Successfully performed, fat grafting is undetectable to the observer as it rejuvenates as well as slows the aging process.
As one of the originators of fat grafting, beginning more than 25 years ago, my patients and I have tremendous confidence in both the retention and functioning of the fat grafts as well as the restoration of one’s natural aesthetic.
“There is nothing currently available that comes close to the aesthetic and anti-aging benefits of fat grafting.” – Dr. Andrew Kornstein
What patients should know about facial fat grafting…
- What exactly is fat grafting?
- Facial fat grafting and Profound-RF® are a powerful rejuvenative combination therapy.
- An FDA approved pulsed radiofrequency anti-inflammatory device is one of the secrets to an enhanced rate of recovery.
- A surgeon’s skill, experience and aesthetic vision is of utmost importance when fat grafting for total facial rejuvenation, from hairline to jawline.
- Fat grafting to the hands rejuvenates hands, naturally blending veins and tendons out of sight.
Fat grafting defined.
Living fat cells are the body’s most powerful stem cells; they are capable of rejuvenating age-related facial skeletal defects as well as the overlying skin. Grafting (what I do) means the fat cells are transferred to their new location where they get a new blood supply and are subsequently energized, secreting growth factors. It is the fat cells derived support and growth factors that rejuvenate the skeletal and skin organ systems allowing them to properly and optimally function.
Although fat cell grafting is long lasting(perhaps permanent), after roughly ten-fifteen years there is enough additional aging around the fat grafts that additional grafting will probably be needed. In comparison, fillers are temporary and do not share the genuine rejuvenative characteristics of one’s own fat-derived stem cells.
Facial fat grafting and Profound RF® are a powerful combination therapy.
Profound RF® quantitatively and qualitatively rejuvenates the facial skin. Profound RF® is either done before fat grafting to reduce skin redundancy relative to skeletal volume and shape, or alternatively many years after surgery when patient return saying, “my fat is gone.” In actuality the facial skin sleeve or skin size is simply too big for the underlying fat grafted structure, not unlike a body builder wearing an overly large garment such that their underlying definition cannot be appreciated.
Profound RF® also qualitatively rejuvenates facial skin restoring collagen, hyaluronic acid and elastin by awakening your on genes for these skin elements. In addition, Dr. Kornstein’s facial muscle rejuvenation technique (kornstein.com/profoundpr/) minimizes or eliminates the redundancy of the forehead, eye and mouth muscles, thereby successfully addressing transverse forehead wrinkles, low brows, crow’s feet, baggy lower lids, long upper lips, “smoker’s lines”, downturned mouth corners and thin lips. This reduces or eliminates the need for neurotoxins, s.a. Botox® used as a Band-Aid for redundancy of these muscles as well as loss of muscle volume of the lips commonly treated with filler.
An FDA approved anti-inflammatory radiofrequency device called “IVIVI” or Soft Pulse® dramatically enhances recovery. Since January 2010 the use of an FDA approved radiofrequency halo post-operatively used while at home has dramatically enhanced the rate of recovery. Proven to be safe in over ten years of clinical testing, it is in fact presently being studied to reduce head trauma in US soldiers. At this time 90% of our patients return to their normal activities within two weeks. For more information, please see the Recovery tab under Before and Afters on our site.
A surgeon’s skill, experience and aesthetic vision is especially important when using fat transfer for facial rejuvenation. Not all surgeons have the same aesthetic vision or ability. Not all surgeons know what youth or beauty looks like on the OR table during the creative process. Misconceptions about fat transfer abound primarily because it is relatively new compared to the mainstream menu of the average plastic surgery procedures. Perhaps some poor results by practitioners untrained in the nuances of the procedure have led to fat transfer being held to a higher standard than any other plastic surgery procedure, even those known to create more post-operative deformities and issues.
Patient Experiences - Facial Fat Grafting (Click Them To Open)
As a cancer survivor, I was waiting for the day people would stop asking “How are you feeling?” and instead say, “How are you?” That day has finally come.
