Sure! Here is the English translation of the text about fat grafting to the face:

Basic Information About Facial Fat Grafting

As we age, a “fat tissue distribution disorder” occurs in our face. The medical term for this condition is “Senile Facial Lipodystrophy.”

Contents

• What Are the Purposes of Facial Fat Grafting?
• How Is Facial Fat Grafting Performed?
• Is Facial Fat Grafting Permanent? Do the Injected Fats Dissolve?
• What Are the Advantages of Facial Fat Grafting?
• Is Facial Fat Grafting a Risky Procedure? What Are Its Side Effects?
• Post-Procedure Care Recommendations for Facial Fat Grafting

What Are the Purposes of Facial Fat Grafting?

One of the most noticeable changes when comparing a person's photo in their 40s with one from their 20s is how much the overall volume of the face has decreased. As we age, the fat tissue in the face gradually diminishes. This decrease is so regular and slow that even though you see your face in the mirror every day, you may not notice the change. Even more interestingly, while some areas of the face lose volume, the volume of fat tissue in other areas (e.g., under-eye bags, submental fat pad, etc.) increases.

How Is Facial Fat Grafting Performed?

One of the most effective methods we have for treating volume loss due to aging is fat grafting. Fat grafting is also referred to as fat filling or fat tissue transfer. This procedure involves harvesting fat tissue from one area of the body (such as the abdomen, inner thighs, or buttocks) and transplanting it to another area. In this procedure, fat is collected using liposuction syringes and special cannulas (a kind of liposuction) and is then processed and injected into the desired area using small cannulas. A cannula is like a needle without a sharp tip, which is why fat tissue transfer is likened to an injection procedure and is also known as “fat injection.” There are no surgical incisions involved.

Small-volume fat injections can be performed under local anesthesia in a clinic or office setting, provided a sterile environment is maintained. These applications are typically limited to one area of the face and involve volumes of less than 10-12 milliliters. I prefer to perform fat grafting for the entire face or multi-plane fat grafting under general anesthesia in a hospital setting because the safe dosage limits of local anesthetic drugs are exceeded when treating large surface areas, and patient comfort decreases.

Is Facial Fat Grafting Permanent? Do the Injected Fats Dissolve?

During fat tissue transfer, since the harvested fats are removed from their natural environment, a significant portion of the cells die during the harvesting process. The cells that survive the injection will remain alive only if they find and attach to a blood vessel that nourishes them in their new location. Thus, a significant portion of the transferred fat volume will dissolve, leaving only a small amount behind. The survival rate of the transferred fat depends on many factors, including the structure and size of the cannulas used, the area from which the fat was harvested, the area where the fat was injected, the medications used, the intermediate steps (filtering, centrifugation, nanofiltering, etc.) employed in processing the fat, and the injection technique. However, the remaining fat will live and age like your natural cells, meaning it is permanent.

In fat tissue transfers, the smaller the size of the transferred fat particles, the lower the survival rate. For instance, while the survival rate in structural fat grafts is around 25-50%, this rate decreases to 10-30% in micro fat (microfat) transfer and to 5-10% in nano fat (nanofat) transfer. Despite this decrease in survival rate, small particle transfers are preferred in some special situations. For example, in areas where the skin is very thin, such as around the eyes, or where the injection will be applied superficially, small particles are preferred because they create a smoother contour. Another important factor is the application technique. In fat tissue transfer, the cannula moves within the tissue like a sewing machine. During each pass, a three-dimensional pattern is achieved by leaving a tiny volume in a thin tunnel, as if weaving. The cannulas must continually enter and exit the tissue and be in motion.

For these reasons, facial fat grafting inevitably causes noticeable swelling and bruising in the tissue. Even if no fat is injected, just inserting and removing the cannulas will cause swelling that may last for several weeks.

Due to the reasons mentioned above, the volume seen in the early period after fat tissue transfer may be almost ten times the final targeted volume. Patients are often uncomfortable with the swelling in the early period, and this swelling is usually not something that can be ignored. After about 10-14 days, the swelling caused by tissue trauma significantly reduces, leaving behind the volume of the injected fat. The volume seen between 10-14 days will further decrease in the following six weeks as the body removes the dead fat and the remaining swelling subsides, revealing the final volume.

