"Once you do it, you won't go back to other fillers," she says.
Fat competes with a growing armamentarium of artificial fillers, but according to Dr. Obagi, there is no comparison. Fat has a better texture and is easier to work with, she says. It can be placed deep, for true volume replacement. It's safe, whereas the problems associated with longer-term fillers remain a question mark.The biggest advantage is abundant, low-cost supply.
"I can't imagine pulling 30 cc of Restylane off the shelf. It's cost-prohibitive," she says.
Shifting paradigms For Dr. Obagi, the process of switching from tightening to volume replacement as a primary strategy for rejuvenation began about seven years ago, she heard a presentation by Sidney Coleman, M.D. She studied chronological photographs of patients, noting volume changes over time. Finally, a patient made the case.
"She'd had a facelift, cheek implants and lower eyelift but looked like a skeleton," Dr. Obagi says. "I wondered what to do for someone like that."
The answer was fat grafting. After three transplants, the patient looked as if she'd lost 15 to 20 years, Dr. Obagi says.
Fat transfer versus facelift According to Dr. Obagi, 80 percent of the people who come into her office for a facelift consultation change their mind and sign up for fat transfer instead.
"They fear looking artificial or too tight, or looking like someone else. I give them a PowerPoint presentation, and patients realize they may need to do the fat transfer once, twice or three times, but they like the look," she says.
Young women who have had babies are another category of patients. After childbirth, some lose facial volume. Cheeks flatten. Nasolabial lines and orbital rims become more noticeable.
Says Dr. Obagi, "Pulling tight isn't the solution. These patients are too young. Implants wouldn't correct the nasojugal junction. But if you fill in, you can hide the fat bags and bony rim and pump up the cheek."
Another group of patients are 60 to 70 years old. They've had laser treatment, but still have mild to moderate facial laxity. Fat transfers fill deeper folds and lines and reduce laxity. Finally, Dr. Obagi uses fat transfer as an adjunct to the full- and mid-facelift.
On the other side of the spectrum are the patients on whom Dr. Obagi will not perform fat transfers. She says the procedure doesn't work for smokers. Fat transfers can't survive the added stress of vascular constriction. People on blood thinners also get poor results, because the drugs induce bleeding into the transfer area, killing fat. About 40 to 50 percent of fat placed in muscles will survive, but overfilling is not the answer.