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An increasing number of plastic surgeons and patients are turning to fat grafting as a way to treat facial aging or enhance the breasts or buttocks. More than 84,000 such procedures were performed in 2015, according to the American Society for Aesthetic Plastic Surgery.

The appeal is understandable. A procedure that can take unwanted fat from one area of the body and use it to create a curvier butt or a more youthful face sounds like the perfect way to kill two birds with one stone. Because transplanted fat contains stem cells, some have even touted fat grafting as “stem cell therapy” that helps reverse the skin aging process.

A surge in popularity does not equate to a confirmation of safety or efficacy. Virtually no scientific evidence exists to back up claims that stem cells in fat offer any special anti-aging effect.

However, a surge in popularity does not equate to a confirmation of safety or efficacy. Virtually no scientific evidence exists to back up claims that fat stem cells have any special anti-aging effect, yet this hasn’t stopped a number of doctors from marketing fat grafting as the holy grail of facial rejuvenation. Even when used primarily as a “permanent” filler to restore facial volume loss, fat is notoriously fickle; not all of the injected fat survives in the new location, and there is currently no reliable method to control what percentage of fat will “take.”

The FDA has taken notice of this situation, stepping up efforts to scrutinize the safety and therapeutic value of fat transfer and other stem cell therapies for cosmetic purposes. A public hearing scheduled for fall 2016 will review how fat is being promoted for anti-aging and facial rejuvenation purposes. Depending on the outcome, the use of these procedures could be limited.

Considering fat transfer? Consider the facts.

Regardless of what the upcoming FDA hearing concludes regarding how fat transfers are marketed, I urge patients interested in fat transfer to carefully consider the facts and weigh the potential risks against any perceived benefits.

Possible benefits of fat grafting

Proponents of fat grafting argue that it offers a safe, permanent, and natural solution for facial rejuvenation. When performed by a qualified provider, fat transfers are generally safe; as no one is allergic to their own fat, there is very little risk for adverse effects relating to using fat as a filler. The portion of injected fat that survives will have a continuous blood supply, so if the procedure is successful, the extra volume provided by fat grafting should last for many years.

Known issues with fat transfer procedures

When performed by a qualified plastic surgeon, fat grafting typically poses little health risk. However, if performed improperly, there is an elevated risk of fat embolization, and this serious complication can be fatal.

Efficacy is also a major concern with fat transfer; predictability of results is a significant problem.

Even with a highly experienced provider, there is no guarantee that enough of the injected fat will survive to deliver the results you want.

Even with a highly experienced provider, there is no guarantee that enough of the injected fat will survive to deliver the results you want. The current solution is to inject a greater amount of fat than what is needed for optimal results, anticipating that some of it will be naturally absorbed by the body. In the event that more fat than expected survives, you could be stuck with results that appear overly full for years.

The consequence of this unpredictability is a comparatively high rate of revision that we do not see with more time-tested treatments, such as hyaluronic acid fillers or facelift surgery. With these solutions, I am able to provide predictable, beautiful results. Juvéderm® VOLUMA XC, for instance, is an excellent option for providing mid-face volumization without risking a permanently “bloated” appearance.

As is often the case with trendy procedures, excitement over fat grafting has led many patients to believe that fat is the ultimate solution for any and all facial volume loss. This is simply not true. Many patients have plenty of fat in their faces; it just may not be in the most favorable or attractive position. In these instances, adding more fat to the face does not always result in a well-balanced and appealing result, particularly if the fat spreads beyond the intended placement.

Does fat grafting work for anyone?

Yes, sometimes. As there currently are no dermal filler products approved for use in the breasts or buttocks, a fat transfer may be a reasonable solution for patients who want to enhance these areas without implants and are willing to assume the risk that the injected fat may not “take” optimally in the new location.

For my part, until I see adequate evidence that a fat transfer can offer the same level of predictability, safety, and aesthetically appealing results offered by FDA-approved injectables, implants, facelift surgery, and professional skin care, I will stick with more time-tested techniques.

If you are weighing your options for facial rejuvenation in Phoenix or surrounding cities, I will be glad to offer honest advice about the most appropriate treatments for your needs. Please contact my office to schedule a consultation.

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