I Tried Facial Fat Grafting and 6 Months Later, I’m Very Into My Results
Courtesy of Dr. Tepper
Fat: It’s a lumpy, liquid gold that—when used as an injectable—promises lifted cheeks and smoothed skin. Fat has evolved into something of a commodity in the world of aesthetic medicine, where there’s a growing appreciation for its ability to augment—boosting volume, for example, in the cleavage or cheeks (either set)—and to improve skin quality. More and more doctors, and their patients, are saying that fat is the natural-looking volumizer we’re all craving in this era of filler fatigue. It’s one reason why I decided to get facial fat grafting earlier this year.
If you’ve been hanging around Allure, you’re probably an expert at this point on how hyaluronic acid-based filler works. If by chance you’re not, here’s the SparkNotes version: It fills where there is facial volume loss and augments areas of the face you might wish to change the shape of, like the lips. Though it’s beloved by many, filler can potentially lead to complications or that puffy appearance known as “pillow face.” While I personally hadn’t experienced facial swelling from filler placement, I did have a mishap from hyaluronic acid filler under my eyes—small, raised mounds (called malar edema). that took several years (yes, years) to resolve naturally.
Fat, on the other hand, behaves differently than filler: It is harvested (via lipo) from your own body, and once it’s injected back into your face, it becomes a part of the areas where it is placed, says Oren Tepper, MD, a board-certified plastic surgeon in New York City, who performed my own fat grafting procedure. The fat attaches to surrounding tissues, forming a new blood supply and acting as if it had always been there. Not all of the fat cells survive: Over the course of several months about 50 percent of the injected fat takes hold and settles into your face, explains Melissa Doft, MD, a board-certified plastic surgeon in New York City. And what’s left is permanent, unlike hyaluronic acid filler. (While new evidence suggests that hyaluronic acid fillers can last longer in the face than doctors originally thought, it’s not permanent.) Of course, there are risks of complications with fat injection, too, including asymmetry or lumpiness. And in this case, they won’t fade away over time, and can’t be reversed with hyaluronidase (an antidote to hyaluronic acid fillers).
Though some of the positive effects of facial fat grafting are immediate, your ultimate results are not seen until you’re six months post-op. You might expect to see more dramatic results from a procedure over time—but with facial fat grafting, it works in reverse, since about half of the fat that’s injected doesn’t “take.” Dr. Doft explains that’s because, “When you’re injecting a whole bunch of cells, for those cells to survive, they have to be able to absorb nutrients and then form teeny little blood vessels so that they’re getting nutrients. And the cells that were damaged or are too far away or in the center and can’t get those nutrients, those cells will die.”
It’s been six months since my surgery, and I am now finally at the point where I can see the full results. Let’s just say my grafted fat is surviving and thriving—but it’s certainly settled.
That’s not necessarily a bad thing. Right after the surgery, I took a look at my face in my phone’s front-facing camera and was stunned to see a completely different person staring back at me. I looked like a South Park character (I just aged myself) with an unnatural-looking round face. Over the next few days, I remained a little swollen and bruised on both sides of my face, mostly by my temples, but my under-eyes were shockingly spared. I developed a weird purple pattern of bruising on the outer corners of both my eyes that looked like winged eyeliner. The pillowy, almost mushy feeling at my temples was the only thing that freaked me out a bit. I was afraid if I touched the area that it would leave a permanent dent and I’d have to go back in to see Dr. Tepper.
I am happy with my results and will probably stop here for now, but might consider another round of fat injections down the road.
Six months later, my face looks fuller than it was before surgery, but not nearly as full as it was post-surgery. Though the fat has remained under my eyes and at my temples, it’s settled and looks natural for me. I tend to notice the fullness in my face more so when I see pictures of myself than when I look in the mirror. I look rejuvenated, my skin quality has improved, there are fewer lines around my eyes when I smile (with or without Botox), and my cheeks look fuller. I couldn’t have asked for anything more from this surgery.
I am happy with my results and will probably stop here for now, but might consider another round of fat injections down the road. I wouldn't be alone in going back for more. Because of the way fat settles, many patients return for a followup procedure if they want a little more fullness than what they ended up with. And how long will the results last? “We say [facial fat grafting] is semi-permanent,” says Dr. Tepper. “I think your fat transfer is going to last forever. What I can’t do is stop the aging process from continuing—you will continue to lose volume in your cheeks and at your temples at the same rate we would have expected.”
You can read about my full facial fat grafting experience below:
In this story:
Why I got facial fat grafting
I was 36 at the time and I wanted more volume under my eyes and at my temples. Where I used to see fullness and rounder features, I now saw hollowness that, despite my best efforts, no energy device like Morpheus 8 or Sofwave could fix. (I did like the improvement in skin quality that I got from Sofwave though).
Taking fat from one part of your body and reintroducing it to another is by no means a new procedure. Facial fat grafting dates back to the 19th century, but gained popularity in the 1980s, thanks to the advent of modern liposuction. In the years since, the understanding of the role that fat plays in the overall appearance of the face has evolved and today, almost half a million facial fat grafting procedures are performed worldwide each year, according to a study published in the Journal of Clinical Medicine.
