Fat implantation into smile lines is one of the most common surgical requests made by patients, popular because it is minimally invasive and uses the patient's own tissue.
Can a fat transplantation procedure fix the wrinkles and smile lines that have formed around the mouth?
Fat injection is only one of many procedures that can be used to treat smile lines and lip wrinkles. This is only helpful if the smile lines are not due to excess skin and muscle laxity, otherwise a facelift will be a better recommendation (which removes the excess skin). Fat is typically harvested during a neck liposuction in combination with a facelift to be used in injections for the smile lines and lips. Skin resurfacing procedures are often combined with fat injection for superficial wrinkles and fine lines surrounding the mouth. Skin resurfacing removes the outer layer of skin using dermabrasion, chemicals or laser, which refreshes the skin with a smoother, younger-looking layer with fewer wrinkles. Crow's feet, facial lines, lines around the mouth and laugh lines can all be eliminated in this way. As it often enhances the natural beauty already present and results in a more youthful look, skin resurfacing has become one of the most popular rejuvenation procedures.
Patients that want to avoid surgery but still want to improve their smile lines and the area around their lips can find alternatives with our physicians. Options such as Botox® and Restylane® are non-surgical treatments available to rejuvenate your appearance for the short term or until you feel plastic surgery is the right choice for you.
Individual results may vary.
Compassionate and dedicated to personalized patient care, Dr. Quatela is a board-certified facial plastic surgeon recognized worldwide for his expertise in facial rejuvenation. He established the Quatela Center for Plastic Surgery in Rochester, New York to provide excellence in aesthetic surgery.
Cheek Implants vs Fat Injections
Cheek implants are inserted into the face to provide structural support. Fat injections for cheek enhancement are not recommended because of the high rate at which it is reabsorbed. Patients seeking to augment that portion of the face (cheekbones, otherwise known as the malar eminence) should investigate cheek implants depending on their needs. If the intention is to address superficial changes caused by acne scarring or from trauma, or for treating smile lines, a fat transplantation would be the choice. Every patient will have a unique request, and looking at before and after photos is an excellent place to begin.
Fat injections usually require an initial over-correction in order to compensate for the fatty tissue that will be reabsorbed into the body. Swelling will be excessive initially for the first week but then recedes, a fact that patients are made aware of before their procedure. After about two weeks, the results are usually presentable. After three months following the procedure, 90% of the final result can be seen. As refinements will be made by the body during the healing process, the final result cannot be determined until one year after the cheek implantation or fat injection was performed.
Fat Injections for Facial Hollowing and Thinness
Regardless of whether your face has become thin due to weight loss (either from changes in diet and exercise or because of a disease process) or heredity, a bony or shrunken face carries with it an unhealthy look and can prematurely age the appearance of a patient. Fat injections, using tissue taken from the abdominal area, can improve this condition considerably, restoring years and rejuvenating a "wasted" look. Naturally, a complete physical exam and understanding of the health history of the patient is necessary before a surgical procedure in order to confirm that the essential cause of the gaunt appearance has been properly treated.
Where is the fat that is used for fat injections taken from?
The fat that is used in fat injections is taken from either the neck or abdominal regions. For the abdomen, a small ½-inch incision is made in the belly button, where the cannula (suction tube) can be inserted without leaving visible evidence. Fat that is acquired from the neck is taken by making small incisions, also about ½ inch, directly behind each earlobe with another tucked under the chin. These incisions heal quickly and leave minimal scarring, if any. If this procedure is combined with a facelift, fat is taken from the neck area.
1) I have very thin lips. Can you make them bigger (fuller)?
Lip enlargement is achieved through a variety of procedures including fat injection, dermal fat graft, Alloderm and V-Y lip advancement. Each approach has advantages and disadvantages. Details about each lip enhancement surgery are listed below. Determining which approach is best for you is achieved by learning a little about each alternative and clarifying your objectives. Consulting with a board certified plastic surgeon for his or her evaluation and expert recommendations would help determine exactly which plan is best for you.
Some patients receive fat injections when the goal is to treat multiple areas, such as the lips and smile lines. Advantages of fat injections include a natural donor (from patient's own body), unlimited availability and a very small donor site.
The fat is obtained from another area of the body (typically the abdomen) through a very small, hidden incision. Therefore, the minimal donor site is cosmetically acceptable and healing time is minimal.
Unlike collagen, which is totally resorbed in six to eight months, approximately 30-50% of the fat injected survives and lasts indefinitely, although patient experiences vary. Although uncommon, in some patients the fat can be totally reabsorbed. Rarely is the fat reabsorbed asymmetrically.
