Is Fat Grafting Better Than Fillers?

Fat grafting and fillers are both important parts of my practice and I perform both regularly. Patients commonly ask, “Which is better?” The answer – it depends!

What are fillers?

Fillers are synthetic material that is kept “on the shelf” until it is used. It is typically a hyaluronic gel that is produced by bacteria, highly purified, sterilized, and provided to doctors in pre-filled sterile syringes. Hyaluronic acid is a natural component of skin and was originally produced for fillers by extracting it from roosters. It is now produced from bacteria using genetic engineering so that the purified material is essentially identical to the hyaluronic material in your skin. Once the gel is purified, it is further modified to produce different products. The products differ by their stiffness and thickness, which allows the different products to be used for different issues. Thin, soft hyaluronics are good for very fine skin lines. Firmer hyaluronics are good for lips and the folds between your nose and thick, stiff hyaluronics are good for building up your cheekbone region.

What is fat grafting?

Fat grafting uses your own fat – taken by a low volume liposuction method that protects the fat. It is commonly harvested from your tummy area, love handle area, or inner thigh area. The fat is washed, concentrated, and then transferred into very small syringes for injection. The harvesting system is a closed system, meaning that the fat is never exposed to the open air to prevent contamination and infection. The fat is gently handled because it is living tissue, and must be treated carefully to maximize the amount of fat that is incorporated into the recipient site (usually your face, lips, and hands) as living tissue.

What is the difference between fat grafting and fillers?

Fillers are gradually absorbed by your body, then disappear. The firmer, thicker hyaluronics last 12-24 months. The thinnest hyaluronics last 2-3 months. Tissues that move a lot like lips tend to absorb the fillers quickly – stable non-moving areas, like the cheek bones, tend to preserve the hyaluronics for the longest time. Hyaluronics can be melted away over 24-48 hours with a dissolving injection (although the thickest hyaluronics may require multiple dissolving injections) so any “mistakes” (like too much, or a small bump) can be corrected quickly. To maintain a correction with fillers, repeated injections are necessary once the filler begins to dissolve. It is often possible to feel and sometimes see hyaluronics that are placed close to the skin surface.

Fat grafts are living cells and must incorporate into the new location where they are injected by establishing a blood supply from the new area. If the cells don’t establish a blood supply, they will be absorbed by the body and disappear. Those cells that do establish a blood supply are permanent, and won’t disappear with time – they are permanent. How much of your fat injection survives depends on many factors and the range is typically between 30% and 70%, but it can be as low as zero and as high as close to 100%. Fortunately, the survival of the fat tends to be symmetric – if 70% survives in one cheek, the likelihood is that about 70% will survive in the other cheek. It’s not easy to correct overcorrection (too much fat). Under correction is fixed by additional fat grafts. Because of swelling from the procedure, it takes about three months to know how much of the fat has survived, and from that point on, the correction is very stable. Large weight gains or losses (15 or more pounds) can visibly increase or decrease the size of the grafted fat cells. Fat cells that incorporate generally cannot be felt or seen unless a small collection or bump of fat is very close to the surface in eyelids or lips, and these can be corrected.

As a general rule, fillers are best when small amounts are used. If you have fine lines, or flatness in the cheekbone area, fillers are best. If you need larger volumes, such as hollow cheeks, or deep nasolabial folds, fat is best. In certain areas like the lower eyelid hollow, the end result is comparable with fillers and fat. Patients often use both methods, fat and fillers, to obtain the best results with the shortest downtime.

So – in the best practices, the doctor will offer both fillers and fat and will spend time with you to determine which is best in your specific situation.

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