Understanding the Aging Process Using Fat Grafting:  A Glass of Water Emptying

The face undergoes significantly less gravitational descent than was once thought.  Although everyone oftentimes takes two fingers to lift up what appears to be sagging, this maneuver does not truly represent what can be accomplished with a lifting procedure nor does it reflect what is happening in the aging process.  What oftentimes seems to be a sagging upper eyelid is in fact a hollow, deflated, and flattened upper eyelid when one looks at one’s old photographs.  Further, the perceived eyebag may in fact in many cases only represent hollowness immediately below the exposed eyebag along the bony eye rim.  Accordingly, fat grafting for the face can be undertaken in which areas of hollowness around the eyes, cheeks, and chin can be rejuvenated by adding fat taken from the belly and/or thighs to restore those areas of fat loss.

A model to understand this process of aging is that of a glass of water emptying.  If one takes a current photograph of oneself and then a photograph every 2 to 3 years back in time for 20 years and line them up one should see that there is ongoing fat loss around the eyes, cheeks, and chin.  The exception to this fat loss would obviously be if weight were gained over time in the lower face and lower cheek area.  Barring weight gain, the face should look like it is progressively shrinking over time like a glass of water gradually emptying.

What is interesting is that when many people look back at their photos in their teenage to early twenties, the face can look almost too full despite a lean body.  Many women in particular are more fond of looking as they did in their early 30s when their face was leaner than in their early to mid-twenties when it was perhaps too full but not as gaunt and tired looking as it appears by one’s late 30s and beyond.  Therefore, when filling up the emptying glass of water with additional water, i.e., when adding fat to restore the fat loss in the face, the surgeon must be wary not to overfill a face to try to make it look like 20 years of age, which can be too much and unaesthetic.  Further, if one’s mother came in for fat grafting, she would need more fat to accomplish the same job to make one look at his or her ideal.  Put in the words of the analogy, her glass of water would be much emptier than yours and require more water to fill it to the appropriate, youthful level.

The question that many ask is whether fat grafting is a permanent filler.  In the right surgical hands it can very much be permanent.  However, we have to define what permanence means more precisely.  As mentioned, one gets older every year and the water level in the glass continues to go down but not by much.  Accordingly, when fat is added back to the face, it does permanently make the face look significantly younger but then additional fat loss over time starts to mildly to moderately erode the results.  So even though the result is forever permanent, ongoing aging will have to be addressed at some point.  These smaller changes can oftentimes be managed with small fillers once a year to every other year to obviate the necessity for another fat transfer for many years if not decades.  Hopefully, this short article using the analogy of the aging process likened to an emptying glass of water was helpful for a prospective patient interested in seeking aesthetic rejuvenation for his or her face.

Samuel M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas. To learn more about Dr Lam’s fat grafting procedures procedures please visit our website www.LamFacialPlastics.com or call 972.312.8188 to schedule a consultation.