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Fat Grafting or Fillers

Fat grafting vs. fillers what works better?

I have had a lot of experience with fat grafting over the last 10 years and I have seen everything including fat lasting 10 years on some people and 6 months on other people.  After thousands of my own patients and thorough discussions with many of my colleagues who I consider to be honest and at the top of the field.  I have some strong opinions about the fat grafting craze. Our discussions have involved the topic of where we have been and where we are headed.

Fat grafting has been around for 40 years but it gained a lot of press and PR in the early 2000’s when the Plastic surgery reality shows hit the airwaves.  It was a time when the economy was strong and there were doctors from all different specialties delving into the plastic surgery world the way pick axe salesman flooded the market at the time of the gold rush.  It is well known that most of the doctors who advertise plastic surgery aggressively are not plastic surgeons at all.  They are usually dermatologists and other Non Plastic surgeons who call themselves “cosmetic surgeons”.  Fat grafting is a very safe procedure to do under local anesthesia and it does not require a scalpel.  As a result of this fact, most of the “cosmetic surgeons” offer and advertise this procedure.  As the plastic surgery boom occurred in the early 2000’s there was aggressive marketing and advertising by the cosmetic surgeons and they most often were advertising fat grafting.  This created a buzz throughout the community and therefore most patients had heard of it and thought it would be the best option for themselves without knowing much about it.  Now that the dust has settled and millions of patients have had fat grafting there is much less excitement about the procedure.

The reality is that the longevity of fat grafting is unpredictable.  Some people will have long lasting results and others will not despite using the same technique and using the same amount of fat.  There are certain things that are essential to do as the surgeon to make sure the fat has the best chance of surviving including low pressure harvesting and micro droplet technique injections. Still, the unpredictable nature remains.  There are certain areas of the face where fat tends to survive like the tear trough. Areas where the fat tends to absorb quickly would be the lips.  It is important to see a surgeon who you trust and who has a lot of experience with fat injections to get an honest idea of what to expect from the procedure.  Fat grafting is still my favorite option for a few very select set of issues a patient may have but I use it much less frequently than I used to as patients often opt for more predictable and more permanent procedures.