There’s no shortage of incredible aesthetic treatments ready to revitalize and prejuvenate. But with all the options competing for your attention, how do you know which is perfect for your goals? In the perceived battle of fat transfer versus injectable filler, Newton, MA plastic surgeon Joseph A Russo, MD clears the air and helps patients find the perfect treatment for them.
Choosing Between Filler and Fat Transfer
“The biggest determining factor in whether I recommend a fat transfer or dermal fillers is age,” Dr. Russo explains. “Younger patients typically don’t have that much volume loss compared to older patients, and they’re typically looking for prejuvenation rather than trying to turn back time.”
On the other hand, patients in their 50s and 60s are more likely to be seeking volume restoration.
“Older patients also tend to have skin that is less elastic,” Dr. Russo says. “And that impacts what we need to do to get a positive result. If we try to use filler in this case, it can take more product and end up looking unnatural compared to a fat transfer.”
Who Is a Filler Patient?
“Patients who are interested in prejuvenation and want to keep looking youthful are almost always filler patients,” Dr. Russo explains. “Their skin still has great elasticity and can hold filler really well, and they’re often looking to resolve very minor areas of volume loss.”
And with so many options in terms of filler type, Dr. Russo is able to tailor the dermal filler formula to the area of the face and patient goals.
“There are fillers designed to raise and lift tissue, versus ones that erase fine lines, versus others that support the chin and jaw,” he explains. “At this point, you can really pick the right filler for the person to give them the most cost-effective, goal-oriented treatment.”
Who Is a Fat Transfer Patient?
“On the other hand, older patients with serious volume loss would be looking at using a lot of product to fill that area, and it may not look natural in the end,” Dr. Russo explains. “These patients have volume loss, and that volume loss is fat loss. So why not replace what was lost?”
And replacing fat loss with a fat transfer, which is harvested from other areas of the patient’s body, results in a natural-looking improvement. Not to mention that it’s a permanent solution.
“A great thing about fat is that it doesn’t care where it lives, as long as it has a blood supply,” Dr. Russo notes. “When we replace what’s been lost and those fat cells survive, they live there permanently.”
The Foundation of the Face
“I think the cheeks are the most important area to address when we’re talking about volume loss,” Dr. Russo explains. “Like the foundation of a house, the cheek provides structure to the face, and adding volume there improves the other areas of the face, like the lower eyelid, the marionette and the jowls.”
Once the cheeks are restored, Dr. Russo turns to the chin and jaw, the other key parts of the face that provide structure. From there, correction can zero-in on smaller details like the nasolabial folds or the lips.
“If you don’t address those areas of structure at the foundation, your house can collapse,” he explains. “That’s why the cheeks, chin and jaw are the most pivotal areas to address if you’re concerned with volume loss.”
Getting It Right: The Risks
Like all things, dermal filler and fat transfer come with risks.
“Placing fat and filler is an artistic exercise,” Dr. Russo explains. “But the technical component is vital, because you can cause issues if its placed incorrectly.”
When it comes to filler, reactions to watch for include vascular occlusion, nodules, lumps and bumps. “Poor technique may also result in infection and abscess, which could result in more volume loss,” Dr. Russo explains. “And the areas of the face that are too vascular, like the forehead, temples, and nose present a serious risk for occlusion. I recommend seeking the advice of a very experienced injector if you are considering treatment in any of these areas.”
And for fat transfer, technique can make the difference between a successful, permanent solution to volume loss and a failed treatment. “When you’re injecting fat into the recipient site, you have to do so in a way that allows the cells the best chance of getting hooked up to a blood supply,” Dr. Russo says. “If they don’t find a blood supply pretty quickly, they die.”
If those fat cells don’t all survive, fat necrosis (fat cell death) can occur, along with the issues like lumps, bumps and even vascular occlusion.
“Similar to dermal fillers, I don’t recommend fat transfers anywhere above the eyes,” Dr. Russo says. “It’s best used in the cheeks and below.”
