Facial Fat Transfer

As time goes by, many of us lose the fullness in our faces. We begin to see cheek hollowing and temple hollowing, thinner lips and flatter cheeks. Laugh or smile lines appear around the lips. Reduced volume in certain facial areas is an inevitable part of the aging process, but with fat grafting to the face we can build back the volume, minimize wrinkles and revitalize the appearance.

Fat grafting is an excellent surgical procedure done under local or general anesthesia to restore facial volume lost through the years and also to bring a little more symmetry to the face. Patients go on to see noticeable results with natural looking, fuller cheeks, temples, lips and eyelids.

Before and After Photos

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Patient story

This is a patient in her 30s who wanted an improvement in her facial contouring, chin projection and lip proportions. We performed Fat Grafting To Cheeks, Chin, Lip Lift.

After the procedure

Facial fat grafting is an outpatient surgery done under general or local anesthesia. After the procedure, there will be visible fine skin sutures in the incisions, some bruising and swelling.

Facial fat grafting is not a painful procedure, but mild discomfort and feeling of tightness in the face and neck areas are expected for a few days to a few weeks after surgery. Bruising and swelling are usually the cause of the discomfort. However, it can be treated with preoperative and postoperative medication and supplementation, ice and anti-inflammatories. Swelling can be minimal or more intense depending on how many procedures need to be done in surgery to make the results the most beautiful and natural possible.

Return to normal daily activities between 1-2 weeks. Expect at least 8 weeks for committing to major social events as residual swelling can remain for some patients after surgery. We are all different, so it is hard to predict who will get more or less swelling and bruising.

General preoperative recommendations

What to avoid before the procedure

1. DO NOT take any aspirin for 7-10 days before your scheduled procedure. Do not take NSAIDS (Aleve, Motrin, Ibuprofen) for 5 days before surgery. You may take Tylenol (Acetaminophen) if needed for aches or pains. Please contact the office at if you have any questions about any medications that you are taking or if you are prescribed aspirin by your cardiologist or Primary Care Provider (PCP).
2. Discontinue Vitamin E 10 days before surgery.
3. Avoid the following herbal supplements for 10 days before surgery: Echinacea, Ephedra / Phentermine (used for weight loss), Feverfew, Fish Oils, Garlic, Ginkgo Biloba, Goldenseal, Kava-Kava, Licorice, Saw Palmetto, St. John’s Wort and Valerian.
4. Stop Smoking. The harmful effects of smoking can cause tissue death, infection, and open wounds. It also makes you age faster!
5. Alcohol can promote swelling of the surgical area and it is best to avoid alcohol intake for at least one week before surgery.

What to take before surgery

1. Dr Miotto will recommend medications and supplements during your consultation to speed up recovery after surgery.

General postoperative recommendations

1. If the procedure is done under general anesthesia, you MUST have a responsible adult to transport you home and stay with you for a full twenty-four hours after your surgery.
2. You will be unable to drive if you are taking narcotics.
3. It is recommended to elevate the head with two to three pillows after all facial procedures.
4. Your initial post-operative appointment will be scheduled by your Patient Care Coordinator; please make arrangements to have reliable transportation for these appointments as you will not be permitted to drive until twenty-four hours after general anesthesia and when you are no longer taking narcotic pain medications.

Activity

1. Please refrain from physical activity that will increase your heart rate or blood pressure for 1 week after surgery. However, bed rest is NOT recommended, and you should be walking at normal pace after the procedure.

Bathing

1. You can shower twenty-four hours after surgery. You may clean the incisions as instructed by Dr Miotto or her nurses after the procedure.
2. Do not submerge yourself into a tub/pool until all wounds have healed (usually in 2 weeks).
3. Do not scrub the surgical sites, however you can allow soapy water to run over them.
4. Avoid lotions on the surgical sites for 1 week, but you can moisturize any other areas as desired.

Returning to work

1. Recovery time will vary; however, most patients return to work within 1-2 weeks after the procedure, within one week you will have a feel for your specific limitations and will be able to determine how comfortable you will be with resuming your daily activities and workload.

