Facial FatGrafting

Volume loss is at the heart of facial aging

The face does not age primarily by sagging — it ages by deflating. Over the course of decades, the fat compartments that give the young face its fullness, convexity, and luminosity gradually diminish. The midface hollows. The temples thin. The undereye area deepens. The cheeks lose the gentle projection that the young face takes for granted. Skin folds and wrinkles are, in large part, a downstream consequence of this underlying volume loss — and no amount of skin tightening can fully address them without first restoring the structural support beneath.

Facial fat grafting — also called fat transfer or autologous fat transplantation — addresses this fundamental cause directly. Fat is harvested from a donor site on the body (typically the abdomen, flanks, or inner thighs), processed to isolate the most viable fat cells, and reinjected into the depleted facial compartments using fine cannulas. The result is a gradual, natural-looking restoration of volume that integrates seamlessly with surrounding tissue — because it is living tissue from the same person.

Unlike hyaluronic acid fillers, which metabolize over 12–24 months and require repeated treatment, a meaningful percentage of transplanted fat survives permanently. After an initial period of settling — during which some fat is resorbed — the surviving fat cells integrate into their new location and remain as long-lasting volume restoration.

Where fat is placed — and why

The face is divided into discrete fat compartments that deflate at different rates and to different degrees. Dr. Rafizadeh addresses each patient's specific pattern of depletion rather than applying a generic injection protocol. The most commonly treated areas include:

Midface / malar eminence — restoring projection over the cheekbone is often the highest-impact change. Even a modest increase in malar volume lifts the midface optically, reduces the depth of the nasolabial fold, and produces a younger, more rested appearance without any upward pulling or distortion.

Tear trough / infraorbital hollow — the shadowed groove between the lower eyelid and cheek is among the most aging features of the face. Small amounts of precisely placed fat in this compartment significantly improve the under-eye appearance, and the result tends to be more stable and natural-looking than filler in this location.

Temples — temporal hollowing is one of the most overlooked aging changes and one of the most effective to correct. Restoring temporal volume produces an immediate impression of youthfulness by re-establishing the smooth, convex skull silhouette of the younger face.

Nasolabial folds / marionette lines — these folds are partly structural (ligamentous), partly sagging, and partly volumetric. Fat grafting addresses the volumetric component by restoring the underlying support, which reduces fold depth without the firm, unnatural feel that filler in this location can create.

Lips — small amounts of fat can be placed in the lips to add natural fullness and address the fine vertical lip lines that develop with age. This is addressed in more detail on the fat transfer to lips page.

Harvest, processing, and placement

Facial fat grafting is a three-phase procedure: harvest, processing, and injection.

Harvest — fat is extracted from a donor site using a small-bore cannula and low-pressure syringe technique. The gentlest possible extraction is used, as high-vacuum or power-assisted harvesting damages fat cell membranes and reduces graft survival. Common donor sites are the lower abdomen, flanks, and inner thighs. Harvest typically leaves minimal bruising and resolves within 7–10 days.

Processing — harvested fat is processed to remove oil (from ruptured cells), blood, and tumescent fluid — all of which reduce graft viability and increase inflammation. Dr. Rafizadeh uses centrifugation at low speed followed by decanting, which concentrates viable adipocytes while removing non-viable fractions.

Injection — processed fat is loaded into fine syringes and injected in small aliquots (0.1–0.3 cc per pass) through micro-cannulas placed through 1 mm access punctures. Injection in micro-aliquots is critical: fat injected in large boluses does not survive because cells in the center of the bolus are too far from the vascular supply to receive oxygen. The threading technique — depositing fat along multiple tunnels in multiple tissue planes — maximizes surface contact between transplanted fat and host tissue.

Fat survival: what to expect

Fat graft survival is the central variable in facial fat grafting and the most common source of patient questions. Published survival rates range from 40% to 80% of transplanted volume at one year, depending on technique, donor site, recipient site vascularity, and patient factors such as smoking status and metabolic health.

Because some resorption is expected, surgeons typically over-correct slightly at the time of surgery — placing a small amount more than the target volume to account for anticipated resorption. In the first 4–8 weeks, the face will look slightly fuller than the final result; the actual result becomes apparent at 3–4 months and remains stable thereafter.

Fat grafting combined with facelift

Fat grafting and facelift address aging from complementary directions: facelift addresses descent and excess skin; fat grafting addresses volume deflation. Combining them in a single procedure — the "volumetric facelift" approach — produces results that neither procedure alone achieves. Tightening without restoring volume can create a hollow, stretched appearance; restoring volume without addressing descent produces a fuller but still aged face. The combination produces a genuinely rejuvenated result that is natural and appropriate to the patient's age.

Fat grafting can also be combined with blepharoplasty to address the tear trough simultaneously with lower eyelid surgery, or with rhinoplasty to provide nasal tip refinement support or dorsal augmentation using fat rather than cartilage in selected cases.

Cost in New Jersey

Standalone facial fat grafting typically ranges from $4,500 to $8,000 depending on the number of facial zones addressed and the volume transferred. When combined with facelift or blepharoplasty, the incremental cost is lower. Financing is available through CareCredit and Alphaeon Credit.