How to make a thin face look fuller with fat injections

The thin face, sometimes called haggard, can exist in both young and old. It is seen more frequently as one ages with loss of fat in the cheeks and the side of the face. But it can also occur as normal makeup on the facial architecture of some people, even when one is relatively young. (Abraham Lincoln is the most famous example from a historical perspective, actor Scott Glenn and others are more recent examples.) Known medically as facial lipoatrophy, it can also occur from certain diseases and medications. (like HIV) Fat replacement by injection is a logical and minimally invasive method of treatment.

Fat grafting is becoming more and more popular and is ideal for the gaunt face. The fat is harvested with a small liposuction cannula from a suitable donor site. The amount of fat required does not usually generate a significant change in the contour of the donor area. Therefore, patients should not expect to obtain an equivalent liposuction result elsewhere. I usually use abdominal fat taken from inside the navel. There is no scientific evidence yet to support one donor site over another in terms of being better fat that will last longer after transfer.

Fat is prepared by removing loose liquids and impurities by washing it and then spinning it in a centrifuge. It is then placed into syringes and injected into desired facial areas through the corner of the mouth, a crease in front of the ear, or within the crease of the nasolabial fold. The fat is injected into multiple small tunnels in a criss-cross pattern if possible. The injected fat is then massaged until smooth with no obvious irregularities.

Injecting fat into the face is a bit of an art form. On the emaciated face, the area below the cheekbones and towards the side of the face are most common. But other areas can be done too, including under the eyes and around the base of the nose. The amount of fat injected is relatively small with less than 10cc on each side of the face. It may be surprising how even small volumes of fat can make a significant volumetric difference.

This procedure can be performed comfortably under local anesthesia, with oral or intravenous sedation if desired. Whether it is done in the office or in an operating room depends on which one provides the best sterility and has the necessary equipment for fat collection and preparation.

The unknown variable in this procedure for each patient is how much fat will survive. 100% fat survival should not be expected. But the lateral area of ​​the face and cheeks is currently believed to be the most favorable with studies reporting retention of up to 70%. My experience is closer to 50%, so an overfill is always done. What is seen three months after treatment can be expected to be preserved in the long term.

In older patients who may have some loose skin in the jowls or neck, it can be combined with a limited or up face lift for even better results. While fat adds volume and can help plump up some loose skin, the improvement under facial hollows must come from tightening the skin. I have seen some reports that the overlying skin improves after fat grafting, suggesting that the new fat somehow rejuvenates the aging skin. Some claim that it is the effect of the transplanted stem cells. I doubt there are any such effects, but the underlying volume filler stretches the overlying skin and can give the impression of smoother skin.