Diet

1. Immediately following surgery, it is best to eat bland, easily-digested food and avoid excess sugar and salt. Healthy proteins (eggs, lean meat, beans, nuts), rice, fruits and cooked vegetables (broccoli, peppers, sweet potatoes) will provide your body with nutrients essential for healing.
2. Eat a few bites of food before taking pain medications as these can cause nausea.
3. A diet low in sodium will help minimize swelling and water retention.
4. Drink plenty of water! Drinking low sugar sports drinks and protein shakes are recommended.

Final results

1. Keep in mind that our goal in aesthetic surgery is improvement and not perfection. You will be followed closely after surgery to assure that you heal well and have the best possible results.
2. It can take months for the very final results of your surgery be apparent. After 12 weeks, you can expect your results to be mostly permanent. Expect subtle changes in swelling and healing (including the appearance of scarring) to continue to improve for up to twelve months.
3. It is important for you to keep open communication with your physician and return for your follow up visits. We will take pre and post pictures along the way and look at the final results together.

Facial fat transfer

With time, many people lose the youthful-looking fullness in their face. Following the onset of facial hollowing, the temples may appear sunken-in, the cheeks might look flatter, the area beneath the eyes may be hollow and the lips frequently appear thinner. This volume loss also causes the development of lines and wrinkles. Although volume loss in the face is expected as part of the natural aging process, Plastic Surgeon and Expert Injector Dr. Gabriele C. Miotto, addresses these changes with facial fat grafting. During this plastic surgery procedure, she can build up the volume in the affected areas of the face, effectively reducing the visibility of wrinkles. In addition, Dr. Miotto fills in the areas that have lost volume, thus, rejuvenating the patient’s face.

Fat grafting

Facial fat grafting is a facial rejuvenation technique in which instead of using dermal fillers to add volume, the patient’s own adipose tissue (fat) is used.

During a facial grafting procedure with adipose tissue, Dr. Miotto harvests the tissue from another area of the patient’s body via liposuction.

Once collected, this adipose tissue is purified and processed for injection. Then, Dr. Miotto strategically injects the tissue into the areas of the patient’s face that appear hollow. She can also use this tissue to address lines and wrinkles.

Since an individual’s own adipose tissue offers a soft, natural-looking result with very little concern related to an allergic reaction, many consider this procedure to be one of the most biocompatible fillers available for facial rejuvenation. Furthermore, on many occasions the results attained with an autologous facial fat grafting procedure are permanent.

Where does Dr. Gabriele C. Miotto harvest the fat for transfer from?

The most common collection areas include the abdomen, inner thighs and hips.

Autologous fat transfer

As an experienced Expert Injector and Facial Plastic Surgeon Dr. Gabriele Miotto understands facial anatomy and structure. This knowledge is extremely important because it provides her with the ability to identify the correct location for injection and the appropriate injection depth for the areas being addressed.

To decrease the likelihood of attaining undesirable results or experiencing complications following this type of autologous grafting procedure, individuals need to ensure that the injector they choose is an expert, has extensive knowledge related to facial anatomy and structure as well as experience performing these kinds of facial rejuvenation procedures.

Fat grafting areas

At ME Plastic Surgery in Atlanta, adipose tissue grafting is used to address areas of the face that have lost volume.

Issues treated with autologous fat transfer include

• Hollowing in the forehead.
• Deep creases, especially those located in the forehead, including the vertical glabellar lines that develop above the nose and between the eyebrows.
• Temporal hollowing.
• Nasojugal grooves (i.e., tear-trough deformity), which are the depressions located between the nose and the eye. These depressions are usually 2 to 3 cm deep, running from the inner corner of the eyelid to the outer part of the cheek area.
• Nasolabial folds, which are also called smile or laugh lines, run from the outer corners of the nose to the outer corners of the mouth.
• Supraorbital hollowing refers to the loss of volume that occurs above the eye sockets where the eyebrows are located.
• Marionette lines are the vertical lines that run from the outer corners of the mouth to the chin. These lines can also cause sagging in the lower portion of the face.
• Periorbital hollowing, which refers to volume loss beneath the eye.
• Jawline contouring (jowls).
• A weak chin.
• Deflated-looking lips.
• The vertical length of the lower eyelid increases with age, Dr. Miotto can address this issue during the adipose tissue transfer procedure.

At ME Plastic Surgery in Atlanta, Dr. Gabriele C. Miotto performs facial fat transfer surgery as an outpatient procedure. Following adipose tissue transfers, patients see immediate results.

