During the ageing process, facial tissues not only sag, but also lose volume. In other words, as time goes by, your face droops and withers. This doesn't sound very encouraging, but it's the stark reality. Several processes contribute to this:
To better understand this process, take two photos of the same person, one when they are young and another at an older age. Pay attention to the changes that occur:
This process has been increasingly studied by science and by professionals dedicated to combating the effects of ageing on the face. Dr. Zamarian has been increasingly dedicated to refining the techniques he uses for facial rejuvenation, and fat grafting has been a game-changer in this regard. The results have been increasingly encouraging, and the high degree of patient satisfaction has stimulated further research in this area.
Stem cells are undifferentiated or barely differentiated cells that have the ability to multiply and differentiate into one of the 200 different types of cells that exist in the human body. Fat is a precursor of stem cells, and it has the ability to rejuvenate the skin under which it is injected. This is a process that is being heavily studied, but what matters to know now about all of this is that, unlike hyaluronic acid which only fills, fat fills and rejuvenates.
This rejuvenation process is seen not only in the beginning, shortly after the application of the fat graft, but the improvement is progressive and can continue for years in that area. An example of this are the so-called barcode wrinkles on the lips, especially the upper lip. These wrinkles are formed by volume loss over the years. Many people attribute these wrinkles to smoking, but even people who have never smoked have these wrinkles. When injecting a fat graft to treat barcode wrinkles, initially, a restoration of lip volume is observed, and a small percentage of wrinkles improves, we can say between 20 and 30%. After six months, the improvement usually reaches 40 to 50%. One to two years after treatment, about 60% to 70%, on average. After 5 years of fat grafting for barcode wrinkles, the improvement can reach 80 up to 100% in some cases. The improvement, therefore, is slow and progressive.
Wonderful, isn't it? The results are even more promising. Let's differentiate the effects after the application of hyaluronic acid and fat:
For this reason, Dr. Zamarian has been increasingly dedicated to improving fat grafting techniques, to promote not only facial harmonisation in his patients but also unparalleled rejuvenation.
It's true that part of the grafted fat is absorbed during the grafting process. However, Dr. Zamarian uses some techniques to decrease fat absorption and maximise results for his patients:
Even performing the technical details presented above, Dr. Zamarian still uses an application of about 20% more fat volume than necessary, already counting on a small absorption that still occurs after the application. With this, the results are usually satisfactory in the first application. In just a few patients, about 5%, a complement may be necessary later, either with a little hyaluronic acid or with a little more fat, especially in areas that were very depleted of volume before the graft.
It is important to remember that when there is an absorption of fat after the procedure, what decreases is the effect of volume that fat exerts, but the rejuvenation effect remains unchanged.
No, not at all. The procedure is not performed to make the face fat. Only a replacement of the volume lost with ageing is performed, but everything in a natural way, leaving a youthful look, not a fat one. Moreover, this procedure is safe to the point that any excess fat, the body intelligently ends up absorbing. Even when you want to have very plump lips, the amount of fat used needs to be very large in order to have some volume increase result. That is, when you want to "overdo" with fat grafting, it is hardly achieved with just a single application, and more than one application may be necessary to obtain something excessively voluminous.
When we talk about fat grafting, as described above, it is only about removing from one place and immediately injecting into another. This can result in rough results and a high absorption rate of the fat. In addition to the mentioned processes of washing and centrifugation of fat, Dr. Zamarian refines the fat with this equipment he brought from the United States, and separates it into three different sizes:
In summary, the thinner the fat, the more discreet its result in terms of volume, but the greater its use for rejuvenation. In this way, during the surgical plan, Dr. Zamarian notes on his chart not only each area of the face that will be filled, but also which of the three different fats he will use in each of them.
Speaking of which, let's describe the areas that can be treated with fat grafting.
The only region that is forbidden to be filled due to the risk of blindness is the glabella. Even so, Dr. Zamarian can safely inject just above it and slide the volume down with the help of his fingers, when he perceives it necessary to improve the volume of the glabella.
The above mentioned areas, if they are very marked, sometimes need more than one size of fat, for example, deep micro or milifat and superficial nanofat, to get a better result.
Generally, there are no contraindications for the procedure. Patients who visit the Zamarian clinic for facial harmonisation and rejuvenation with fat are typically aged 40 or older (or a few years younger if they have early signs of ageing). Those aged 45 to 50 often seek the procedure alongside a facelift, as sagging facial tissues start to become noticeable. When paired with a facelift, the results are much more noticeable, as sagging tissues and skin laxity are addressed at the same time as the fat grafting.
The thicker the skin, the more natural and predictable the results. Patients with very thin skin may require a larger quantity of nanofat to improve skin quality, from the inside out.
In the past, a facelift operation was performed solely to lift tissues and remove excess skin laxity. Many patients required complementary treatments such as hyaluronic acid filler to address the volume loss caused by ageing. As research evolved and it was realised that the face indeed loses volume with age, facelifts started being paired with fat grafting, becoming a far more comprehensive treatment, yielding much better and longer-lasting results.
Currently, in about 95% of cases where Dr. Zamarian performs a facelift, he also incorporates fat grafting. This has more than doubled the effectiveness of the results, adding only an extra two and a half hours to the surgery time. It's important to remember that while fat grafting reduces the need for hyaluronic acid filler after surgery, it does not eliminate the use of botulinum toxin (Botox) as a complementary treatment, as fat fills like the acid, but doesn't provide the muscle-paralysing effect that Botox does.