Dermal Fat Graft
In a dermal fat graft procedure, a thin strip of skin and fat is threaded through a tiny incision at each corner of the mouth. This approach is typically used if there is skin left over from a simultaneous plastic surgery procedure such as a facelift. However, a dermal fat graft can also be performed as an independent procedure (typically a low abdomen donor site) and is sometimes requested if fat reabsorbed from a previous fat injection.
The advantage of dermal fat grafting is again a natural donor (from your own body) and increased longevity when compared to collagen injection. With a dermal fat graft more of fat survives because the dermis (skin) acts in a similar fashion as a skin graft and nourishes the fat. Therefore, the likelihood of the fat surviving long-term is better. Disadvantages include a separate donor incision if not performed simultaneously with another plastic surgery procedure where skin is left over.
Unfortunately, dermal fat grafts are contraindicated in people with thick, heavy hair growth in donor areas. Dermal fat grafts can also have upwards of 30-50% resorption when final results are evaluated at one year's time.
One advantage of Alloderm, a soft, pliable, artificial implant (not from the patient's own body), is that there is no donor site, therefore, no secondary incision. Alloderm also has the advantage of safety because it is processed human skin where all the cells are removed and therefore, can not transmit disease.
Because of its pliability, it is easily threaded through the lip incision at the corners of the mouth. Like dermal fat grafts, Alloderm provides moderate augmentation and can reabsorb 30-50% over one year's time. Rarely, as in the case of fat injections, Alloderm can be completely reabsorbed.
V-Y Lip Advancement
V-Y lip advancement is typically reserved for patients who want the maximal amount of result with long-lasting correction. In this lip augmentation procedure, small incisions are made inside (under) the lip and then closed in a fashion that rolls the lip outward a bit.
One advantage of the V-Y Lip Advancement procedure is no donor site. Patients are educated ahead of time to a temporary disadvantage; the lips can feel tight for several months. Also temporary is the numbness that is associated with V-Y lip advancement. V-Y lip advancement procedures result in more swelling, which takes about four weeks to resolve.
As with all lip augmentation surgery, final results are assessed at one year. Determining which lip augmentation procedure is best for you requires expert recommendation from your plastic surgeon.
2) Will fat transplantation improve my smile lines and wrinkles around my mouth?
One of the most common requests from patients is for fat transplantation into smile lines. It's a less invasive procedure and uses an individuals own tissue for cosmetic improvement. Fat injection is one of several ways to address smile lines and lip wrinkles. However, if smile lines are due to excess skin and muscle laxity, fat injection surgery will not replace the benefits of a facelift (removal of excess skin). One of the most commonly requested procedures at the Quatela Center for Plastic Surgery is to harvest fat with neck liposuction during a facelift for injection into smile lines and lips. For superficial wrinkles and fine lines around the mouth, one could combine fat injection with a skin resurfacing procedure. Skin resurfacing is the removal of the outer layer of the skin — using dermabrasion, chemicals or laser — resulting in smoother, younger-looking skin with less wrinkles such as crows feet, face lines, lines around the mouth and laugh lines. Skin resurfacing is one of the most popular plastic surgery procedures because often the results enhance one's natural beauty. Skin resurfacing results in a more youthful appearance.
For patients who want improvement in their smile lines and area around the lips but aren't ready for plastic surgery, alternative options can be found at Q the Medical Spa at Lindsay House. Botox and Restylane are just two of the many ways to maximize your beauty temporarily for a special event or until you are ready for plastic surgery.
3) Do I need cheek implants or fat injections?
Cheek implants are placed to provide structural support. We do not recommend fat injection for cheek augmentation because of the reabsorption rate. Patients who want to augment the malar eminence (cheekbone area) should read about cheek implants. If you were trying to fill in some surface changes from acne scaring or trauma for example, or address puppet lines (smile lines), fat transplantation would be a better approach. While every patient's request is unique, looking at some Before and After Photos is a good place to start.
Fat injection often requires over correction initially to compensate for the reabsorption of some of the fat. In other words, patients are made aware prior to the fat injection procedure that swelling can be excessive in the first week but then settles. Results are typically presentable by two weeks postoperatively. At approximately three months postoperatively you see about 90% of the final result. Due to refinements that take place as the body heals, the final result for fat injections is not to be determined for one year.
4) I want to dramatically change the appearance of my chin. Can I do that?
