Dermal Fillers vs. Fat Grafting: What’s Best For You?

Facial rejuvenation and contouring is possible with both dermal fillers and autologous fat transfer. So, which injectable solution is best for you?
Patient Perspective
Written by India Bottomley
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Dermal Fillers vs. Fat Grafting: What’s Best For You?Olena Yakobchuk/Shutterstock

At this point, you’re likely familiar with the idea of dermal fillers. Not to be confused with neurotoxins like Botox® that temporarily reduce the appearance of lines and wrinkles by paralyzing the muscle responsible for movement, fillers are used to contour the face by restoring volume to areas that show signs of aging or reshaping certain features (think: nose and lips).

Depending on the type of filler used, touch ups may be needed as frequently as every six months. For patients seeking a longer lasting solution that doesn’t involve a foreign substance, fat grafting offers similar facial rejuvenation without the risk of rejection.

So, what are the pros and cons of each procedure? And which one might be best for you? A board certified dermatologist and two patients weigh in on how dermal fillers and facial fat grafting work.

What Are Dermal Fillers?

Dermal fillers or ‘fillers’ as they’re commonly known, are substances that are injected into the skin to restore volume or reshape a particular area. “Fillers require no surgical procedures, and you can just come in and do the injection,” says Samer Jaber, MD, a board certified dermatologist in New York City. “Most fillers can be dissolved. So, if you don't like the results or have an unusual reaction, it can be removed.”

Made of hyaluronic acid (HA), calcium hydroxylapatite (CaHA), and poly-l-lactic acid (PLLA) to name a few, fillers have varying degrees of permanence. While HA fillers like Juvederm® and Restylane® need to be touched up every six to 12 months, semi-permanent options like Sculptra® (a PLLA filler) Radiesse® (a CaHA alternative) can deliver results for upwards of two years or more.

What Are Fillers Used For?

Fillers are used to rejuvenate areas of the face that have lost volume due to the natural aging process. Commonly used to plump the lips, volumize the cheeks, and minimize the appearance of under eye bags, filler can also be used to alter refine the shape of the nose (a.k.a. liquid rhinoplasty) and define the jawline. For patients with atrophic (read: depressed) scarring, a small amount of filler may be injected to smooth the skin.

What Is the Procedure and Recovery Process?

Downtime after fillers is minimal. Normal activity can be resumed immediately (though you may be told to refrain from working out for 24 hours). Patients are often able to schedule the procedure during their lunch break, but it should be noted that swelling and bruising at the injection site is possible and usually resolves over the course of five to seven days. Unlike neurotoxin injections that take a week or more to kick in, filler results are immediate.

How Much Do Dermal Fillers Cost?

The cost for fillers varies greatly depending on which product is used and how many units is required. Generally speaking, cost varies between $250 and $1,500 per syringe.

What Is Facial Fat Grafting?

Also known as lipoinjection and autologous fat transfer, facial fat grafting offers an alternative to dermal filler. Rather than having a forgeign substance injected into the face (like the ones described above), fat grafting involves the injection of a patient’s own fat cells to plump areas of the face that show signs of aging. As such, there is no risk of your body rejecting the graft.

Unlike the immediacy of fillers, the final results of fat grafting can take three to six months to reveal themselves. This is the length of time it takes for the graft to become established in its new location. During that time, the body re-absorbs a percentage of the fat (30 to 50 percent) that was injected, which is why providers often ‘overfill’ the area to start. Once the process is over, the graft is permanent, though revision procedures may be considered down the line.

What Is It Used For?

Fat grafting is used for facial rejuvenation, including volumizing the cheeks, plumping the lips, filling in the under eye area, reshaping the nose, defining the jaw, and even augmenting the breasts.

What Is the Procedure and Recovery Process?

Lipoinjection is a two-part process. First, fat cells must be surgically harvested from one part of the body, so they can then be purified and then injected into the face. Fat is generally collected from the hips, thighs, or stomach. Both of these procedures can be carried out as outpatient surgery under local anesthesia (some providers and patients may prefer general anesthesia to control pain).