Another operation that can be combined with fat grafting is blepharoplasty, or plastic surgery of the eyelids. This operation may be suggested for patients needing fat grafting who have excess skin or fat on their eyelids, but whose face is not showing signs of sagging tissues or laxity.
During the consultation for facial harmonisation and rejuvenation with fat, Dr. Zamarian will list all the areas of the face that are suitable for the fat graft, as well as determine which type of fat will be used in each of them. He will explain about the procedure, what results you can expect based on your anatomy, and the necessary care for your best recovery.
In addition to assessing the face, he will check which region the fat for grafting will be collected from. The first choice is the inner thighs in women, but other areas may be selected if the inner thighs have previously been subjected to liposuction or don't have enough fat. The donor areas can be:
The surgical plan consists of the notes in your file regarding the details of your surgery (areas to be grafted, donor area, types of fat, etc.), as well as the requirement for any other associated procedures, such as facelift or blepharoplasty. This plan will be strictly adhered to on the day of your surgery. Dr. Zamarian will make markings (drawings) on your face, in the operating theatre, while you are awake, following the surgical plan. These drawings indicate where each fat graft will be performed and are essential for the direction of the grafts, since your anatomy may change once you lie down on the operating table.
Dr. Zamarian will discuss with you the medication that you regularly take and whether there is a need to suspend it prior to the surgery.
Some tests are necessary to evaluate the patient's health and ensure the surgery can be carried out safely and without unexpected events. If there are any changes in the tests, it does not mean the surgery cannot take place, but that the changes need to be assessed and corrected if possible, before the procedure.
Dr. Zamarian requests the following tests:
Dr. Zamarian performs a small liposuction on the donor area to collect the fat for grafting. In the vast majority of cases, this collection is of small volume and barely alters the donor area.
After collection, the fat is washed with a Ringer's lactate solution and left for a short while to float. The fat from the lower two-thirds is aspirated into syringes that are placed in a centrifuge. After centrifugation, the fat is passed through transfer devices that reduce the size of the fat globules into millifat, microfat, and nanofat, with the quantity of each type of fat dependent on the individual case.
A microcannula is used for the injection (grafting) of the fat into the desired areas. Each area has a specific depth and quantity in order to achieve the desired outcome. Areas that require more volume are treated with millifat. Thin-skinned areas that require a more delicate result are filled with microfat. Regions that have many wrinkles and require little volume are treated with nanofat.
The swelling in this procedure occurs because several passes of the microcannula are needed in the same place, at different depths and directions, in order to optimise the uptake of the graft and provide natural results, without causing fatty necrosis nodules. The swelling is most pronounced on the day after the procedure, in the afternoon, and begins to improve from the second day after surgery. If the swelling is substantial at your first follow-up appointment for dressing assessment, Dr Zamarian may prescribe medication to speed up the swelling reduction process.
The bruising also results from the use of the microcannula and peaks on the fifth day after the procedure. This is because it takes up to five days for the blood to reach the skin's surface and reveal its colour. Haemoglobin, a component of the red blood cells that comprise the blood, takes three weeks to fully degrade. This can be tracked according to the apparent colour at each stage of its degradation and absorption: first purple, then green, then yellow, and finally, the colour disappears.
In the first seven days after the procedure, the change is swift. There's initially an increase in volume due to swelling, which then rapidly starts to decrease. The largest uptake of the fat graft occurs in the first seven days, which is the most critical phase. During this time, patients are advised to rest more to avoid interfering with the surgical outcome. After the first week, the swelling slowly subsides, while a slow absorption of some of the grafted fat occurs. It's four months after the procedure when the remaining amount of fat is considered to be permanent, with no further decrease in volume anticipated.
The grafted fat should last many years, behaving according to the donor area, but the existing facial fat should continue to reduce due to ageing. Therefore, the procedure is expected to maintain a good result for at least ten to fifteen years.
From the moment the fat grafting is carried out on the face, the fat begins to work, improving skin hydration, radiance, vitality, and the overall quality of the skin. It's as if the face stops ageing and slowly starts to rejuvenate. This process indicates that the results improve as time passes, to the extent that a year after the procedure, the appearance is better than it was two months post-procedure. And the improvements don't stop there. Even after five years, wrinkles can still be seen to decrease or disappear.
Dr Zamarian emphasises: "I'm not aware of any other aesthetic treatment that is as promising as fat grafting. Lasers enhance the skin from the outside in, but the injected fat has the ability to enhance the skin from the inside out, more effectively and excitingly than lasers. Furthermore, it fills and harmonises, countering the volume loss in the face due to ageing. Lastly, the fat doesn't cause allergies, since it's from the individual's own body, and there's an abundant supply of it in the donor areas."
Arrange your consultation for facial rejuvenation and harmonisation with fat with Dr Walter Zamarian Jr. in Londrina, Paraná. Contact the Zamarian Clinic and speak to one of our secretaries, who can answer your queries and book your assessment.
Cosmetic plastic surgeon in Brazil
Rua João Wyclif, 111, Sala 1702
Londrina - PR