The best approach to a "weak" or ill-defined chin is chin implant for structural support. Fat injection serves best in smile lines and as soft tissue filler. Of course, this question can only be answered on an individual basis. A sign of a good facial plastic surgeon is one who can tell the difference between realistic and unrealistic expectations and one who will be truthful about meeting each patient's desires. Our biggest referral source is from satisfied patients — ones who have had realistic expectations and were satisfied with results.
5) My face is too thin.
Whether your thin face is a result of intentional weight loss (changes in diet and exercise), unintentional weight loss (i.e. a disease process) or due to heredity, a gaunt or emaciated face looks unhealthy and can add years to one's appearance. Fat injection — typically from an abdominal harvest — can significantly improve a "wasted" look to a much healthier appearance. It goes without saying that a complete health history and physical exam would precede any plastic surgery procedure to be certain that the underlying cause had been completely addressed.
6) Where does the fat come from?
Fat for transplantation is obtained either from abdominal or neck areas. In the abdomen, a tiny 1⁄2" incision is made in the belly button (umbilicus) so the cannula (tube with suction) can be inserted without a trace. Fat obtained from the neck requires tiny (about 1⁄2") incisions immediately behind each ear lobe and a third incision tucked up under the chin. These incisions heal very well with minimal if any residual scaring. When combined with a facelift, fat is obtained from the neck area.
7) There are so many fillers — Restylane, fat, implants — how do I know which is right for me?
Fat transplantation is suited for "puppet" smile lines (nasolabial folds), lip augmentation or used in combination with a forehead lift filling in skin creases such as frown lines. Formed implants such as those appropriately used in the chin or cheek area provide foundation or structural support. Restylane, Radiesse, Juvederm and Perlane are used primarily for patients who are not yet ready for plastic surgery but wish to have temporary improvement obtained in the office setting.
8) Are the results of fat transplantation permanent?
Approximately half of the fat will be reabsorbed; however, this varies between patients. As with everything in medicine, there are trade-off's to consider. Many patients prefer fat transplantation because tissue from the patient's own body is used to make the requested improvements. Second, fat transplantation is commonly performed with some adjustments for over-correction at the time of plastic surgery to compensate for part of the resorption. Also, fat for transplantation is most often readily available without an additional incision or expense.
9) Is fat transplantation painful?
After any plastic surgery procedure, some discomfort can be expected. All patients are provided with prescriptions for pain medication. Patients typically use the prescription medication after surgery for a few days and then switch to Extra Strength Tylenol. It is uncommon for patients to report unmanageable pain after their plastic surgery procedure.
10) Will I be awake during fat transplantation surgery?
Using IV sedation (medicine administered through an IV) and a local anesthetic (numbing medication administered in the operating room), patients are asleep during their plastic surgery. Patients do not hear or feel anything and are comfortable during fat injection surgery. Patients wake up very soon after the operation is completed. Intravenous sedation is a type of anesthesia; therefore all patients must have a responsible adult to stay with them through the night following their fat injection surgery. Patients may not drive for 24 hours after their procedure and this time may be longer, depending on the plastic surgery procedure.
11) How long does my fat injection surgery take?
The length of your plastic surgery procedure depends on several factors including the size and location of the area to be treated and the complexity of the underlying anatomy. Many patients who have previously had facial plastic surgery are referred to the Quatela Center for Plastic Surgery for revision plastic surgery. Revision surgery can take a little longer because of corrections that need to be made as a result of the initial plastic surgery.
12) Can I drive myself home after fat injection surgery?
NO. Because of the effects of anesthesia, patients are not able to drive themselves home after the surgery. Transportation and a responsible adult at home following your plastic surgery is required.
13) How long should I stay in Rochester following fat injection surgery?
Most patients stay in Rochester about seven to ten days following their plastic surgery. After that it's ok to fly or travel long distances.
14) I'm from out of town. Where can I stay overnight in Rochester, NY?
Accommodations are comfortable and convenient for Quatela Center for Plastic Surgery clients. The Strathallan, located "just down the street" provides upscale, affordable accommodations for our visitors. For added convenience following ambulatory surgery, some patients elect to stay in our Carriage House, located adjacent to the Lindsay House. For guests without the benefit of family or friends in the Rochester area, our staff will be happy to assist you with arrangements for a smooth, restful experience following your plastic surgery procedures.
15) How long will bruising and swelling last after my fat injection surgery?
Postoperative bruising and swelling begins to resolve at the end of the first week of your fat injection surgery. Full resolution of swelling and puffiness may take two to four weeks. Any residual bruises camouflage fairly easily at seven to ten days with make-up.
