Richmond’s Nasal and Facial Plastic Surgery Specialists

Liposuction and Fat Grafting

watermark.glamourshot.fat trans“In October 2008, [Dr. Armstrong] transferred unwanted fat from my belly to replace long lost baby fat in my cheeks. A month later he performed a mini-facelift in his office with local anesthesia only. In less than a week, I was able to apply makeup and feel comfortable in public.”

-Barbara Slayton, a 75 year old patient of Mike Armstrong, MD


Liposuction is performed to reduce specific pockets of fat in the lower face and neck.  Even patients as young as twenty will notice pockets of fat in the neck or jowls but simply won’t respond to diet and exercise liposuction can help you to sculpt the neck and jaw line making you appear younger and swimmer.

Fat transfer is used to build up areas of thinning in the upper and middle face.  Fat is collected from other parts of the body, often by liposuction, and then injected into the face to add volume.  Fat provides a more permanent solution to facial volume loss when compared to commercial fillers.

Pre- and Postoperative Gallery

Frequently Asked Questions

What is liposuction?

Liposuction is the permanent removal of unwanted fat under the skin using a small suction tube, or cannula.  Under local or general anesthesia, the surgeon passes with the cannula back and forth under the skin.  The fat is pulled into small openings along the side of the cannula in little pieces break off to be removed by the suction.  Important nerves and blood vessels simply bounce off the blunt tipped cannula.  The incision is usually less than 1/4 inch and requires a single stitch to close.  Liposuction may be performed almost anywhere in the body, but is most commonly performed around the trunk or thighs.  Facial plastic surgeons typically perform liposuction in the jowls and in the neck under the chin.

Is liposuction for me?

Liposuction of the face and neck is most effective for young people with good skin elasticity.  If you are less than 40 years old and have specific areas of increased fat under the chin or in the lower face, then liposuction may be an excellent way to sculpt a more elegant jaw and neckline.  If your skin feels loose about the lower jaw and neck, then you may wish to combine liposuction with a facelift.

What is fat grafting?

watermarked surgical planFat grafting is transplantation of fat from one part of your body to another.  Typically, the fat is collected from an area of excess by liposuction.  The fat is then injected into the desired area through a small cannula (blunt tipped needle).  Small injections of fat can be used to fill specific defects on the face, such as the dark circles under the eyes, or to add volume to thin lips.  With structural fat grafting, much larger volumes of fat are used to replenish the volume of the entire face, injecting the cheeks, temples, eyebrows, nasolabial creases, and jaw line.

Is fat grafting for me?

If you are athletic and over 40 years old, you are likely beginning to see some thinning in your face around the cheek bones, under the eyes, and perhaps in the temples.  Fat grafting can replace the lost volume with greater permanence compared to commercial fillers.  For many patients, fat grafting alone can restore an appearance of youthful health without major surgery.  Transplanted fat retains the characteristics of the donor site, and should be used only if your weight is stable.  If you gain weight, the fat in your face is likely to grow.

What are the alternatives to fat grafting?

Fat grafting is the most permanent, natural solution for volume loss in the face, as it replaces lost fat with similar tissue.  Alternative surgical procedures include the use of implants, such as solid silicone or Gortex (ePTFE) implants that may be used in the cheeks, chin, jawline or lips.  Facial implants can last a lifetime and can be removed if necessary.  Implants are better at providing firm tissue support where the bone is inadequate, such as in the chin.  Implants can also be made soft enough to place in delicate areas, such as the lips.

For those who do not want a surgical procedure at all, commercial fillers such as Radiesse, Sculptra, and Juvéderm Voluma may be injected as a simple office procedure.  When used to enhance facial volume, these products last about 2 years.

Read more about injectable fillers

What are the risks of liposuction and fat grafting?

Liposuction can cause rippling, dimpling, and irregularities under the skin.  Liposuction does not correct “cellulite,” the lumpy appearance caused by large fat lobules or dimpling of the skin.  If liposuction is performed without a facelift and then the skin does not contract evenly, it could cause increased wrinkling.  Liposuction could potentially cause injury to nerves or blood vessels.  Bleeding is usually minimal, although bruises are expected, and a compression garment is usually required for the first week after liposuction.  Liposuction is properly performed superficial to the muscles.  Muscle weakness or injury to deeper structures is conceivable but quite unlikely.  Numbness of the skin is not expected and would likely recover within a few weeks if it occurred.  Most importantly, the volume of fat they can be safely removed at one time is limited. Liposuction is not a weight loss procedure and is not intended to replace diet and exercise.

Fat grafting is less predictable than injectable commercial fillers.  Typically, a surgeon injects about 50% more than the desired volume to account for expected volume loss of 1/3-1/2.  There is always a potential for over injection or under injection, which is dependent partly upon the artistic judgment of the surgeon, and partly upon the healing process.  Under treatment can readily be corrected with additional fillers, but over treatment may be difficult to remove.  By contrast, solid implants can generally be removed if unsatisfactory and most dermal fillers are temporary.

What can I expect after liposuction?

For liposuction to be effective, it is important to wear a compression garment for at least a week, so that the tissues can contract around the fat that has been removed.  In the face, this typically consists of an elastic sling under the chin and passing over the top of the head.  You should wear this at all times for the first week, except when bathing.  Continued use of the elastic sling during the second and third week is advisable at home or when otherwise socially acceptable.  Pain is generally mild after liposuction of small areas in the face and neck or after harvesting fat grafts from the thigh or abdomen.

What can I expect after fat grafting?

watermarked 5 days post fat transfer

5 days after fat grafting

Fat grafting causes significant swelling when compared to commercially injectable fillers.  You can expect that the surgeon will inject about 50% more volume than is cosmetically desired.  With additional swelling, it may appear that twice is much has been injected by the following day.  Most of the swelling will resolve within the first week, but the over correction may take several weeks to resorb.  The final result can be better predicted after at least 6 weeks.  There will be a sense of fullness or pressure, but pain is generally mild.