“Of all the things I’ve seen in my 20-plus years in plastic surgery, I think there is nothing that has changed the paradigm of facial aesthetics more than the appreciation of volume in the face as a whole,” says Dr. Tepper. “We’ve come to realize that fat is important to maintaining the structure of the face—and that we can prepare and safely place fat back into the face to maintain and enhance that structure.”
Fat has evolved into something of a commodity in the world of aesthetic medicine.
Fat transfer can add volume and even change the shape of the face, like evening out the under eyes and rounding out the temples. It’s most often performed concurrently with facelifts, blepharoplasties, and brow lifts. “I would say 90 percent of my facial rejuvenation patients, like facelift patients, are getting some [facial fat grafting], as well,” says Dr. Tepper. As a standalone procedure, facial fat grafting saw a 1% rise in the US in 2023 for a total of about 34,000 procedures (a far cry from the 5.3 million hyaluronic acid filler procedures performed the same year). That statistic, however, does not account for the times when it's performed in conjunction with a larger facial rejuvenation procedure, like a facelift. When facial fat grafting is performed on its own, it tends to be on patients in their 20s to mid-40s, explains Dr. Doft. “Some of my patients say, well, let me start with the fat grafting, and put off a facelift for a few years.”
In my case, I really wanted to address the volume loss at my temples and under my eyes, but I wasn’t willing to try hyaluronic acid fillers again out of a horrible fear that if I dared to put filler in my tear troughs, my malar edema would resurface. (As an asterisk, I continue placing filler into my lips and chin.)
I ultimately decided to go for a consultation with Dr. Tepper, who specializes in a facial fat grafting procedure that he calls the Boomerang Lift—adding fat to the upper cheeks and around the eyes, in the shape of a boomerang. (Dr. Tepper estimates that the Boomerang Lift accounts for about 25% of the procedures he performs, almost always done as a standalone.)
At my consultation, I was quite humbled when Dr. Tepper projected a large photo of my face, with every pore and thread vein magnified, to show me where he would be filling with fat: under my eyes, in my upper cheeks, and in my temples.
Though he said that I didn’t really need the procedure per se, as I have a relatively full face with minimal volume loss, in transferring fat to the areas where hollowing was starting to occur, I would simply be enhancing my features. “By even adding the smallest bit of fat into a face such as yours, it makes a huge difference in enhancing already great features,” Dr. Tepper explained.
I was excited at the thought that my own fat could correct hollowing and brighten any trace of dark circles under my eyes. Additionally, having fat injected into my temples would lift my brows slightly and round out the upper part of my face.
A few weeks after my consultation with Dr. Tepper, I decided to schedule my surgery for late February because I wanted to make sure I could take the time off from work (I am a teacher) and not have to go to school swollen and bruised and scare any of the kids away. (Although in hindsight, maybe that wouldn’t have been such a bad idea.) Unlike a quick trip to your dermatologist or plastic surgeon for hyaluronic acid filler, fat grafting involves going under IV sedation, a type of anesthesia administered through a vein, and requires much more forethought and planning.
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A quick lesson (promise!) on facial fat grafting
I would be remiss as an educator if I didn’t give you some context on fat grafting and what the procedure actually entails. In the biz, we call it “prior knowledge” so listen up!
“[Fat grafting] is the idea that you’re taking fat from one part of the body and you’re placing it elsewhere,” says Dr. Tepper. The fat is taken by means of liposuction from your abdomen (as was the case for me), flanks, or, if you’re on the thinner side and don’t have enough fat in those areas, the middle and back of the thighs.
Once the fat is removed and placed in syringes, it’s reintroduced or injected into the areas in the face where you want to add volume. Again, in my case, it was reintroduced into my tear troughs (under eyes) and temples. Dr. Doft explains that once the fat is injected and settled, to only expect “about 50% of the fat to take.” Although in the face, she says, it could be up to 70%. Though fat is used to augment similarly to filler, fat is a live substance and filler is not, so the two are not interchangeable: “As a general rule of thumb, when fat is used for structural support to build foundation and volume, it’s very good,” says Dr. Tepper. “I think when it’s used simply as a replacement for filler, for fine lines and wrinkles, and areas of depression like the nasal labial folds, that’s not good. That’s not what it’s intended for.”
Goodbye filler, hello fat
Before my fat transfer, Dr. Tepper said I would have to prep the canvas first. So two weeks prior to my surgery, I had the remaining filler under my eyes dissolved. It was approximately five years old at that point and still causing me grief and swelling.
Dr. Tepper used hyaluronidase to dissolve my filler and though it stung my undereyes when injected, it hurt so good knowing that the filler was finally being put out of its misery. It’s not exactly necessary to dissolve filler first, says Dr. Doft—there is no contraindication with filler and fat—but your results might not look quite right if fat is injected under filler.
Beyond that, the majority of my preparation occurred the night before surgery: I ate nothing past 12am and avoided coffee in the morning. I was allowed to have water two to three hours before my surgery but no food.
