How to make a thin face look fuller with fat injections
The thin face, sometimes referred to as emaciated, can exist in both the young and the old. It is seen more frequently as one ages with loss of fat on the cheeks and the side of the face. But it can also occur as normal makeup on some people’s facial architecture, even when one is relatively young. (Abraham Lincoln is the most famous example from a historical perspective, actor Scott Glenn and others are more recent examples) Known medically as facial lipoatrophy, it can also occur from certain diseases and medications. (like HIV) Fat replacement by injection is a logical and minimally invasive method for its treatment.
Fat grafting is becoming increasingly popular and is ideal for the emaciated face. The fat is harvested with a small liposuction cannula from a suitable donor site. The amount of fat needed does not usually generate a significant change in the contour of the donor area. Therefore, patients should not expect to obtain an equivalent liposuction result elsewhere. I usually use abdominal fat taken from the inside of the belly button. There is still no scientific evidence to support one donor site over another in terms of being better fat that will last longer after transfer.
The fat is prepared by removing loose liquids and impurities by washing it and then spinning it in a centrifuge. It is then loaded into syringes and injected into the desired facial areas through the corner of the mouth, a crease in front of the ear, or within the crease of the nasolabial fold. The fat is injected into multiple small tunnels in a crisscross pattern if possible. The injected fat is then massaged until smooth with no obvious irregularities.
Injecting fat into the face is a bit of an art form. On the gaunt face, the area below the cheekbones and towards the side of the face are the most common. But other areas can be done as well, including under the eyes and around the base of the nose. The amount of fat injected is relatively small with less than 10cc on each side of the face. It may be surprising how even small volumes of fat can make a significant volumetric difference.
This procedure can be comfortably performed under local anesthesia, with oral or intravenous sedation if desired. Whether it is performed in the office or in an operating room depends on which provides the best sterility and has the necessary equipment for fat collection and preparation.
The unknown variable in this procedure for each patient is how much fat will survive. 100% fat survival should not be expected. But it is currently believed that the lateral area of the face and cheeks is the most favorable with studies reporting up to 70% retention. My experience is closer to 50% so an overfill is always done. What is seen three months after treatment can be expected to be preserved in the long term.
In older patients who may have some loose skin around the jowls or neck, it can be combined with a limited or upward facelift for even better results. While fat adds volume and can help fill in some of the loose skin, improvement under facial hollows should come from skin tightening. I have seen some reports claiming that the overlying skin improves after fat grafting, suggesting that the new fat somehow rejuvenates the aging skin. Some claim that it is the effect of the transplanted stem cells. I doubt there are such effects, but the underlying volume filler stretches the overlying skin and can give the impression of smoother skin.