DANA POINT, CALIF. – Fat transfer for facial volume restoration holds certain advantages over off-the-shelf fillers, according to Dr. Lisa M. Donofrio. Chief among them is that the procedure involves adding a biologically identical substance to the targeted treatment area.
Fat transfer "is also capable of dramatic changes [and] has the potential for permanence; it's nonreactive, and it may promote stem cell growth," Dr. Donofrio said at the Summit in Aesthetic Medicine sponsored by Skin Disease Education Foundation (SDEF).
In the upper third of the face, the goal of fat transfer is to achieve a smooth, convex forehead, forehead to brow continuity, full temples, and a "railroad tracking" of the upper lid, "so that the upper lid margin and the sulcus are parallel," said Dr. Donofrio of the department of dermatology at Yale University, New Haven, Conn. Advantages of using fat in the upper face, she said, "are that the results can be dramatic; it’s opaque; it’s structural and can be put in all layers of the skin; and it’s very long lasting."
In the middle third of the face, the goal of fat transfer is to achieve a smooth, convex cheek, lid to cheek continuity, full buccal fat, and a broad cheekbone, said Dr. Donofrio, who is also with the department of dermatology at Tulane University in New Orleans. She characterized fat transfer in the middle third of the face as "the longest lasting and [most economical] large-volume filler. It’s able to achieve three-dimensional volumization and it has very predictable longevity."
Dr. Lisa M. Donofrio
In the lower third of the face, the goal of fat transfer is to achieve cheek to prementum continuity, bucca to chin continuity, a continuous jawline sweep, and a full submandibular area. "The strength of fat in this area is its ability to be structural," she explained. "When combined with microsuction, it can redistribute fat to a youthful contour."
Dr. Donofrio routinely freezes fat prior to transfer "because it works," she said. "Why does it work? I have no idea, but maybe there is some microenvironment that is creating growth factors."
She uses the centrifuge minimally, "just to remove some of the tumescent fluid," and leaves triglycerides in the syringe. She places the fat into a freezer at –20° C for up to 12 hours, and then moves it to a plasma freezer at –30° C. She defrosts the fat rapidly prior to transfer.
Of the more than 6,000 fat transfers she has performed, about three-quarters of them have involved frozen fat. When patients return to her for additional volumization, "they will not entertain the idea of doing only a fresh fat transfer, because they think the frozen fat transfer did so well," she noted.
Dr. Donofrio disclosed that she is a member of the scientific advisory board of, a consultant to, and investigator for Allergan and Medicis. She is also an investigator for Cynosure, Kythera, Mentor, and Merz.
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