Diane’s journey was very different from most. She wasn’t looking to shed years. She was hoping to erase the effects of multiple cancer surgeries, chemotherapy and radiation. “I did what I had to do to cure my cancer but the ravages of both the cause and the cure were written all over my face. The lower layers of fat that most people take for granted was erased and left me looking so gaunt, I would look in the mirror and not recognize myself.”
After waiting a couple of years, recovering from the inside-out, Diane decided she was ready to find a surgeon to restore her image. “I was trying to be hopeful. After so many surgeries I was a little nervous – there is always a risk.” But Diane was pleasantly surprised the day she met with Dr. Kornstein. “I immediately felt comfortable and safe. Everyone was so accommodating and helpful. They all seemed sensitive to the fact this was very personal for me. That was reassuring.” After the consultation Dr. Kornstein recommended fat grafting for Diane’s facial rejuvenation. “His confidence and track record with the procedure really won me over.”
Despite the considerable amount of fat used to rejuvenate and sculpt her face, the surgery was quite a success. Diane admits, “I took several months to completely heal, but it was worth it.” As a public speaker, her confidence is back – and so is her image. “I feel so back to myself. There is no evidence of the medical challenges I had to endure. I look better than ever.”
A genuine concern for how Diane is “feeling” has been replaced with a more casual, “how are you?” and Diane is grateful. “I know why Dr. Kornstein is so confident. His knowledge gives him an understanding of the procedure from the beginning to end. And in his fabulous hands and experience and you have the most important ingredients in a plastic surgeon.”
A Conversation with Dr. Andrew Kornstein: Pacesetter in the art of fat grafting.
Autologous Fat Grafting (AFT) is Mother Nature’s natural filler. Using one’s own living fat-derived stem cells in combination with experienced and time tested hands, an undetectable and natural look and soft feel to the face and other areas of the body is restored. Many physicians have joined in the fat grafting/injection rage in order to address patient demand, but few have the training, experience, knowledge or skill required to successfully deliver consistent results with this highly technique dependent procedure.
Fat Grafting (AFT) has caused considerable buzz lately and continues to grow, yet you have been involved with this procedure for over 25 years. What precipitated you interest that long ago?
Dr. Ralph Millard is not a household name, but to those of us well trained in plastic and reconstructive surgery, he is a mentor and legend. His publication, The Principalization of Plastic Surgery suggests physicians “replace like with like.” I was lucky enough in the early 1990’s to be in the same training program with Dr. Sydney Coleman when the whole notion of “replacing fat with fat” was born. At first it was rudimentary and experimental, but today after years of discussion, observation, combined with innate sense of aesthetics and artistry it has become my signature procedure. I am a proponent of reshaping (fat grafting), shrinking (Profound RF®) versus removing tissue whenever appropriate.
These principles apply for rejuvenation of the hands and breast augmentation/revision(where fat is the predominant element giving shape and size to the breast gland.
What is your opinion on synthetic fillers and collagen?
I started my private practice in 1993. Botox, Restylane®, Juvederm® or Radiesse® did not exist. Philosophically collagen did not strike me as the right thing to do because in fact it was the patient’s body rejecting the cow protein that created the clinical effect through swelling and allergic response. Clearly this is not a natural restoration of human tissue, nor a long term solution.
For me, the only authentic way to re-volumize the face or body was through fat grafting. It appealed to my aesthetic sense and philosophical belief that being Mother Nature’s partner was the right thing to do. I began doing it out of instinct and it has not only rewarded my patients, but myself as well.
What exactly is AFT? Why do you call it “dynamic surgery?”
AFT stands for Autologous Fat Transfer.
In short it is using your own fat tissue: taking the fat cells from one area (the donor site), purifying the fat cells which contain stem cells, and transplanting them into another area where they survive, grow and function--- excreting growth factors and other anti-aging co-factors.
