Fat Transfer vs. Dermal Fillers: Which is Better?

By Timothy McGee, MD November 20, 2019 No Comments

fat transfer vs dermal fillers

Non-surgical treatment options for facial aging include facial fat grafting (also called facial lipografting and fat transfer) and facial demal fillers (like Restylane, Sculptra, or Radiesse). Facial fat grafting and fillers are two of the most effective cosmetic treatments to replace the loss of volume and fullness that occurs with facial aging.

Age-associated loss of facial volume is a result of a decrease in skin thickness, adipose/fat layer, muscle mass, and bone mass. By age 55, most people have lost up to 40% of the fat in their face. This volume loss leads to several aesthetic aging symptoms that become visually prominent including:

  • the hollowness in the cheeks, temples, or under-eye areas
  • development of lines and wrinkles
  • sagging of the skin
  • the decrease in the fullness of lips
  • “bony” or “skeleton” appearance
  • the decrease in width of the upper third of the face

Facial fat grafting and facial fillers restore facial volume to achieve a younger-looking face. Both treatments have their respective strengths and weaknesses. Here’s more information about difference between facial fat-grafting and facial fillers.

Composition Differences

Facial fat grafting utilizes the patient’s fat.The fat grafting procedure involves the harvesting of fat from the patient’s body (usually the stomach, love handles, and/or thighs) via harvesting liposuction. The technique to harvest fat for grafting is a more gentle type of liposuction than the standard type of liposuction. The harvested fat is carefully processed to remove impurities, resulting in the isolation of living fat. The fat graft is further processed to a small size so that it will pass through a 0.7 or 0.9mm diameter cannula.These small fat grafting cannulas are then used to inject the fat graft into targeted facial areas.

Alternatively, facial fillers are scientifically created soft tissue formulations that are created from naturally occurring components of human tissue like hyaluronic acid (HA) used in Restylane. There are also fillers comprised of poly-l-lactic acid used in Sculptra, calcium hydroxyapatite used in Radiesse, and many others. The various types of fillers have different benefits and drawbacks. The HA based fillers are the most common form of filler used today. The HA fillers come in many different formulations and viscosity that can be injected at various depths which allows the injector to customize the result. Facial fillers are typically supplied to the injector in a 1 ml syringe and the filler is injected into the area(s) with a small gauge needle where the patient wants volume restored.

Results 

Does one method offer a more dramatic result? Or a more natural-appearing result? Is it true that fat transfer results are less predictable? The results obtained with any type of filler is dependent on many factors but the absolute most important factor by far is the provider that is injecting the filler. The location of and the volume of filler injected determines how dramatic the results are and how natural-appearing the results. Fat grafting results typically undergo a 15% decrease in volume from the immediate post inject results from graft loss. Since fat grafts are living grafts the amount of loss of graft can be greater or less than 15%. In the hands of a plastic surgeon trained in fat grafting the results should be within 1 standard of deviation from 15%. Facial fillers used in the United States are all FDA approved and subject to strict quality controls and thus they are very predictable from syringe to syringe.

How Quickly Do Results Appear?

The results of fillers and fat injections become apparent immediately, the increase in facial volume will be apparent instantly after injection. For both procedures, bruising and swelling may occur in the injection area which may alter some of the immediate results. These issues will subside over a couple of days when the swelling resolves. With both techniques the greater the amount of filler injected the greater the chance of bruising and swelling.  The results of fat injections are typically realized at about 3-6 weeks post-procedure as the selling both in and around the fat graft resolves. HA Facial fillers are only subject only to swelling of the surround tissues since the filler itself is not a living graft. Sculptra (poly-l-lactic acid) is a unique type of filler that is injected and re-hydration and quickly resolves back to pre-treatment condition then over a 6-8 week period the body responds to the Sculptra and creates the facial filling results.

Result Duration

Fat grafting transfers the patient’s own fat to the targeted areas in the face. The transferred fat integrates and receives blood supply from surrounding tissue to sustain itself, becoming living tissue in the area grafted. The living graft nature of fat grafting is the key feature that allows fat grafting results to last longer than facial fillers. Potential patients should realize that not all transferred fat will survive after being transplanted. A highly trained and experienced cosmetic surgeon will use advanced technology and methodology to boost the survival rate of injected fat cells which is generally around 85%.

In contrast, facial fillers are a temporary treatment, with results lasting anywhere from 9 months to 2 years depending on the type of filler used. The treatment area can also influence how long the filler will work, as repeated muscle contractions in high motion areas of the face, like the cheeks, cause the efficacy of the filler to fade. Eventually, the filler is fully absorbed by the body through the natural metabolic process. This gradual absorption causes the face to return to its pre-injection state. Results can be maintained permanently if the patient chooses to undergo regular maintenance treatments.

However, it is important to note that no technique stops the aging process. The facial volume will continue to decrease over time. Thus, with either technique as time marches on more filler will be required to maintain the result or the overall volume of the face.

Invasiveness

For both techniques, a topical cream is used to numb the facial treatment area. The facial injections are virtually painless. However, fat grafting requires a minor liposuction procedure to harvest the patient’s fat. The fat is harvested discretely usually from the stomach, thigh or hip. The 3 mm incision at the harvesting site is very small and requires a single stitch. Alternatively, patients who choose to use manufactured facial fillers, like Sculptra or Restylane, will not undergo harvesting liposuction and will not have any incision or stitches.

Recovery

Both procedures have the same minimal recovery from facial injections. While some patients may experience some redness, swelling and bruising in the treatment area, these side effects are generally mild and will resolve in a few days. Patients can also wear makeup to conceal these effects.

The facial filler patients can return to their normal activities immediately, but the fat grafting patients require additional recovery time from the minor liposuction. Most of those patients return to normal physical activity in 7-10 days. However, many patients choose to have standard liposuction as a secondary procedure while undergoing a fat grafting procedure. In that case, additional downtime and compression garments may be needed. Learn more about liposuction recovery here.

Costs

The total treatment cost differs based on several factors including the volume of filler the patient needs, the level of experience of the provider, and where the procedure is performed. Fat grafting is priced as a surgical procedure and not priced on the volume of fat grafted since the patient is supplies the fat graft. Most patients receive in the range of 25-75 ml of the volume of fat graft. In general, fat grafting procedures are more cost-effective for the patient who requires more volume (6.0 ml or greater) to achieve the intended result.

Facial fillers are less expensive for a single treatment/syringe (generally priced per 1.0 ml syringe), However facial fillers can cost more than a fat transfer procedure if the patient requires multiple syringes to obtain their result or the patients undergoes multiple treatments to maintain their effect. The cost of facial fillers increases linearly based on the amount of facial filler (two syringes costs twice as much as one syringe).


Timothy McGee, MD

Dr. McGee has been practicing plastic surgery for more than 18 years in all areas of the field, including cosmetic surgery and reconstructive breast and facial surgery. Dr. McGee is board certified by the American Board of Plastic Surgery and the American Board of Surgery. He has numerous hospital affiliations in the Round Rock and greater Austin areas and is a member of the American Society of plastic Surgeons, American Society for Aesthetic Plastic Surgery, American College of Surgeons and Austin Smiles.


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