The very real (and detailed) experience of having my stomach fat placed into my face
On the day of my surgery, not counting pre-op and post-op time, the actual procedure took a little under an hour. I opted for IV sedation, a twilight sleep, though a patient has the option to use only local anesthesia for a fat grafting procedure. Personally, I wanted to just wake up with a fuller face without having to endure the poke of the cannula going deep into my skin.
Before the anesthesia, Dr. Tepper took a pen and drew on my face to indicate the access points where he would be placing the fat. I walked from the consultation room to the operating room and laid down on the table. I turned my head to find the anesthesiologist looking for “a good vein” and moments later I dozed off to sleep.
Dr. Tepper made two openings in my abdomen—one was right below my belly button and the other a few inches below that—then performed tumescent liposuction (the medicine in the tumescent fluid helps to numb the area and also minimize bleeding). Due to the nature of the procedure and the importance of keeping the fat cells in good condition, he harvested the fat from my abdomen manually (instead of using a power-assisted liposuction machine).
The next step of the process was preparing my abdomen fat to be transferred into my face: Dr. Tepper let my fat sit out on a table for about 20 minutes so it could “settle by gravity” before being “placed in a centrifuge,” he says. “The way I like to prepare the fat is to roll it out on the table onto some non-stick gauze because it helps to get rid of any excess fluid and then run it through a strainer.” Once the fat was ready, Dr. Tepper placed it into small syringes that are the same size as those used for filler, measuring around 1 milliliter (mL) or 1 cubic centimeter (cc). “You use these really fine cannulas, which are needles with a blunted tip,” he says. With the syringes of my fat ready for injection, Dr. Tepper placed the cannula into the two different access points on both sides of my face: at the corner of my eyebrows to fill the tear trough and cheek area, and at the hairline to fill my temples. These access points were chosen because they are hidden; no one would ever know once I was healed that I had fat transferred to my face. The fat was placed under my muscle and just above the bone and the results showed immediately.
On the healing road—with my abdomen fat now in my face
Once I regained consciousness in the recovery area after my surgery, I looked weird and swollen, but I knew that the fat would settle over the next couple of weeks so I was happy. The only discomfort I experienced after surgery was in my abdomen. It felt sore, as if I had just completed an intense abdominal workout.
As soon as I returned home I started on oral antibiotics, which I remained on for a week to prevent an infection, along with oral steroids for five days to minimize swelling. I was advised by Dr. Tepper to relax and stay home for three days post-procedure. I heeded his advice. Despite diligently taking my steroids, I was still a little swollen and bruised on both sides of my face.
I took extra care of my stomach which was also bruised—and sore. I felt virtually zero discomfort in my face. By the fourth day post-procedure I was back to my normal routine; my foundation and concealer covered up my bruises beautifully. About a week after surgery, I was able to get back to working out–but nothing too intense, Dr. Tepper advised, because my abdomen was still a little sore. He told me to expect 90 to 95 percent of my results at the two-month mark as the skin contracts. “That last 5 percent takes longer,” he says.
The risks involved with facial fat grafting
Any surgery involves risk. With facial fat grafting the risks are low but always possible. They include insufficient survival of the fat that was grafted, infection, lumpiness, asymmetries on either side of the face, and growth of the fat cells if you gain or lose weight. While the thought of fat cells expanding in your face sounds extremely scary, Dr. Tepper assured me that you won’t get “isolated specific growth” in just those areas where you reintroduced fat. If you do experience a significant amount of weight gain, these pockets of new fat in your face would grow proportionally to the other areas of your body.
If a patient is over-injected and wants less dramatic results, the fat can be removed—but it’s extremely difficult to do so. That’s because once the fat is reintroduced into areas of the face it “incorporates into your tissues,” Dr. Tepper explains. It can only be removed surgically by means of liposuction—and the thought of that does not sound fun at all. “A micro-cannula is placed into the face, and micro-liposuction is performed manually,” says Dr. Tepper.
There is another—very rare, but very serious—potential complication: “It is possible that, when injecting fat, the fat enters an artery and then travels through the arterial system to the brain, leading to a stroke. This is very uncommon and using blunt tip cannulas reduces the risk,” says Dr. Doft. One review of literature, published in the Journal of Clinical Medicine in 2022, states that severe complications “should be considered very rare and almost anecdotal (roughly one in 5 million). Still, it is impossible to know if all the cases of severe complications have been reported.”
Drumroll please—how much does facial fat grafting cost?
While filler is certainly more affordable in a single visit, if you continue to use filler over the course of your lifetime, it adds up. I say that partly to soften the blow of how much fat transfer costs: The procedure I got runs between $10,00 to $15,000—the former being the cost of the under eye and cheek area and the latter being the cost if you add fat grafting to the temples. For each additional area of the face that you want grafted, expect to pay an extra $2,500 to $5,000. The cost of facial fat grafting will of course vary based on the surgeon and geographic location. In New York City, prices are on the high end of the spectrum.
Also, it’s worth considering that some patients wind up going back for a second round to add more fat. It all adds up, but in my opinion, now that I’ve seen my own results, there is just no substitute.
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Originally Appeared on Allure
