Facial fat grafting: how fat transfer to the face works and when it's the right choice

Facial fat grafting — also called autologous fat transfer or structural fat grafting — uses your own fat cells to restore facial volume. It's positioned between injectable filler and surgery: more invasive than filler, less invasive than a full facelift, but potentially more durable than either.

How facial fat grafting works

Harvesting: Fat is removed from a donor site — typically the abdomen, flanks, inner thighs, or medial knees — using liposuction. This is typically done under local anesthesia with tumescent solution, sometimes with light sedation.

Processing: The harvested fat is centrifuged or filtered to separate pure fat cells (adipocytes) from blood, fluid, and broken cell debris. The processing technique significantly affects graft survival.

Injection: The processed fat is injected in small, 0.1–0.5 mL aliquots across the treatment area using fine cannulas. Fat must be placed in small amounts through multiple passes to ensure each fat parcel is in contact with surrounding tissue (which provides the blood supply that keeps the fat cells alive).

This is technically demanding — syringe pressure, cannula size, injection speed, and the number of passes all affect graft survival.

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What fat grafting can address

Volume restoration (primary use):
Temporal hollowing
Mid-face and cheek volume loss
Tear trough / under-eye hollowing
Nasolabial folds and marionette lines
Lip volume
Forehead and brow area volume

Skin quality improvement:
Fat grafts contain adipose-derived stem cells (ADSCs) and stromal vascular fraction (SVF), which have regenerative properties. Many practitioners and researchers believe that the stem cell component of fat grafts improves overlying skin quality — texture, hydration, and collagen density — beyond simple volume restoration. This is an additional benefit not achievable with HA filler.

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Advantages over dermal filler

Longevity: The fat that survives the grafting process is permanently incorporated into the surrounding tissue. Unlike HA filler (which dissolves in 12–18 months) or even Sculptra (which lasts 2–3 years), surviving fat is permanent. You only pay once.

Volume: Fat grafting can restore large volumes more economically than filler — a patient needing 10 mL of facial volume replacement would spend $10,000–$15,000 in filler; fat grafting that volume costs $3,000–$7,000 as a one-time procedure.

Natural material: No foreign substance introduced — the fat is your own tissue.

Skin quality benefit: The stem cell fraction may improve the overlying skin's quality over time.

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The survival rate challenge

Not all transferred fat survives. Fat survival rates are typically 40–70%, meaning:
30–60% of injected fat cells die and are resorbed by the body within the first 3–6 months
The surviving fraction remains permanently

This unpredictability is the main limitation of fat grafting. A patient injected with 6 mL of fat per cheek may end up with 3–4 mL surviving on one side and 2.5 mL on the other — creating asymmetry. Over-correction (injecting more than needed) is a common approach to account for expected loss, but it requires careful judgment.

Factors that affect survival:
Processing technique (gentle handling preserves more viable cells)
Recipient site vascularity (well-vascularized areas survive better)
Injection technique (small aliquots placed carefully have better survival than large boluses)
Surgeon experience (technique variation accounts for much of the variability in outcomes)
Patient factors (smoking, poor circulation, certain medications reduce survival)

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The procedure and recovery

Anesthesia: Local tumescent anesthesia with optional oral sedation or IV sedation. General anesthesia is sometimes used when combined with other procedures.

Session duration: 2–4 hours depending on harvest volume and treatment areas.

Recovery:
Donor site: Bruising and soreness like liposuction for 1–2 weeks; compression garment for 1–2 weeks
Recipient face: Significant swelling and bruising for 1–3 weeks; may look over-corrected initially
True result: 3–6 months after the procedure, once resorption stabilizes and remaining fat integrates

Patients should not evaluate results at 1 month — the appearance at this stage doesn't reflect the final outcome.

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Cost

| Treatment scope | Typical cost |
|---|---|
| One area (e.g., temples only) | $2,500–$5,000 |
| Full-face fat grafting | $4,000–$8,000 |
| Fat grafting combined with facelift | $6,000–$15,000 (combined) |

Facility fees, anesthesia, and surgeon fees are included in these ranges (unlike filler, which is just the product and injection fee).

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Fat grafting vs. filler: when to choose each

| Factor | Fat grafting | HA filler |
|---|---|---|
| Duration | Permanent (surviving fraction) | 12–24 months |
| Predictability | Lower (40–70% survival) | High |
| Reversibility | No | Yes (hyaluronidase) |
| Volume capacity | Large (cost-effective for 5+ mL) | Small (expensive at large volume) |
| Recovery | 2–3 weeks | 1–3 days |
| Cost for large volume | More economical | Expensive |
| Touch-up ease | Requires a procedure | Single syringe |
| Best for | Large-volume restoration, permanent solution | Targeted correction, first-time treatment |

Practical guidance: For patients needing 1–3 syringes of filler in specific areas, HA filler is simpler and more predictable. For patients with generalized volume loss requiring 8–15 mL of correction across multiple areas, fat grafting becomes more economical and offers permanence. Many plastic surgeons consider fat grafting when patients have had repeated filler and are spending $3,000+/year on maintenance.

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Who is a good candidate

Good candidates:
Patients with significant generalized facial volume loss (not just one specific area)
Patients who want a long-term solution and are comfortable with a surgical-level procedure
Patients who are having another procedure (facelift, blepharoplasty) and can combine fat grafting efficiently
Patients with adequate donor fat (very thin patients may have limited donor supply)

Less ideal:
Patients who want predictable, immediately accurate results — filler is more reliable for precision
Patients who want complete reversibility
Patients not willing to accept 2–3 weeks of visible recovery

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Questions to ask before booking

How much fat do you estimate you'll need to harvest and inject to achieve my goals, accounting for resorption?
What processing technique do you use (centrifugation, filtration, PRP enhancement)?
Will you over-correct, and how do you manage the swelling phase so I know what to expect?
At what point post-procedure can I add HA filler touch-ups if needed for symmetry or additional volume?
Given my goals and how much filler I currently use annually, is fat grafting more economical for me over a 5-year horizon?

This procedure is performed by plastic surgeons and facial plastic surgeons — not typically at med spas without a physician on-site. If a med spa offers this, verify the credentialing of the performing physician carefully.

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