Fat Injections & Fillers
Typical changes associated with aging include gradual loss of fat in the face, with resultant flattening of facial contours and sagging of the overlying skin. Procedures that restore lost facial volume, such as fat injections and dermal fillers, result in a more youthful, rejuvenated appearance. They may be performed concurrently with complementary aesthetic procedures: either with more extensive plastic surgery, or with more superficial treatments that improve skin tone and texture, in order to achieve comprehensive facial rejuvenation. As a completely natural option that only use a patient’s own tissue, fat injections offer a unique option for increasing soft tissue volume anywhere in the body, providing a natural alternative for breast augmentation and breast contour enhancement.
Autologous fat injections provide fat that is obtained from a patient’s own fat deposits and used to fill in depressions, diminish wrinkles and creases, or augment soft tissues by increasing volume. As an alternative, fillers are injectable synthetic materials that are injected in areas that need volume correction. FDA cleared fillers include those made of hyaluronic acid (HA), a naturally occurring protein in the human body. These are available under the name Juvéderm®, Restylane® and Perlane®.
Dr. Hutchinson is one of a select group of plastic surgeons who qualify as an ExpertInjector™, endorsed by the prestigious American Society for Aesthetic Plastic Surgery (ASAPS).
Fat Injections – Fat Grafts – Autologous Fat Transfers
Fat injections are often referred to as autologous fat transfers (AFTs), fat grafts, or liposculpture. A patient’s own fat provides an alternative to commercially available hyaluronic acid injectables. Using your own fat to augment certain areas or to correct depressions involves two stages: the first stage is the harvesting of the fat, and the second is the injection. Dr. Hutchinson performs the fat harvest in a method similar to liposuction, using very small cannulas to remove fat from areas such as the abdomen, thighs, or flanks. The fat is then allowed to separate from other tissue components before being injected. Injection of fat utilizes purified fat and multiple passes into the area that requires correction or augmentation. This procedure requires local anaesthetic and possible sedation for maximum patient comfort. Some of the fat may be resorbed, but the majority of fat cells do survive and produce a very long lasting result.
Advantages of AFTs include the following:
- Uses a patient’s own fat, natural tissue harvested from the abdomen, flanks, or thighs
- Fat contains a large amount of stem cells, which have anti-aging and rejuvenating properties for the skin
- Both facial contour and skin quality are improved following treatment
- Results last for many years and time before additional fat injection procedures are indicated is usually on the order of several years
Natural Breast Augmentation With Autologous Fat Transfers
For women who are interested in increasing the size of their breasts, or restoring breast volume and shape after pregnancy, autologous fat injections may be a natural option. Fat is harvested from the abdomen, flanks, or thighs, and purified prior to tranfer into the breasts. The transferred fat is incorporated into the surrounding breast tissue, and results are permanent. Natural fat breast augmentation differs from breast augmentation with implants as it does not require insertion of a saline or silicone implant.
Specific features of natural breast augmentation with fat injections include:
- requires only a patient’s own fat for breast augmentation
- increases total breast volume in women with small breasts
- restores lost breast tissue after pregnancy, breastfeeding, or massive weight loss
- corrects asymmetry or size differences between the breasts
- offers an alternative for breast volume restoration after breast implant removal
- provides additional layer of soft tissue coverage around breast implants used in augmentation or reconstruction
Natural breast augmentation with fat injections is safely performed under IV sedation anaesthesia. Appropriate candidates for the procedure are women who desire a moderate increase in breast volume and have sufficient fat available for transferring into their breasts. Although most of the grafted fat will retain its volume, multiple sessions may be necessary to achieve best results with the desired breast shape and size.
Juvéderm® is an FDA-approved smooth consistency gel capable of restoring volume to the skin while smoothing away moderate to severe facial wrinkles and folds. This injection is made of hyaluronic acid, a naturally occurring substance in the skin that adds volume and hydration as well as instantly natural results. No pretesting is required with this product.
Patients can achieve a fuller, younger appearance while still maintaining the natural features that define who they are. Juvéderm® is most effective in adding volume in areas of soft tissue loss and in filling depressions from deep wrinkles and scars. There are several different types of of Juvéderm® currently available, in order to best treat each particular patient concern: Volbella, Ultra, Ultra Plus, and Voluma. The gels are usually used as XC formulations which contain lidocaine and minimize patient discomfort.
Juvéderm® can reduce the appearance of nasolabial folds, the “smile lines” that run from the bottom of the nose to the corner of the mouth on both sides of the face. It may also be used to fill in contour deformities in other areas of the face, such as frown lines, lower eyelid tear trough deformity, and marionette lines at the sides of the mouth. It increases volume in the lips and cheekbone area to create better shape and contour in the face and restore a more youthful appearance.
Juvéderm® is available in two formulations with different viscosities, each being used for different treatment effects. Juvéderm XC® now comes with lidocaine, an anaesthetic agent, and this has significantly increased the comfort for our patients undergoing treatment with this filler. Dr. Hutchinson may choose to apply a topical or injectable anesthetic to numb the treatment area and even further reduce any potential discomfort. The injection is then administered under the skin in the targeted area to add volume or fill in wrinkles and folds. After the injection, Dr. Hutchinson may gently massage the treated areas.
The results of a Juvéderm® treatment are visible immediately after the procedure, and will continue to improve over the next few days as any swelling and bruising subside. Results are expected to last six to nine months, but in many cases last up to year or even longer. For the first 24 hours following treatment, you should avoid strenuous exercise, excessive sun or heat exposure, and consumption of alcoholic beverages in order to help minimize risk of temporary redness, swelling, and/or itching at the treatment sites.
The patient below is an example of results that may be obtained after treatment of the cheeks, lips, and perioral area with Juvéderm® Voluma, Ultra Plus, and Ultra. Photographs are taken before and 1 month after treatment. For this patient, 2.6cc of Juvéderm® Voluma were injected into the cheek area; 3.05cc of Juvéderm® Ultra XC were injected into the parentheses lines, marionette lines, and corners of the mouth lines; and 0.7cc of Juvéderm® Ultra was injected into the lips. (Photos courtesy of Allergan.)
Restylane® and Perlane®
When we are young our skin is smooth and elastic with a healthy glow. As we age, our ability to maintain that smoothness and elasticity diminishes, resulting in skin that becomes drier, thinner and less able to replenish itself. Our body’s natural collagen and hyaluronic acid levels decrease and our skin becomes looser. This leads to our skin wrinkling and appearing older than it should.
Restylane® and Perlane® are FDA-approved injectable fillers used for smoothing out facial wrinkles. They are biodegradable gel composed of hyaluronic acid, a natural substance occurring within the body. In addition to adding fullness to the skin, Restylane® and Perlane® attract water molecules to the site of the injection, further enhancing their effectiveness.
Since no pre-testing is required, Restylane® and Perlane® treatment can be performed almost immediately. Restylane® and Perlane® are commonly used to treat the nasolabial folds. They can also be used to enhance the volume and shape of the lips. Treatment usually takes about 30 minutes depending on the type of correction you want. Most people find the injections relatively painless, but a topical anesthetic can be applied to the area prior to your treatment. You will be able to see the results as soon as your treatment is completed, although it may take a few days for swelling to subside. Patients should refrain from rubbing or massaging the treated area for approximately 48 hours.
Dr. Hutchinson is a member of the American Society of Plastic Surgeons (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS), which are jointly sponsoring the Physician Coalition for Injectable Safety in order to educate the public about injectable cosmetic treatments and board certified physician injectors.