Fat Transfer – Face

Facial fat transfer (also called autologous fat grafting or "fat injections") is a procedure that harvests your own fat — usually from the abdomen, thighs, or flanks — and re-injects it into areas of the face that have lost volume with age, such as the cheeks, temples, and under-eye area. Because it uses your own tissue, it is generally well tolerated by the body.

Your surgeon will assess you and advise whether this procedure is suitable, but the final decision is always yours.

You may benefit from facial fat transfer if you have:

• Volume loss in the cheeks, temples, under-eye (tear trough), or around the mouth associated with ageing
• A hollow or gaunt appearance you would like to soften
• A preference for a natural, longer-lasting alternative to dermal fillers using your own tissue

Fat transfer is often combined with a facelift or performed as a standalone procedure for patients not yet ready for more extensive surgery.

Fat transfer restores lost facial volume using your own tissue, avoiding the allergy risk of synthetic fillers. A meta-analysis of thousands of patients undergoing facial fat grafting found high patient satisfaction (over 90% in reconstructive series) . Because some of the transferred fat can establish a blood supply and survive long-term, results can last years, although some of the initial volume is typically reabsorbed by the body.

Dermal fillers (hyaluronic acid-based) provide similar volume restoration without a donor-site procedure, are adjustable, and can be dissolved if needed — but require repeat treatments every 6–18 months and do not use your own tissue. A facelift repositions sagging tissue rather than adding volume, and is often combined with fat transfer for a complete result. Facial implants provide permanent structural augmentation but are more invasive.

The procedure is usually performed under local anaesthetic with sedation, or general anaesthesia if combined with other surgery, and typically takes 1–2 hours.

• Fat is harvested from a donor area (commonly the abdomen or thighs) using a gentle liposuction technique through a small incision
• The harvested fat is processed (commonly by centrifugation) to separate healthy fat cells from blood, oil, and fluid
• The purified fat is then carefully re-injected into the face in tiny amounts, using multiple passes with a blunt cannula, to maximise survival and create a smooth, even result
• Because 20–50% of transferred fat volume is typically reabsorbed by the body over the following months, your surgeon may intentionally place slightly more than the ideal final volume

All surgery carries risk. The figures below are based on published meta-analyses specific to facial fat grafting.

General risks of any operation: infection, bleeding, allergic reaction (though allergic reactions are very unlikely since your own tissue is used).

Specific risks of facial fat transfer:

• Overall complication rate: meta-analyses report rates ranging from 2.27% to 7.7%, depending on how strictly complications are defined and reported
• Contour irregularity: the most common local complication, occurring in 0.5%–2.9% of cases; usually related to uneven fat placement and can often be improved with massage, additional fat grafting, or minor touch-up procedures
• Prolonged bruising or swelling (over 2 weeks): occurs in around 0.6% of patients and usually settles with time
• Fat necrosis / oil cysts / granuloma formation: occurs when a portion of the grafted fat doesn't establish a blood supply; can present as small lumps and occasionally needs drainage or minor excision
• Infection: rare, reported at 0.10%–0.54% of cases
• Over- or under-correction: fat survival is not fully predictable, so results can be more or less than intended; further grafting or minor adjustment (including surgical removal, if needed) can address this
• Donor site complications: contour irregularity or firmness at the fat harvest site occurs in around 1.2% of cases, with less common issues including prolonged redness (0.9%) and infection (0.5%)
• Serious vascular complications (rare but important): the most serious possible complications result from fat accidentally being injected into a blood vessel. This is very rare but can potentially cause:
• Vision loss: caused by fat travelling into the blood vessels supplying the eye; this is a recognised though rare complication, and unfortunately current treatments are not reliably effective once it occurs — which is why prevention through careful injection technique (blunt cannulas, low pressure, avoiding high-risk areas like the glabella/between the eyebrows) is critical
• Stroke: an extremely rare complication from fat entering the blood vessels supplying the brain; symptoms would appear rapidly (within hours) and require emergency treatment

Your surgeon will use recognised safety techniques — including blunt, large-bore cannulas, low-pressure injection, and avoidance of high-risk zones — specifically to minimise the risk of these very rare but serious events.

• Tell your surgical team about all medications, blood thinners, and supplements — vitamin E, fish oil, and ginkgo biloba are typically stopped beforehand to reduce bruising risk
• Avoid smoking, as it significantly affects fat graft survival by reducing oxygen delivery to the grafted tissue
• Discuss your goals and the amount of volume restoration you're hoping for — understanding that some of the grafted volume will be reabsorbed is an important part of planning

• Swelling is often more pronounced than you might expect initially, and can take 2–4 weeks to substantially settle, with subtle final changes over several months
• Bruising at both the donor and injection sites is common and usually fades within 1–2 weeks
• You will be advised to avoid pressure on the treated facial areas (e.g., sleeping face-down, tight masks) for a period after surgery to protect the delicate healing fat graft
• Because some fat volume is reabsorbed, the final result is usually assessed at 3–6 months, and occasionally a second, smaller top-up session is planned

How much of the transferred fat actually stays? On average, around 50–60% of the grafted volume remains at one year, though this varies from patient to patient and by facial area — the perioral (around the mouth) and temple areas tend to have lower survival rates .

Is fat transfer safer than synthetic fillers? Both have excellent safety records overall. Fat transfer avoids any risk of allergic reaction since it's your own tissue, but the harvesting process and injection technique carry their own specific (though rare) risks, including the serious vascular complications described above.

What is the most serious risk I should know about? Although extremely rare, the accidental injection of fat into a blood vessel can cause vision loss or stroke. This is why experienced surgeons use specific techniques — blunt cannulas, low injection pressure, and caution around high-risk areas like the area between the eyebrows — to minimise this risk as much as possible .

Will I need more than one treatment? Some patients achieve their desired result in a single session; others, particularly those seeking significant volume restoration, may plan for a second smaller session once the initial results have settled at 3–6 months.

Can this be combined with a facelift? Yes, fat transfer is very commonly combined with a facelift, as repositioning sagging tissue and restoring lost volume address different aspects of facial ageing.

--- This document is for general information only and does not replace a full, individualised consultation with your surgeon.