Who should consider facial fat transfer procedure?

Individuals who are looking for a more permanent solution to facial hollowing than can be accomplished with dermal fillers may want to consider a facial grafting procedure using adipose tissue.

Anesthesia

At ME Plastic surgery patients may receive general anesthesia, which is the type of anesthesia that puts the patient fully asleep or local anesthesia with oral sedation, which places the patient in a semi-conscious state.

The local anesthesia with oral sedation is frequently referred to as twilight anesthesia because with this form of anesthesia, the patient can be awakened easily but will not remember much about the facial fat grafting procedure itself.

When patients are having several facial areas addressed, Dr. Miotto recommends either oral sedation combined with local anesthesia or general anesthesia.

When the patient is only having a small facial grafting procedure, he or she can remain awake during the transfer because Dr. Miotto can just use local anesthesia.

Dr. Gabriele Miotto always discusses the anesthesia options with her patients before the procedure.

Transportation policy

ME Plastic Surgery is dedicated to providing patients with safe, high-quality care, as such, for their own safety, patients are not permitted to use for-hire transportation services or public transportation following any procedure in which general anesthesia is used.

What to expect

Since the patients who receive general anesthesia during their facial grafting procedure are not be permitted to drive for 24 hours after their procedure, these patients need to bring a driver with them on the day of their surgery. Patients arriving without a driver will have to reschedule their facial grafting procedure using adipose tissue.

Patients should arrive for their facial transfer with adipose tissue procedure at least 15 minutes before their scheduled appointment. This allows plenty of time to complete any last-minute paperwork or gather information from the patient before his or her facial grafting procedure.

Facial grafting with adipose tissue is an excellent facial rejuvenation option. Besides rejuvenating the face, facial fat transfer can be used to make the patient’s face appear more symmetrical. After this procedure, patients enjoy noticeable, natural-looking results in the areas that received adipose tissue.

Pre-op

The patient is taken into the pre-op area. Dr. Gabriele C. Miotto will most likely visit the patient to answer any last-minute questions he or she has about the facial fat transfer procedure. In addition, Dr. Gabriele C. Miotto makes several markings on the patient’s face. She uses these markings as a guide during the patient’s facial grafting surgery.

Prior to surgery, the treatment areas are discussed with the patient. The areas that Dr. Miotto addresses during a facial transfer procedure using adipose tissue are those areas displaying the most hollowing.

Facial fat grafting

A facial grafting using adipose tissue has three steps: The harvesting of the adipose tissue, processing the tissue collected and then strategically transferring the processed tissue.

Patients who are only have a small area addressed may choose to remain awake during their procedure. These patients do not receive general or twilight anesthesia, but they will receive local anesthesia in the treatment areas.

Once the patient has received anesthesia and is comfortable, Dr. Gabriele C. Miotto harvests adipose tissue from the areas of the body that are usually considered problem areas, which include the abdomen, hips and thighs. Donation locations are discussed with the patient prior to his or her surgery.

After using liposuction to harvest the adipose tissue, Dr. Miotto prepares the tissue and purifies it. Now, the patient’s own tissue has been transformed into his or her natural filler.

Using very fine hollow tubes (i.e., cannulas), the adipose tissue is injected into the areas of the face that need additional volume.

What to expect

Once Dr. Miotto has completed transferring the adipose tissue, she uses fine sutures to close the incisions.

Patients should expect to have some inflammation and bruising.

Patients who experience the most swelling and bruising are those who have adipose tissue transferred to multiple areas of the face. However, by addressing every area that requires attention during a single transfer session, patients receive beautiful youthful-looking results that appear completely natural, rejuvenating the patient’s entire face.

Recovery

Directly after surgery the patient remains in the recovery area until he or she is fully awake. Once awake, the patient receives information about what to expect during recovery, caring for his or her face and when to return for the post-operative appointment. Any questions the patient has are also addressed.

A patient care coordinator schedules the patient’s post-operative appointment

ME Plastic Surgery’s Patient Care Coordinator schedules the patient’s post-operative appointment, which is scheduled for the following day, therefore, the patient is still unable to drive. He or she needs to find a trustworthy driver as public transportation or for-hire transportation services are not recommended until the 24-hour anesthesia restrictions have passed.

Once the post-op appointment is scheduled, the patient is released to his or her driver.

