Fillers for Post-Fat Grafting Finesse

This is part 2 of a 2-part series

Part 1: Filler or Fat: How Do You Choose?

It’s not always simply a matter of choosing one or the other, say the experts. Generally, fat is best used for global facial volumization and fillers can help to finesse results.

Think of fat grafting as an opportunity to create a better template to work from, suggests Cameron D. Chesnut, M.D., F.A.A.D., a dermatologic surgeon in Spokane, Wash.

“I view it as [a] reset button, and that's their new point of aging and then they're going to… keep up to it from there. So for [a] nurse practitioner or PA or nurse injector, you're starting with a better template to work with moving forward. Your results are going to be better because that patient had an initial fat grafting or two... I know they're going to be happier,” says Dr. Chesnut.

Although many patients can expect to need to have a touch up with fat, fillers or both, Dr. Prada says he doesn’t use the phrase “touch up.” He explains it in terms of “building” to patients.

“You need to allow a certain foundation to solidify before you can add more and you build that wall up slowly with fat. If you just clump the fat into an area, that fat isn't touching viable tissue. It's going to go away. It's not going to survive,” says Dr. Prada. “I tell all of them that you just can't clump 20 cc's in the face. It's not like a filler. The filler will sit there. The fat — you’re going to lose two-thirds of that.”

He tells patients there’s a 50% chance they’ll come back to continue building viable fat.

“I'd rather add more [later] than put too much in, and so that's another thing that I always tell them,” says Dr. Prada.

Despite the likeliness of fat resorption, Frank Fechner, M.D., a facial plastic surgeon in Worcester, Mass., says he doesn’t usually do touchups with fat.

“Everything after [fat grafting] is going to be managed by fillers, and there's always going to be something else that patients want to have tweaked, early or later,” he says.

The panel overwhelming agrees on the need to wait at least 6 months for fat transfer touch up.

The Skin Benefit

Fat grafting isn’t just about adding volume, says Dr. Chesnut. It also benefits the skin.

“There’s an unquestionable paracrine effect that happens,” he says.

And that, Dr. Chesnut says, is a result of stem cells.

“I get really nerdy on this and like to get into different types of fat — micro fat, milli fat, nano fat — and I really focus on the stromal vascular fraction, which means my harvests are generally a little higher even for small volumes because I’m trying to get that stem cell dense portion… [which] I feel makes my results a little bit better, but it also sets it apart from filler… we know from… transferring human fat to mice that they get more stimulation of angiogenesis in fat, so there’s an unquestionable improvement with that transfer.”

Dr. Chesnut says he usually sees those skin results in a 6-month timeframe. For Dr. Lam, it’s closer to one to two years.

“I do a fair number of [fat transfers] alone without resurfacing too… and it’s more than just volume. There’s a quality change to the skin,” says Dr. Chesnut.