Facial Fat Grafting in Brazil

Hollower temples, a more noticeable line under the eyes, or flatter cheeks can change the way light falls across the face. People don’t always say they have lost fat; often they just notice that they look drawn.

I examine where volume is missing and where the tissue has simply shifted. That distinction keeps me from adding fat to an area that actually needs repositioning. I also look at the face as a whole: a small hollow shouldn’t be treated in a way that leaves another area looking heavy.

I want the volume to serve a purpose. Before we talk about amounts, I want to understand which contours you would like to get back and which features you want to keep.

I recommend fat grafting when the exam shows volume loss in areas such as the temples, the cheeks, the transition between the lower eyelid and the cheek, or the jawline, and when there is fat available elsewhere on the body. The American Society of Plastic Surgeons describes the technique as using your own fat to restore fullness to the face and soften shallow contours, with a liposuction step that off-the-shelf fillers don’t require. ASPS on fat injections in the face.

To restore volume, I use fat prepared in a way that preserves the components suited to grafting. Particle size and the recipient area affect how the fat is distributed. The terms microfat and millifat describe preparations used in this setting, and methods vary.

Nanofat is emulsified and filtered. In the original 2013 work by Tonnard and colleagues, no viable fat cells (adipocytes) were found in samples of this preparation, although other cells from the fatty tissue were present. The study focused on skin quality, not structural volume replacement. Original publication on nanofat.

I also don’t call fat grafting a stem cell treatment. Transferred fat does carry cells that are naturally present in the tissue, but the 2011 joint position statement of the American Society for Aesthetic Plastic Surgery (ASAPS) and the American Society of Plastic Surgeons (ASPS) recommends that conventional grafting be described as fat grafting rather than as a stem cell procedure, and states that the marketing of these procedures in aesthetic surgery was not adequately supported by clinical evidence. ASAPS and ASPS position statement.

That’s why I explain separately what I propose for contour and what may be considered for the skin. Calling all of it “fat” doesn’t make these uses equivalent.

One thing is specific to my practice: for certain deep under-eye hollows, I prefer nanofat because of how I see it settle under the thin skin of the lower eyelid. This clinical observation does not show volume retention equivalent to microfat, nor does it change the findings of the original study. I explain the indication, the limits, and the alternatives on the lower blepharoplasty page.

1. Choosing the donor area

   These days I prefer the lower abdomen and the inner thighs, and I consider another area when needed, taking into account how much tissue is available, previous surgeries, and harvest marks.

2. Harvesting and processing

   I remove the fat through small incisions and prepare it. The donor area will also need care and may be sore and bruised.

3. Placing the fat in the face

   I plan the amounts and tissue layers for each selected area. The point is not to place as much as possible, but to distribute only what is indicated.

When I combine it with a facelift, I build these steps into the operating time and the anesthesia plan. I don’t treat the harvest as a minor detail with no effect on recovery.

Combined with a facelift, fat grafting is done during the same operation, in the hospital, under the facelift’s total intravenous anesthesia (TIVA). On its own, I also use total intravenous anesthesia, as in almost all my surgeries; in my hands, fat grafting takes about 2 hours. Because I operate on these cases in the afternoon, you can go home the same day if you wish, at around 10 p.m. The harvest marks are small cannula entry points, placed where they will be discreet.

As you prepare, please tell me if you use cigarettes, vapes, or other nicotine products, what medications you take, and whether you plan to lose weight. This information is part of the evaluation before we decide on surgery; don’t change any treatment on your own. If the change in volume started after weight loss, I explain at the consultation how I tell the possibilities apart.

In the first few days, the volume you see is a mix of grafted fat and swelling. The tissue integrates over the course of recovery, and some of the fat may be reabsorbed. I don’t use a single survival percentage as a promise for every area and every person.

A review by Gornitsky and colleagues included 43 studies and 4,577 patients who had facial fat grafting. Weighted mean retention of fat without cell enrichment was 41.63% at a mean follow-up of 13.9 months, and 104 complications (2.27%) were reported, asymmetry being the most common. The review also showed why retention and complications need to be measured with defined methods. The studies vary in technique and follow-up, which limits exact predictions for any one face. Review of effectiveness and complications.

The American Society of Plastic Surgeons states that about half of the injected fat survives; in the face, most of the transferred fat usually survives, but results are a bit less predictable, and more than one session is usually needed. ASPS on fat retention.

If a top-up is needed, that decision is made once I have seen how the fat settles. Gaining or losing weight can also change your face and the grafted tissue; discussing any weight-loss plans before surgery is part of your care.

Fat requires harvesting and a surgical procedure. Hyaluronic acid works differently: the way it is injected, how long it lasts, and how it is managed are not the same. The right choice depends on the area, the goal, your history, and how much recovery you are willing to go through; I don’t present either one as better in every situation.

If you have had fillers before, bring the product names, dates, and injection sites. Previous products and changes can affect the exam. Removing something beforehand isn’t always necessary, and any decision should come from the evaluation, not from a rule found online.

We may also conclude that your concern calls for a facelift, skin treatment, or no treatment at that point. The consultation is there to sort out these possibilities.

This comparison is for education only: I don’t perform hyaluronic acid filler injections in my current practice. When I mention other approaches, I am explaining differences, not offering these treatments.

I also think it’s important not to confuse the possibility of removing a product with a guarantee of reversing a complication. The FDA states that removing fillers may require additional procedures, carries its own risks, and can be difficult or impossible in some cases. A vascular injury can leave permanent effects. That’s why I don’t present fillers as a no-commitment trial before surgery. FDA information on risks and removal.

Fat grafting can cause uneven reabsorption, asymmetry, irregularities, lumps, oil cysts, infection, and the need for revision. The donor area can also develop contour changes and healing problems.

Serious vascular complications have been described in the literature, including vision loss and neurological events when fat enters the arterial circulation. The 2024 review by Brucato and colleagues analyzed reported complications; it is not a measure of how often they occur across everyone who has surgery. It covered 58 complications in 38 patients, described in 22 articles; the forehead and temples were the areas with the most reports, which calls for particular anatomical care in those areas. Review of complications.

That’s why careful anatomical planning and execution are essential, without turning technical care into a promise of zero risk.

Seek emergency care right away if you have a sudden change in vision, weakness, difficulty speaking, shortness of breath, or chest pain; don’t wait for a reply on WhatsApp. A painful, swollen calf also needs urgent evaluation. You can check the warning signs the NHS describes for stroke and deep vein thrombosis.

On your face or at the donor site, pain that keeps getting worse along with rapid swelling, fever, discharge, or a marked change in skin color needs immediate evaluation. Contact the team; if you can’t reach us, seek emergency care. Don’t wait until your next follow-up visit to tell us things are getting worse.

I give you care instructions for your face and the donor area and explain when to come back. Swelling, bruising, and tenderness can occur; how intense they are and how long they last also depend on any combined surgery. Don’t massage the area or try to fix a bump on your own.

When the fat comes from your own body, recovery takes longer than with a filler and may take a few weeks, according to the ASPS guidance on recovery. After fat grafting alone, how soon you can go back to work depends on the areas treated, the swelling, and the kind of work you do. Combined with a facelift, it follows the timeline for the whole procedure, with a return to social activities at about two weeks in my practice. Light exercise is allowed after one month; any physical activity, including contact sports, after two months.

If fat grafting is part of your facelift, you will follow the plan for the whole procedure, with frequent checkups, follow-up visits for one year, and photos taken over the months. The patient journey page helps you plan this period.

I want to follow how the contour settles and hear what you notice. This series of checkups is what lets me tell a temporary phase apart from something that needs treatment.