It is important to know these facts because patients who undergo fat tissue transfer and are not adequately informed about these aspects may feel disappointed, thinking that “the fat is gone, and I didn’t achieve the desired result.” Due to their disappointment, they may be reluctant to proceed with follow-up sessions. However, we typically achieve the desired volume in 3-4 sessions. If we try to achieve the target volume in a single session by injecting high volumes, the patient may end up avoiding social life for weeks due to excessive swelling and bruising. High-volume injections in a single session also carry other risks. Since this fat tissue is “alive” and has its own characteristics, sometimes more of the injected fat survives than expected, which can lead to problems.

It is better for the fat to survive less than more because if there isn’t enough fat, additional sessions can be done later, but if too much fat survives and causes irregularities, surgical intervention may be required to remove the excess fat. A good example of this is fat tissue transfer around the eyes. If a large amount of fat, especially large particles, is transferred around the eyes and a higher percentage of the fat survives than expected, new bags or visible fat cysts may form under the thin eyelid skin. When this situation becomes permanent, surgery may be required to remove the excess fat.

One of the problems encountered in fat tissue transfers is that the fat is injected into a single area and not distributed well enough. This can result in swelling, a lump, and an abnormal, unnatural contour at the injection site. To prevent this, as mentioned earlier, the cannulas need to integrate the fat cells into the tissue during multiple passes.

What Are the Advantages of Facial Fat Grafting?

Facial fat grafting allows for facial volume enhancement using the patient's own tissue without the need for foreign materials. Although most of the fat will dissolve, the remaining part is permanent. Unlike hyaluronic acid fillers, which need to be repeated every six months, the desired volume can usually be permanently achieved in 2-3 sessions.

One of the biggest advantages of fat grafting is the transfer of stem cells along with the fat tissue. Stem cells can create a noticeable skin glow in some patients between 6-12 months, which can be a desirable aesthetic gain on its own. The basic logic of nanofat application, where most fat cells are intentionally killed, and stem cells are preserved, is also based on this principle.

Is Facial Fat Grafting a Risky Procedure? What Are Its Side Effects?

Facial fat grafting is a relatively safe procedure with a low complication rate when performed according to modern principles and the precautions established in the literature. However, there are still some risks involved. The injected fat can become infected, and treating an infection caused by fat woven into the tissue can take up to 1-2 weeks. Large amounts of fat injected under very thin skin can cause lumping or cyst formation, with the under-eye area being the most at-risk region. In very rare cases, fat tissue can enter a blood vessel and block blood flow. This situation occurs in about 1 in 30,000 patients, but cases of tissue loss and blindness have been reported in the literature. Another possibility is that the transferred fat cells do not survive due to the patient's biological characteristics, and despite 3-4 sessions, the procedure may not yield any benefits. Smokers, diabetics, and individuals with capillary disease are at risk of total fat absorption. When performed with appropriate techniques by a plastic surgeon who knows facial anatomy, the risk of damaging deep muscle and nerve tissues during fat grafting is very low.

Post-Procedure Care Recommendations for Facial Fat Grafting

After facial fat grafting, it is necessary to apply cold to the treatment area for 5-7 days. Cold reduces the metabolism of the fat and increases its survival chances. It also helps minimize swelling. We usually recommend taking a preventive course of antibiotics for 48 hours after the procedure. Since there are no incisions in facial fat grafting, no special dressing is required. You can shower on the same day as the procedure and start using creams and makeup products to camouflage any swelling and bruising from the following day.

Fat tissue transfer is one of the most powerful applications of modern plastic surgery. It is a key procedure in facial rejuvenation. However, like every medical procedure, it has its own limitations. Be sure to discuss with your doctor how many sessions you may need to achieve your goals, the cost of each session, the total cost, the technique to be used, and how to deal with potential complications before the procedure.

If you would like to learn more about fat tissue transfer and whether this procedure is suitable for you, please contact us.

Let me know if you need any further adjustments or additional information!