeons.

Fat loss is mostly noticed around the eyes and within the cheeks. The loss of fat around the eyes creates a sunken in appearance. Another characteristic is that the facial skeleton becomes more and more apparent. Deep circles and bags become obvious as the fat either drifts downward or goes away. By replacing the fat these processes can be reversed.

Benefits

The biggest benefit that fat transplantation has to offer is that it is your own tissue. You are replacing fat lost because of the aging process with fat from other parts of the body. Here is a summary of fat transplantation benefits.

• The fat is your own.
• You get the additional benefit of liposuction.
• There is no better replacement of fat than fat itself.
• Fills in the tear trough crease underneath the eyes.
• Dramatically improves or eliminates circles under the eyes.
• Corrects the sunken in look seen around the eyes as we age.
• Corrects the sunken in look within the temple region common with aging.
• Dramatically helps corrects crow's feet.
• Is able to re-create full, high cheeks seen in the youthful face.
• Can fill in other soft tissue defects and divots all over the body.
• The fat that successfully survives is permanent.
• The procedure can be done under local anesthesia.
• The procedure can be repeated over and over until the desired results are obtained.

Are you a good candidate?

The biggest benefit that fat transplantation has to offer is that it is your own tissue. You are replacing fat lost because of the aging process with fat from other parts of the body. Here is a summary of fat transplantation benefits.

• Your own tissue is used.
• You get the additional benefit of liposuction.
• There is no better replacement of fat than fat itself.
• Fills in the tear trough crease underneath the eyes.
• Dramatically improves or eliminates circles under the eyes.
• Corrects the sunken in look seen around the eyes as we age.
• Corrects the sunken in look within the temple region common with aging.
• Dramatically helps corrects crow's feet.
• Is able to re-create full, high cheeks seen in the youthful face.
• Can fill in other soft tissue defects and divots all over the body.
• The fat that successfully survives is permanent.
• The procedure can be done under local anesthesia.
• The procedure can be repeated over and over until the desired results are obtained.

Possible complications

The most common complication with fat transplantation is inadequate volume. This, however, may not be a complication as it may be necessary to do it twice to obtain the desired volume. Other possible complications are asymmetry, skin irregularities, infection, and fluid or blood collections.

Do's and Dont's prior to surgery

• Medications. Certain medications thin your blood and should not be taken within 3 weeks of surgery. The most notable is aspirin and aspirin containing products. Vitamin E and many herbal products also thin the blood and should not be used within 3 weeks of surgery. Your doctor will go over this more thoroughly prior to the procedure.

• Sleep. It is important to get a good night's rest prior to the procedure. If you think this may be a problem, please, do not hesitate to ask your doctor for something to help to sleep.

• Smoking. Please do not smoke within 3 weeks before and after surgery. Smoking has a profound effect on reducing wound healing capabilities. It significantly increases the likelihood for infection, wound healing problems, and scar formation. It also affects your airway, therefore, makes anesthesia much more difficult.

• Eating. Do not eat within 8 hours of surgery and do not drink within 6 hours of surgery. It is OK to take medications with a sip of water. Please discuss all medications with your doctor and the anesthesiologist.

• Washing. It is a good idea to wash the surgical area thoroughly the night before and the morning of surgery. If the abdomen is being used to harvest the fat, please be sure to wash the belly button. Do not apply any make up.

• Arrival. It is best to arrive on time so everything goes smoothly. Please be sure to have someone else drive you.

• State of mind. Remember, this should be a happy and exciting time. A certain amount of nervousness is normal but you should not be overly concerned. Excessive worrying can actually be detrimental and you should discuss this with your plastic surgeon prior to surgery so that something can be prescribed to make sure you remain calm.

Anesthesia

The anesthesiologist will discuss with you what type of anesthesia is best for you. He/she will take into consideration your medical history, the procedure, and your personal wishes.

Normally, fat transplantation is performed under local anesthesia. It may be done under general anesthesia or with sedation but this is usually when it is done with other procedures.

After the procedure

Immediately. If only fat transplantation is being done the procedure normally takes about 1 to 2 hours. After which, you may have tape applied to the areas where the fat has been injected to hold it in place.  You will be encouraged to walk around immediately. It is important that you have someone else drive you home. Do not touch the areas where the fat has been transplanted. It takes about 3 days before the fat is revascularized by the surrounding tissues. If there is a lot of movement within the transplanted area revascularization may not occur and the fat will die. You will be given as much pain medication as necessary both immediately after the operation and for the postoperative period. There will be some swelling and bruising but there is surprisingly little pain. You must sleep sitting up or at least with your head elevated on 2 ore 3 pillows for the first week so that swelling is minimized.

That evening. It is recommended that you take it easy. You can walk around, eat, but not too much more. You must sit and lay with your head up on at least 3 pillows. You should take as much pain medication as necessary and try to go to sleep early. Do not apply ice to the fat transplantation site as this may diminish blood flow and inhibit revascularization of the fat cells. You will be given medication to help keep the swelling down as well as to prevent infection.

First week.  You can take a body shower the day after surgery. Let cool water run over your face. Do not wash. Dab dry. Keep the tape on for as long as it will stay on. If it starts to peel off, gently cut off the portion that is lifting. Just be gentle. You will see your doctor in the office 1 week after surgery.

First month. Begin gentle massage with a vitamin E cream 1 week after surgery. Gently massage your skin from your nose to the side of the face to encourage lymphatic drainage. This will help bring the swelling down. At 2 weeks after surgery you can begin to massage a little more firmly. Massage at least every 4 hours for 2 minutes.

Beyond. Swelling will not completely resolve for about 6months but, as mentioned above, the majority of it will be gone by 2 weeks. The final result will become evident at 3 to 6 months.

Recovery time

Resolution of the swelling and bruising is variable. Some people do not bruise at all while others have bruising for 2 weeks. People with sedentary jobs go back to work after 2 weeks. If you work at home or are not self-conscious about the swelling then you can return after 4 days. If your job, however, requires strenuous activity then it may take as long as 3 to 4 weeks to return to work. Most people return to work within 2 weeks.