16) When can I go back to work after my fat injection surgery?
Most patients take one to two weeks off work depending on bruising and over correction to compensate for future fat reabsorption. Patients who are more concerned with privacy return three weeks after fat injection surgery. Return to work depends on many factors including the nature of your occupation and your general state of health. Patients are asked to avoid any heavy lifting, bending and straining for two weeks following their fat injection surgery.
17) When can I "work out?"
While patient experiences vary, aerobic activities should be avoided for two weeks following fat injection surgery and heavy weight lifting or more strenuous workouts should be avoided for three weeks postoperatively. As we mentioned above, it's important to avoid bending, lifting or straining during the postoperative period as these activities can increase swelling and delay healing.
19) I really want to do this but I'm nervous. What if I get stressed?
It's ok to be nervous. (Frankly, we would be nervous if you were taking this step lightly!) One of the best ways to deal with nervousness is to see what other patients have gone through. Contact us to talk to a patient who has had fat injection surgery or to talk to one of our experienced staff members. As you learn in Selecting a Plastic Surgeon an educated patient knows when and if the time is right for plastic surgery.
1) What do I do to prepare for fat grafting surgery?
Although the preparation for fat grafting surgery is pretty simple, it is an essential element in a successful outcome. To prepare for your plastic surgery, a preoperative appointment will be scheduled with one of our experienced nurses.
2) What happens at the preoperative appointment?
Many things! To name a few, you will meet with our nurses to review your health history, answer your questions, instruct you on how to prepare for your plastic surgery, receive the prescriptions for use after surgery and tell you what to expect. Most of the instructions are listed here. This list of questions, however, will not take the place of a preoperative visit, which is essential in determining a patient's understanding and readiness for plastic surgery. We will be sure you are signing for informed consent.
3) What does informed consent mean?
Informed consent means you have an excellent understanding about the benefits of plastic surgery as well as any risks, and all the preoperative and postoperative information. You are making an "informed" decision as to whether plastic surgery is right for you.
4) What are the benefits and risks of the fat injection procedure?
As part of your initial consultation, your plastic surgeon will review your expectations for plastic surgery. At that time, he can provide a realistic picture of what plastic surgery can and cannot accomplish. Depending on which plastic surgery procedures you are interested in, we will provide you with a list of any risks reported in the medical literature associated with any plastic surgery procedures you are considering. Although risks from cosmetic surgery are uncommon, every patient should be fully informed.
5) Will I have any incisions in my skin?
Patients who undergo fat transplantation will have one or two tiny incisions in the donor area that is typically closed with one to two sutures. Abdominal donor sites the incision is in the belly button. For neck liposuction incisions are behind each ear lobe and tucked under the chin. Most incisions heal very well. Frequently we hear that patients and family members do not notice them after a few weeks.
6) What if I have a history of bad scars?
If you have pierced ears, the way you healed there is a good indication of how you will heal from cosmetic surgery. Scars on the rest of the body typically are not an indication for how patients heal following facial plastic surgery. At the time of your consultation, it's important to show your plastic surgeon any previous scars that are of concern so he can give you a realistic assessment of your healing potential following facial plastic surgery.
7) What are some of the other things to do to prepare for fat injection surgery?
We review your health history and any daily medications you may be taking. Because tobacco abuse impedes wound healing, you will be asked to stop for two weeks before your plastic surgery and two weeks following surgery. Our nurses will be happy to discuss over-the-counter aids to help you with this.
8) What about my daily medications before fat injection surgery?
You will have a preoperative appointment well in advance of your surgery when our experienced staff will review all medications with you. If you are on "blood thinners," you will be asked to stop them approximately one week prior to surgery. We will provide you with a "Medication List" for medications and supplements to avoid prior to your plastic surgery.
9) I take vitamins and supplements. Do I need to stop them before plastic surgery?
Most vitamins and supplements have few side effects. However, there are some, such as vitamin E and ginkgo-biloba that can affect bleeding during fat injection surgery. Our "Medication List" reviews medications and supplements to avoid prior to your plastic surgery.
10) Do I need any special prescriptions before fat injection surgery?
Most patients do not need any special prescriptions before surgery. Please let us know of any special medical concerns you may have. We do ask you to start Vitamin C 1000 mg, which promotes wound healing, one week before fat injection surgery. We will discuss prescriptions needed after surgery below. We will ask you not to eat or drink anything after midnight the night before your plastic surgery.
11) Why will I be asked not to eat or drink after midnight before the fat injection procedure?
