As natural as it gets
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.
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.”
Explains Dr David Loh. “Re-injecting the processed fats into the face to create a more youthful contour is a skill honed from years of injecting facial fillers.”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.
| Comparison Point | Facial fat grafting | HA fillers |
|---|---|---|
| Filler material | Your own fat (autologous), harvested by mini-liposuction from the abdomen or inner thighs | Hyaluronic acid gel |
| Areas treated per session | Whole face: forehead, temples, cheeks, chin, plus nanofat for under-eyes and around the mouth | Individual areas, as needed |
| How long it lasts | Fat that survives the first month (around 40–60%) lasts long term | Temporary; repeat treatments needed to maintain results |
| Allergy or rejection risk | None, as the fat is your own | Low |
| Procedure | About 60 minutes under local anaesthesia, including mini-liposuction | Injection only, no liposuction needed |
| Downtime | Swelling and bruising at the face and donor site, usually settling within about 2 weeks | Minimal |
| Skin quality improvement | Yes: nanofat softens fine lines and improves skin texture | Mainly volume and contour |
| Best for | Whole-face volume loss, hollowing and mild sagging | Areas needing firm structural projection, such as the chin and nose (e.g. Volux) |
Long Term Results
“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. "
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 2 weeks. 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.”
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 volumisation 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.”
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.
Fat grafting to the face |
$4,500 |
| There are obvious advantages to using your own fat cells as a dermal filler. For one, fat cells that “take” after the transplantation process will last for the long term. And we do not need to worry about “rejection” or “allergies”, as the fat cells are autologous (patient’s own). This price includes a mini-liposuction, the processing and re-injection of nano-fat as well as structural fat. We will always treat the whole face, rather than in parts, in each session of fat grafting since a mini-liposuction is involved. | |
Some grafted fat does not survive the transfer. Thanks to the face’s rich blood supply, survival is typically around 40–60%. The fat that remains after about one month develops its own blood supply and lasts long term. It behaves like fat elsewhere in your body, so it expands with weight gain and shrinks with weight loss.
The donor area, where fat was harvested, may be bruised and uncomfortable for a few days to a week. The face is usually slightly swollen, about 20% fuller, and tender to the touch, with some bruising. Swelling and bruising generally settle within about two weeks, and overall discomfort is mild.
Fat grafting is a transplant of living cells, and some cells will not “take” in their new location. A small amount of extra fat is deliberately injected to allow for this expected resorption. The face’s good blood supply means only a little overcorrection is needed.
Each session treats the whole face because a mini-liposuction is involved every time. This typically includes the forehead, temples, cheeks and chin. Nanofat is also used for the under-eye area and around the mouth.
Both have a place.
Dr Loh’s published DL Lift technique (2018) can be performed with HA fillers, CAHA or fat.
Our Founder
Dr. David Loh founded David Loh Surgery in 2002, during the early days of Aesthetic Medicine. He obtained his Bachelor of Medicine and Surgery from the National University of Singapore and has over 30 years of clinical experience, with more than 20 years dedicated to aesthetics.
Dr Loh is Accredited by MOH to perform liposuction. He is best known as an international trainer for BTX and Dermal Fillers. He has published extensively on injection techniques and the management of serious complications, with one of his papers awarded a Gold Medal by the PRS Global Journal. His contributions to the field include serving as the immediate past President of the Society of Aesthetic Medicine in Singapore.
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