Once harvested by hand-held liposuction (tiny incision in the skin), the centrifuged cells are placed in syringes and tiny strands of fat-derived stem cells are placed strategically so each has access to blood supply. Fat can be taken from anywhere on the body – no one source is better than another. It becomes an active part of the recipient area and ages like the recipient destination, not the donor site. This must be done in the operating room under general anesthesia(you are breathing on your own) for your safety as well as control of blood pressure to minimize bruising, swelling and for an accurate assessment of the final outcome while on the OR table.
I call it a “dynamic surgery” because after successful fat grafting, not only does the patient look younger but they actually grow younger, presumably through the active secretion of vascular (circulation) and other growth factors.
If one looks at an AFT patient who had the procedure 5 years ago, they will age more slowly going forward. It’s virtually universal. There is an active stem cell element at work, these fat cells are adult stem cells with the ability to repair and rejuvenate the area in which they reside.
With conventional surgery and fillers, you are cutting and tightening or adding volume respectively, but gravity and atrophy will continue to occur with time.
Who is a candidate? Who is not?
Virtually everyone is a candidate, but timing is important. The more aging to be repaired, the longer the recovery and once the facelift layer of the face has descended it may need to be surgically “lifted.” Profound PR® may be required before surgery to shrink excess skin and redundant muscle or many years (a decade or more) after AFT for the very same reasons. It is always better to consider AFT earlier rather than later.
Many surgeons are doing fat grafting today. How does your approach differ?
First, any procedure can be done well, or poorly. Not everyone has the patience, training or aesthetics. The learning curve is steep. Fat grafting is very technique dependent both in terms of preserving viability and function of the fat cells as well as determining their precise location. It demands a keen aesthetic sense because it is a truly a three dimensional proposition. Second, I understand the facial aging process including how the facial skeleton and fat pads age. I have the ability to look at a patient, glimpse into the future and predict how they will look in 5 years. That way I can anticipate how to apply the fat for the best outcome. Three, many practitioners use fat as a filler. They treat one or two areas and the cells don’t survive. I treat patients globally, from hairline to jawline, by doing the entire face as an anti-aging procedure. As a result, they age more harmoniously with all the aspects of the face aging at the same rate. The number of surgeons who prescribe to this method exceptionally are few and far between.
Dispel some common myths associated with AFT.
This is a good question. Many people leave my office excited, however, by the time they speak to friends or other practitioners they have doubts and default to conventional surgery. In retrospect I can assure you that those who opted for AFT are universally rewarded. It exceeds their wildest expectations.
Facial aging is multi-factorial. What I mean is that it is more than skin redundancy and fat displacement. Cutting and repositioning the skin and facelift layer one won’t always make the face look young; it may look a bit tight, shiny, flat, and thin or all facial areas do not look the same age. On the other hand, both the quality and global rejuvenation with my fat grafting technique is extraordinary. It’s the best way to turn the clock back and keep it moving in that direction because of Mother Nature’s growth factors.
The other myth is that fat does not survive. If done properly, fat will always survive. Lumping and bumping is another myth. This is also technique dependent. One reasonable fear is being “overfilled” where the face becomes distorted. This usually is the result of treating only one area on the face versus taking the entire face into consideration. The fat grafting operation is as close to perfect as any surgery can be, and more because of the inherent growth factors that remain active for years to come…assuming you have the right surgeon.
If you are using someone’s own tissue, what can go wrong? Are there any risks?
Not really. There is no opportunity to reject your own fat. Lumps can happen if enough care is not taken. Again, it is very practitioner dependent. Infection is always a risk as with any surgery, but my O.R. is rigorously sterile
You like to see patients in consultation twice prior to doing a procedure. Why?
It’s important to me to see someone as both a patient and a person. The first time we meet we discuss their medical history and I do a physical examination. Then I evaluate them and make recommendations based on their concerns. At the time of the second appointment, I have had time to think about them and review photos and notes. Our subsequent meeting helps us connect on a more intuitive level and more closely define our mutual aesthetic plan. I always learn more the second time around. The final encounter is the day of surgery, when they are photographed, marked and the marking are reviewed with the patient in the mirror prior to embarking on surgery.