A tight sensation in the face and neck is common following this procedure

A tight feeling in the neck and face after this procedure is likely. Since each patient is unique and heals at his or her own pace, the length of time a patient experiences this sensation varies. This tight sensation can last just a few days or continue for several weeks. It is the inflammation and bruising that causes this feeling of discomfort.

Addressing inflammation and discomfort after a facial transfer using adipose tissue

Preoperative and postoperative medications in conjunction with supplementation can help reduce the amount of discomfort a patient experiences. In addition, regularly scheduled at-home cryotherapy treatments (treatment with ice packs) and anti-inflammatory medication (approved for use by Dr. Miotto) can greatly decrease the amount of inflammation a patient experiences. Reducing inflammation minimizes the tightness the patient feels on his or her neck and face.

Patients usually return to their normal activities at some point after a week or two.

To ensure that all the inflammation and bruising has subsided, patients should wait at least 8 weeks before making a commitment to attend major social events (e.g., a wedding, class reunion, etc.).

Preparing

To ensure each patient receives beautiful, natural-looking results, complications must be avoided, therefore, Dr. Gabriele C. Miotto takes every precaution necessary before, during and after treatment to accomplish this goal.

Prior to the facial fat transfer, patients need to avoid products and lifestyle choices that could cause a complication during or after surgery.

The following herbal supplements and vitamins must be avoided for at least 10 days before surgery

Medications that need to be avoided at least 7 to 10 days before the day of surgery include

For at least 5 days before surgery, patients must avoid taking non-steroidal anti-inflammatory drugs (nsaids). drugs to avoid include

Patients who need to take medication for pain prior to surgery can safely take Tylenol (Acetaminophen, Non-Aspirin).

Patients with questions about a certain medication that they are taking, including aspirin prescribed by their Primary Care Physician or Cardiologist, should call ME Plastic Surgery at (404) 850-5851. For safety reasons, it is important to note that patients should never discontinue prescription medications of any kind without first receiving approval from the prescribing physician, Dr. Gabriele Miotto or Dr. Felmont Eaves.

Avoid These Lifestyle Choices

Stop using products that contain nicotine

Discontinue using products that contain nicotine (e.g., traditional cigarettes, chewing tobacco, e-cigarettes and smoking cessation products, etc.) for at least four weeks before and four weeks after surgery.

Following this recommendation is vital to the outcome of this procedure because continuing to use these products can lead to the development of an infection, open wounds due to slowed healing and tissue death. Furthermore, while all nicotine-containing products accelerate the signs of aging, when it comes to smoking traditional cigarettes, an individual can look up to 10 years older than he or she truly is.

Accelerated aging and slowed healing occur because the nicotine in these products causes blood vessels to narrow. By reducing the size of the blood vessels, the oxygenated, nutrient-rich blood takes longer to reach the incision sites, thus, slowing the healing process, which may result in open wounds, an infection or even necrosis (i.e., tissue death).

Avoid alcoholic beverages

Avoid alcoholic beverages for at least a week before the facial fat transfer.

Alcohol promotes inflammation, therefore, patients who consume alcohol within a week of surgery or during the recovery phase after surgery should expect to experience more inflammation than a patient who does not. This inflammation can lead to additional bruising and an increase in the tight sensation patients experience after this type of surgery.

To speed up the recovery process, Dr. Miotto recommends that her patients take certain supplements and medications after their adipose tissue transfer to the face.

For general anesthesia patients and those taking narcotics

Patients who are having general anesthesia during their procedure must bring a responsible, physically capable adult who has a valid driver’s licenses with them on the day of their facial fat transfer. Patients who arrive without a driver will need to reschedule their procedure because, for the safety of the patient, after having general anesthesia individuals are not permitted to drive for at least 24 hours.

Transportation policy

At ME Plastic Surgery, safety is always top priority. For this reason, patients are not permitted to use any type of transportation service, be it public or for hire services, after having a procedure that requires the use of anesthesia. This policy is in place to protect patients because they may be vulnerable after having these kinds of medications.

Patients taking narcotic pain medication

Patients taking narcotics are not permitted to drive, therefore, it is crucial that these patients ask someone they trust to bring them to their follow-up appointments at ME Plastic Surgery in Atlanta. Once a licensed patient no longer needs narcotics, he or she can resume driving.

