During the aging 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 harsh 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 aging 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 harmonization 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 maximize 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 aging 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.
In general, there are no contraindications for the procedure. Patients who come to Zamarian clinic for facial harmonization and rejuvenation with fat are typically 40 years of age or older (or a few years younger if they show signs of premature aging). Often, those above 45 to 50 years seek the procedure in conjunction with a facelift, as sagging facial tissues begin to become visible. When paired with a facelift, the results are much more pronounced, as sagging tissues and skin laxity are addressed simultaneously with the fat grafting.
The thicker the skin, the more natural and predictable the results. Patients with very thin skin may require a larger amount of nanofat to achieve improved skin quality, from the inside out.
In the past, a facelift surgery was performed solely to lift tissues and remove excess skin laxity. Many patients needed complementary treatments like hyaluronic acid filler to address the volume loss caused by aging. As studies deepened and it was realized that the face indeed lost volume with age, facelifts began to be paired with fat grafting, thus becoming a much more comprehensive treatment with significantly better and longer-lasting results.
Currently, in about 95% of cases where Dr. Zamarian performs a facelift, he also incorporates fat grafting. This approach has more than doubled the results, with only an additional two and a half hours of surgery time. It's important to remember that while fat grafting reduces the need for hyaluronic acid filler post-surgery, it does not eliminate the use of botulinum toxin (Botox) as a complementary treatment, as fat fills like the acid but does not provide the muscle paralyzing effect that Botox does.
Another surgery that can be paired with fat grafting is blepharoplasty, or eyelid plastic surgery. This surgery may be recommended for patients needing fat grafting who have excess eyelid skin or fat, but whose face is not experiencing tissue sagging or laxity.
During the consultation for facial harmonization and rejuvenation with fat, Dr. Zamarian will list all the areas of the face that have an indication for the fat graft, as well as determine which fat will be used in each of them. He will explain the procedure, what to expect in terms of results based on your anatomy, and the necessary care for your best recovery.
Besides evaluating the face, he will check which area will be the source of the fat for grafting. The first choice is the inner thighs in women, but other areas may be chosen if the inner thighs have already undergone liposuction or do not have sufficient fat. The donor areas can be:
The surgical plan consists of the notes in your file about the details that will be executed in your surgery (areas to be grafted, donor area, types of fat, etc.), as well as the need for other associated procedures, such as facelift or blepharoplasty. This plan will be strictly followed on the day of your surgery. Dr. Zamarian will make markings (drawings) on your face, in the operating room, with you awake, following the surgical plan. These drawings indicate where to perform each fat graft and are fundamental for the direction of the grafts, as your anatomy can change after you lie down on the surgical table.
Dr. Zamarian will discuss with you about the medication that you regularly use and whether there is a need to suspend it before the surgery.
Some exams are necessary to assess the patient's health and allow the surgery to be performed safely and without surprises. If there is any alteration in the exams, it does not mean that the surgery cannot occur, but that the alterations need to be assessed and corrected if possible, before the procedure.
Dr. Zamarian requests the following exams:
Dr. Zamarian performs a small liposuction on the donor area to harvest the fat for grafting. Most of the time, this harvest is small in volume and barely modifies the donor area.
After harvesting, the fat is washed with a ringer-lactate solution and left for a short time 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 depending on each case.
A microcannula is used for the injection (grafting) of fat into the desired regions. Each region has a specific depth and amount to achieve the desired result. Areas that require more volume are treated with millifat. Thin skin areas that need a more delicate result are filled with microfat. Regions that have many wrinkles and require little volume are treated with nanofat.
Swelling in this procedure occurs because multiple passes of the microcannula are needed in the same place, at different depths and directions, in order to optimize the graft uptake and promote natural results, without causing fatty necrosis nodules. The swelling is greatest on the day following the procedure, in the afternoon, and begins to improve from the second day after the surgery. If the swelling is significant at your first return visit to the office for dressing evaluation, Dr. Zamarian may prescribe medications to help accelerate the process of reducing swelling.
Bruising, too, results from the passage of the microcannula, and peaks on the fifth day after the procedure. This is because blood takes up to five days to reach the surface of the skin and show its color. Hemoglobin, a component of red blood cells that make up the blood, takes three weeks to fully degrade, and this phenomenon can be tracked according to the apparent color at each stage of its degradation and absorption: first purple, then green, finally yellow, and then the color fades.
In the first seven days after the procedure, the change is rapid. Initially, there's an increase in volume due to edema and then it quickly starts to deflate. The largest fat graft uptake occurs in the first seven days, which is the most critical phase and when patients are advised to rest more to avoid interfering with the outcome of the surgery. After the first week, the edema slowly fades, while a slow absorption of part of the grafted fat occurs. Four months after the procedure, the remaining fat is considered to be the final amount, with no expected reduction in volume after this period.
The grafted fat should last many years, behaving according to the donor area, but the fat that already existed in the face should continue to diminish due to aging. Thus, the procedure is expected to maintain a good result for ten to fifteen years, at least.
From the moment the fat grafting is performed on the face, the fat starts to act, improving skin hydration, brightness, vitality, and overall skin quality. It's as if the face stops aging and slowly starts to rejuvenate. This process suggests that the result gets better as time goes on, so much so that a year after the procedure, the appearance is better than it was two months immediately following the procedure. And the improvement doesn't stop there. Even after five years, we can still see wrinkles diminishing or disappearing.
Dr. Zamarian stresses: "I don't know of any other aesthetic treatment that is as encouraging as fat grafting. Lasers improve the skin from the outside in, but the injected fat has the ability to improve the skin from the inside out, in a more effective and exciting way than lasers. What's more, it fills and harmonizes, counteracting the volume loss in the face due to aging. Finally, the fat doesn't cause allergies, as it's from the person's own body, and there's a vast supply of it in the donor areas."
Schedule your consultation for facial rejuvenation and harmonization with fat with Dr. Walter Zamarian Jr. in Londrina, Paraná. Contact the Zamarian Clinic and speak with one of our secretaries, who can answer your questions and arrange your assessment.
Cosmetic plastic surgeon in Brazil
Rua João Wyclif, 111, Sala 1702
Londrina - PR