Thanks to today's cosmetic revolutions, a lot of Canadian women are now thankful for those few extra pounds.

This is because, with facial fat transfers, cosmetic surgeons have found a way to use excess fat to enhance the appearance of Canadian women, most commonly aged 40 and older.

As we age, our faces not only droop but also lose volume, much like a balloon losing its air. Up until now, synthetic fillers have been the cosmetic product of choice for dealing with this aging issue. And while these fillers are a great option for those wanting a temporary and predictable solution, for those not keen on short-term results from a foreign substance, facial fat transfers might be worth looking at.

Good candidates for the procedure

If you're healthy, have a good donor area (some extra fat to give) and have a substantial amount of volume loss in the face, you are a good candidate for a facial fat transfer. Risk of complications are uncommon, but if you suffer from zylocaine allergies, uncontrolled diabetes, hypertension, hemophilia or have poor health, you may want to consider other options.

A procedure that uses a patient's own fat from the lower abdomen or inner thighs, facial fat transfers utilize local anesthesia and syringe liposuction. The fat is centrifuged and processed to remove cellular debris and excess oils. That processed fat is then transferred to smaller syringes for injection within minutes to an hour after processing.

While the transfers can be injected into the eye area, lips and cheeks, it's the cheeks that tend to yield the best results, says Dr. Philip Solomon, MD, FRSCS, otolaryngology head and neck surgeon, practising facial plastic surgeon at The Solomon Nasal Facial Surgery Centre in Toronto. "It's uncommon to over-volumize the cheeks," he says. "Around the eyes and lips there is more risk associated. Because of the very thin skin in those areas, the fat could show up as bumps or lumps. It can be a negative consequence of grafting."

The risks

Another factor to take into consideration: facial fat transfers are difficult to reverse if you don't like the results. "You can try and break it up with a needle, but unlike synthetic fillers, which are easy to reverse, fat is more difficult to reverse. That's one of the reasons fewer doctors are providing it as service compared to injectable fillers," says Dr. Solomon.

Also worth noting, says Dr. Kris Conrad,MD, FRCS, FRCSC, FACS, associate professor division of Facial Plastic and Reconstructive Surgery at the University of Toronto, is that predicting outcome can be challenging because results are individual — in every case, a certain amount of fat cells will not survive the new location.

"Approximately anywhere from 10 per cent to 90 per cent absorption will occur," says Dr. Conrad. "We allow about 30 per cent absorption. In fact, the surgeon injecting fat to be treated usually prefers to over-inject about 40 per cent more than the patient needs, allowing for absorption to occur. That way the correction will be as complete and close to the desired level as possible."

The procedure and results

The procedure is done under local anaesthetic in office and takes approximately one hour. Patients can expect swelling and bruising for about 10 days after the procedure, but Dr. Solomon says results are noticeable right away. The final effect won't be fully visible until after four weeks, at which time, Dr. Conrad says, skin should look more youthful and healthy, and will stay that way for three to 10 years.

To take some of the guess work out of how long results will last and to achieve optimal results with the procedure, some cosmetic surgeons, such as Dr. William Middleton, B.Sc., MD, FRCS(C), cosmetic surgeon, at the Advanced Laser and Cosmetic Surgery Centre in Toronto, use Selphyl in combination with fat injections.

Selphyl is blood that's drawn from the patient and the "platelet-rich plasma" (PRP) portion is separated from the blood by centrifuge. The PRP contains growth factors, which are activated by the addition of Selphyl. A portion of this PRP/Selphyl mixture is added to the processed fat and then injected into the area. When mixed with fat, which is a thicker product, a bigger needle is used for Selphyl injections.

"For this reason, local anesthesia is injected first to numb the area for fat augmentation, thus preventing any additional discomfort during the fat injection procedure," says Dr. Middleton. "These products may also be injected under general anaesthesia if the patient is having additional surgical procedures, such as liposuction or facelifting."

As for results, the Selphyl/PRP/fat mixture is believed to increase the longevity of fat injections, although Dr. Middleton notes that it also adds to the cost of the procedure. The average cost of a facial fat transfer for a small area ranges between $1,000 and $1,500. With the addition of Selphyl, the cost goes up to about $3,000.