Following surgery, the patient must have a caregiver for at least 24 hours

Directly after their adipose tissue transfer surgery, patients must have someone stay with them for at least 24 hours. This individual will serve as a caregiver, therefore, he or she needs to be physically capable of helping the patient with multiple tasks (e.g., walking around without falling, etc.). Many times, the person who takes the patient home from surgery stays to serve as his or her caregiver.

Recovering

Patients should expect to have inflammation and bruising. A patient’s recovery time is based solely on the amount of adipose tissue he or she had transferred and the number of areas that received treatment.

On average, the recovery time following this procedure ranges from one to two weeks. However, some patients experience more bruising and inflammation than others, these individuals may need an additional week for the visible signs of their surgery to dissipate.

Patients should sleep with two or three extra pillows following their facial procedure.

For at least 7 days, patients must refrain from participating in physically demanding activities that could increase blood pressure or elevate their heart rate. That said, patients should still be active because inactivity in and of itself can lead to post-surgical problems. Patients should be walking around at a normal pace following their facial fat transfer in Atlanta.

Bathing and showering

Patients can shower 24 hours after their surgery, however, they must avoid scrubbing the surgical sites, instead patients should gently clean the incisions as they were instructed to do so by the nurses in recovery or by Dr. Miotto.

Patients must not submerge themselves in a pool, tub or any other body of water until all surgical wounds have completely healed. Complete healing usually takes about 2 weeks.

Patients need to refrain from applying lotion to the surgical areas for at least a week, however, patients can moisturize other areas of their body, as desired.

Returning to work

As previously stated, recovery times following facial transfers vary, nevertheless, most patients can return to work a week or two after their transfer.

After about a week of recovery patients can usually recognize their limitations, which helps the patient determine how comfortable he or she feels about returning to work and resuming daily activities.

Diet

Directly after surgery, Dr. Gabriele Miotto recommends that her patients implement a bland diet full of foods that are easily digestible. Additionally, she recommends avoiding excess salt and sugar. Instead, patients should eat healthy proteins, cooked vegetables, rice and softer fruits. These foods provide the body with the nutrients it needs during the healing process.

Healthy proteins

Cooked vegetables

To help prevent medication-induced nausea, patients should take a few bites of their food before they take their medication.

Limiting salt intake helps to minimize the amount of water the patient’s body retains. Reducing water retention translates into less inflammation.

Stay hydrated by drinking water, protein shakes and sports drinks that are low in sugar.

Results

Following injection, approximately 50 percent of the injected adipose tissue remains permanently. The body absorbs the other 50 percent that was transferred.

After about 12 weeks the results the patient sees are mostly permanent, however, as time passes, the patient should expect to see subtle changes. These subtle changes can continue for up to 12 months. As time passes, the visibility of the incisions continues to diminish.

How painful is the facial fat grafting procedure?

When a skilled expert injector performs this procedure, patients experience minimal discomfort because the injector’s skills play an important role in the adipose tissue harvesting process and in the facial injection process. Furthermore, for the comfort of the patient, Dr. Gabriele Miotto uses a medication to numb the areas receiving treatment as well as the areas from which the adipose tissue will be harvested.

Dr. Gabriele Miotto closely monitors each of her patients to make sure that healing is moving along as planned.

Keeping communication open and returning for follow-up visits is the best way to ensure optimal results. At these follow-up appointments, Dr. Miotto takes pictures for comparison purposes. Once the patient’s healing process is complete, Dr. Gabriele C. Miotto enjoys reviewing these photos with her patients.

Potential risks

This is a very safe procedure, however, as with all procedures, potential risks should be addressed.

Potential risks associated with transferring adipose tissue to the face include

How much does facial transfer of adipose tissue cost?

Since every patient is unique, Dr. Gabriele Miotto can only determine how much an individual’s procedure will cost during an initial consultation.

If you are interested in having facial fat grafting to address the signs of aging and add volume to areas of the face that look hollow, contact ME Plastic Surgery today at (404) 850-5851 to schedule an initial consultation with Facial Plastic Surgeon and Expert Injector Dr. Gabriele Miotto or click here to request an appointment. ME Plastic Surgery is located at 3200 Downwood Circle, Northwest, Suite 640, Atlanta.

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