The procedure where fats are used like dermal fillers is called fat grafting, fat-transfer or lipo-filling. One’s fat deposits come in particularly handy for people who cringe at the idea of having a foreign filler material injected under the skin. Fat grafting uses their own fat cells as dermal fillers. This is as natural as it gets.
THE LIQUID FACELIFT
Although not exactly a new technique, having been described in textbooks since the 1970s, fat grafting had a resurgence in popularity because of advances in small-area office-based liposuction techniques. “Extracting 100mls of good quality fat is a very safe and relatively easy for those of us who have the setup for office-based liposuction.”
By strategically using the grafted fat to restore the volume in selected fat compartments, particularly around the hairline, we can create a mild lifting of the face. This has been published as a technique using HA fillers by Dr David Loh. The DL Lift, as it is known, can also be used with fat grafting.
The other recent advancement in fat grafting technology has to do with the separation of fat into various fractions – Milli-fat, Micro-fat and Nano-fat. These mimic dermal fillers of various gel-hardness and as such can be used interchangeably with hyaluronic acid fillers. The bigger fractions are used for volimization and support, and the finest for are used for skin quality improvements.
All 3 fractions are used to varying degrees in all cases. And also since a minor surgical procedure (a mini-liposuction) is involved, we will extract enough fat to treat the whole face in that session.
“So fat grafting procedures are whole-face treatments each time.”
THE FAT GRATING PROCEDURE
The fat grafting procedure by Dr David Loh is a 60 minute affair under local anaesthesia, that involves firstly extracting some fat cells from either the abdomen or the inner thigh. The fat cells are then gently washed and filtered. They are then re-injected back into the face to mimic youthful fat pads and to prop up sagging skin. Most of the time there is only a little swelling and some bruises on both the donor site as well as the face. These usually subside after 1-2 week. We normally over-inject a little to account for some cells that won’t take after grafting.
“The good thing about fat grafting is that whatever fat that remains after the first month, which is about 60% or more, will remain for the long term.
This transplanted fats are incorporated into the surrounding tissues and will have its own blood supply.
In fact they react to weight gain by swelling up, and to weight loss by shrink. As if they were still in the thigh or the abdomen.”
There has been much hype about being over-filled, probably arising in the media of celebrities who have gone over-board with their fillers.
The truth is that it takes many syringes of fillers to reach anywhere near what some of the well-known cases of overfilled celebrities look like. Most people would simply not be able to afford it.
And most conscientious doctors would hold the patient back from reaching that kind of look. I think.
However, in the case of fat grafting, we do deliberately over-fill so as to account for a bit of resorption that normally takes place. Afterall we are doing a transplant procedure of living cells. Some of the fat cells simple cannot “take” in the new environment. Although, because of the rich blood supply in the face, the usual “take rate” is high.
We must acknowledge that a face with the right amount of padding evokes youthfulness. There’s no denying that hollows make us look aged and “unwell”. In real life practice, a fine balance needs to be struck when we do fillers or fat transfer.
And this can only come from years of experience and technical skill.
DR DAVID LOH
Dr David Loh
Dr David Loh founded David Loh Surgery back in 2002 when Aesthetic Medicine as a field was still in its infancy. He obtained his basic medical and surgical degree from the National University of Singapore. He has over 30 years of clinical experience, 18 years of which were in aesthetics. He is MOH-accredited to perform office-based Liposuction. He is perhaps best known for being a trainer for B*tox and Dermal Fillers in the region. He is the President of The Society of Aesthetic Medicine in Singapore.