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Surgeons face off on virtues of fillers versus fat grafting

Key iconKey Points

  • Fillers more easy to remove than injected fat, one physician says
  • Successful fat grafting is technique-dependent and has steep learning curve

Cosmetic and plastic surgeons agree that replenishing volume loss is key among the goals of facial rejuvenation. But how best to achieve that volume restoration remains a subject of debate.

There's the autologous filler — fat — and then there's an array of other injectable fillers that each have their own strengths and weaknesses. Val Lambros, M.D., of Newport Beach, Calif., and J. William Little, M.D., clinical professor of plastic surgery, Georgetown University School of Medicine, Washington, recently faced off on this question at the annual meeting of the American Society of Aesthetic and Plastic Surgeons.

Dr. Lambros defended the use of fillers, while Dr. Little championed the use of fat. In a recent interview with Cosmetic Surgery Times, the pair reprised their views, and they are presented here.

VAL LAMBROS, M.D.: "In the right hands, volume can be a valuable component of making an older face look better. As certain faces age, they get thinner, and we can make these faces look better by putting something in rather than taking something out. The question is, what kind of 'tool' should we use to accomplish this? I do some fat injections in nearly everyone for whom I do a facelift. Fat has advantages, and so do off-the-shelf fillers. Unfortunately, outlandish claims are being made about fat grafting's efficacy with no evidence to support those claims. Consequently, the use of fat is garnering a fair amount of enthusiasm without users fully understanding some issues surrounding it.

"For instance, injected fat can grow. This will be the greatest long-term problem with fat. I have seen increasing numbers of people who have gained weight after their fat injections: Their faces are growing and it doesn't look good. What's more, fat is difficult to remove. You can remove it from certain areas, but if, for instance, someone's entire cheek has been filled with fat, you just can't get it all out. I think that, in the future, we are going to see a wave of people who can be identified as those who have had overzealous facial fat grafts. Just like you can tell a '60s rhinoplasty or an '80s facelift, you'll be able to identify people who have had fat grafts that continued to grow because their faces will look like balloons.


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