Anesthesia medications can cause stomach upset. The best way to prevent after effects from anesthesia will be to avoid food or drink from midnight the night before fat injection surgery. For patients with special concerns, such as a patient with diabetes, our anesthesia team will be happy to address special arrangements with you ahead of time.
12) I'm concerned about privacy.
During a recent independent study, privacy was found to be one of the advantages that attracted people most to the Quatela Center for Plastic Surgery. Because all consultations, office visits, surgical and nonsurgical experiences take place at the same address, the check-in process is completely confidential.
13) What happens when I check in for surgery?
Our nurses will help you get ready for surgery. Please let them know of any special needs you may have. Also, be assured that you have plenty of time for any last minute questions with your surgeon.
14) Does someone have to stay at the Lindsay House while I have my fat injection surgery?
No one needs to stay at the Lindsay House during your surgery. However, you must have someone available by telephone at all times during your plastic surgery.
1) What do I look like when I wake up from fat injection surgery?
Following fat transplantation, most patients experience swelling and bruising, however, this typically is more pronounced 24-48 hours after the procedure. Swelling can take upwards of two to three weeks to resolve.
2) What does it feel like when I wake up from fat injection surgery?
You will be comfortable and groggy as you awaken. We will make sure you are not nauseated or queasy. Our nurses will be right there with you as you wake up from your fat grafting surgery to give you special attention.
4) Are there any dietary restrictions following fat injection surgery?
Typically there are no dietary restrictions. Patients can eat whatever they want. Advance your diet from liquids to soft food to solids as tolerated. Please drink as much fluid as you can which will help you from becoming dehydrated. If for any reason there are incisions inside the mouth, your plastic surgeon may ask you to refrain from dairy products for four days following fat injection surgery.
5) Are there any instructions about regular daily activities?
Sleep with head of the bed elevated or use two to three pillows for one week. Lip fullness and disrupted sleep are very normal fat injection postoperative symptoms and will decrease as the healing process occurs. Absolutely no bending, lifting or straining for three weeks following surgery. If you have little children, bend at the knees or sit on the floor and let them climb on to your lap.
6) Will I need any special prescriptions following fat injection surgery?
Yes. Postoperative prescriptions are provided well in advance of your surgery day so you arrive home completely prepared. Postoperative prescriptions and over-the-counter medications for patients undergoing fat implant surgery include the following:
A) An antibiotic (typically Keflex/cephalexin) following fat injection surgery to prevent
B) Pain medication (typically Vicodin/hydrocodone) to minimize any discomfort following your plastic surgery. It is best to take pain medication with food.
C) Ointment (Polysporin/bacitracin), an antibiotic ointment, to place on sutures with
a Q-tip to keep them soft and lubricated so they are easy to remove.
D) Vitamin C 1000 mg with food for one week following fat injection surgery to promote healing.
7) When do I start taking these prescriptions?
Patients take their pain medication as needed. You will begin the antibiotic medication when you arrive home from fat injection surgery. Wound care instructions are provided at the time of discharge.
8) How long will bruising and swelling last?
For most patients, bruising at the site of transplantation is minimal. The donor site (abdomen, neck, etc.) may have bruising for about two weeks. Depending on the size of the surgical area, swelling lasts upwards of two to three weeks or more.
9) Can I do anything to prevent bruising and swelling?
Most patients will have a little bruising. We can minimize bleeding and bruising by avoiding aspirin and ibuprofen prior to the surgery. For many patients, arnica, an over-the-counter supplement, significantly lessens bruising. Adhering to activity restrictions postoperatively will help swelling disappear more quickly.
10) How long after my fat injection surgery can I shower?
If one has sutures at the donor site, they must remain dry and in place until your suture removal appointment. Therefore, you will be instructed to cover sutures with plastic wrap (saran, glad, etc.) before showering and remove after showering.
11) When is my first postoperative fat injection appointment?
The appointment for your first office visit (typically at five days postoperatively) will be arranged at the time of the preoperative appointment. This allows you to plan on transportation if it is required.
12) When will I look normal after my fat injection surgery?
You will be presentable at about two weeks. You will look great at six weeks and even better at six months as things settle and expressions become more natural. At two weeks you know you are well on the way to recovery. Final results are evaluated at one year.
13) How long does healing take?
Healing from cosmetic surgery in Rochester to evaluate the final result takes one full year. However, three months after fat injection surgery, most patients have about 90% of their final result.
The Quatela Center's reputation as one of New York's finest cosmetic plastic surgery practices attracts patients to Rochester from throughout the state. Choose one of the locations below for driving directions to our practice.
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