Bruising and swelling can be expected at both the donor and recipient sites, and advice on how to manage this will be explained during preoperative consultations. “Both [filler and fat grafting] have minimal pain and discomfort during the injection, which can be easily managed with topical numbing gel,” Dr. Jaber says. “You may be slightly more swollen for a few days with fat transfer, and both procedures can result in mild bruising.”

How Much Does Fat Grafting Cost?

The average cost of a facial fat transfer is $5,000, though this varies depending on the area being treated.

Patient Perspective

Here, two patients share their experience with facial fat grafting. In one case, the treatment replaced a high-maintenance filler habit. In the other, it delayed the need for a more invasive facelift.

Mila, 35, New York, NY

Mila started her facial contouring journey with HA-based Juvederm® fillers. As time went on, she decided she would like a longer term solution and opted for facial fat grafting about a year ago.

The AEDITION: How did your filler experience differ from fat grafting?

Mila: I started getting fillers when I was 25, so I spent close to 10 years getting injections topped off every eight months or so. The procedure for getting fillers is very straightforward. I used to have them during my lunch hour at work! With fat grafting, the process is somewhat more involved. They have to collect the cells, which is a procedure in itself, and then inject them. The collection procedure was new to me, but it was straightforward and painless. I would say the fat injections were a little more painful than fillers, but still absolutely manageable.

The AEDITION: How did you find the fat grafting process, from the procedure to recovery?

Mila: Both parts of the procedure went very smoothly for me. I had local anesthesia for both parts. There was some discomfort, but I didn’t feel any pain whatsoever. In terms of recovery, I found that I felt quite tired for the first couple of days. It could have been stress from the lead up to the procedure or the actual surgery. I’m not sure. I had a fair amount of bruising but not too much pain. I followed my surgeon’s directions regarding pain management, and it worked very well for me.

The AEDITION: In terms of results, how were they different for each treatment?

Mila: I have found the results from the graft to be softer than the results achieved from fillers. It could simply be because I went to a different practitioner though. The main drawback for me was the length of time between the procedure and being able to see the final results. I had to wait a good few months for the area to completely settle, which is a contrast to quick-fix fillers.

Sonia, 43, Long Island, NY

Sonia opted for fat grafting after discussing rejuvenation options with a plastic surgeon. As she noticed her face beginning to lose volume as she aged, she thought it was time for a facelift, but the injections have so far offered the results she was looking for.

The AEDITION: What led you to consider facial fat grafting?

Sonia: I found myself becoming increasingly bothered when I looked at my face in the mirror. I was seeing deeper and deeper wrinkles, my skin had lost its youthful appearance, and I was generally looking for a do-over. My cheeks had previously been very plump and were a real trademark for me when I was younger. Not seeing them when I looked in the mirror anymore was pretty disheartening.

The AEDITION: How did you find the experience of having the procedure?

Sonia: I had initially been considering having a facelift, so, by comparison, this was a real walk in the park! Both parts of the procedure were straightforward, and I was taken care of very well by my surgeon and his team. I opted for local anesthesia, which allowed me to have a somewhat quicker recovery than I would have had with general anesthetic involved. The process is painless, and I can’t even say I was uncomfortable at any point. I was asked continuously if I was in any pain, so the team was very careful to take care of that.

The AEDITION: Are you pleased with the results?

Sonia: I really am. For me, it was the perfect solution for what I was looking for. It’s a treatment that will tide me over until I have a facelift when the time is right. The results make me look better than I could have imagined — better than I did in my younger days even! The fact that they will stay like this for some time is a relief and having my next procedure in mind for whenever I am no longer satisfied with the results from this one is very reassuring.

The Takeaway

Dermal fillers and fat grafting both offer facial rejuvenation and contouring results in an injectable form. While filler provides an immediate result, it requires regular maintenance. Fat grafting is a slightly more involved procedure because it is a two-step process and results take three to six months to take effect. Once the graft becomes established, it is permanent (though touch ups may be needed down the line). Consulting with a board certified dermatologist or plastic surgeon will ensure you receive the best treatment for your aesthetic goals.

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INDIA BOTTOMLEYis a contributing writer for AEDIT.

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