Fillers Versus Fat: Shifting Sand Concept

Many of my patients try to weigh the merits of fat grafting versus fillers since they both seem to be equally beneficial to fill in the hollows of an aging face.  However, I would disagree.  For younger faces still replete with enough fat and in whom I worry about weight gain with aging, I think fillers are more than adequate to accomplish the intended goals.  However, for someone with stable weight, older than mid-30s and done with childbirth (if possible), nothing looks better than the soft, radiant effect that fat transfer offers.  Is there a stem-cell effect with fat grafting?   I don’t know but I can attest that my patients continue to look better and better over time minus the effects of ongoing aging.

In many individuals fat grafting provides a more global rejuvenation than is possible with fillers and for this patient actually more economical.

What I have found that really becomes the dividing factor for those who choose to have fat grafting and those who choose to have fillers is simply put cost.  Those who can afford to have fat transfer should seriously consider it, as it offers unparalleled improvement in facial rejuvenation.  In addition, doing facial fillers first as a “test” or as a trial first is less than ideal.   A huge reason for this is that with enough facial fillers placed into the face, it makes adding fat grafting later on a less than desirable endeavor. With sufficient fillers in the face, it is always hard to know how much is left over when putting fat on top of the fillers.  If using fillers like Restylane or Juvederm, i.e., hyaluronic acid based fillers, theoretically they can be dissolved but that is hard to do when multiple syringes have been used over many parts of the face.  Therefore, putting fat (a permanent filler) on top of hyaluronic acid (a temporary filler) is like building a house on shifting sand, i.e., a permanent structure on an unstable one.  In addition, I have noticed that when I do 3 to 4 syringes of filler product, most people simply want more because it looks really good.  In that case, over time I continually do more to make the face look more rejuvenated.

In summary, if someone can afford to do fat grafting and that person meets the safety criteria outlined above, I highly recommend for them to consider having a fat transfer.  For those who do not have the budget to consider fat grafting (or who do not fit into the safety profile mentioned above), then I recommend fillers and for that person to continue to do fillers and not worry about doing fat grafting.  Hopefully, this explanation of my philosophy of when to do fat grafting versus fillers makes practical sense.

Samuel M. Lam, MD, FACS is a board certified Dallas plastic surgeon. To learn more about Dr Lam’s facial plastic surgery procedures please visit our website or call 972.312.8188 to schedule a consultation.