FAMI (Facial Fat Transfer)
Frequently Asked Questions about FAMI
What is so special about facial fat transfer?
We love the procedure (for the right patient) because it provides very natural results, corrects abnormalities that no other surgery can address, requires no incisions, is completely "custom" for each patient, can obviate the need for other facial rejuvenation, yet may be combined with other procedures to achieve "multi-dimensional" results. I can three dimensioanlly "sculpt" a face from the inside out. With the possible exception of multiple artificial facial implants, no other procedure offers this capability. When combined with other facial procedures, the results can be even more remarkable.
Aren't you just injecting fat to "poof out" my facial skin, like the fillers Hylaform and Restylene?
The fat is actually grafted to the muscles in the facial area in which it is injected. Although it is rarely discussed, a portion of body fat is stem cells. When these stem cells are placed near any tissue (bone, muscle, cartilage), the fat stem cells actually become that tissue, and enhance its volume. This is a very different concept when compared to injectable fillers.
What causes aging of the face above the chin line?
Gravity, skin laxity and damage, muscle weakening and fat loss above the chin cause many of the aging changes which are most apparent. Contrary to popular belief, facial aging above the chin line is caused by fat loss, not fat gain. That is why many patients who are moderately overweight have youthful facial skin, with fewer wrinkles, and why many over 35 years of age (who are in superb shape and very thin) have premature aging and "hollowness" of the face, with creases and wrinkling. In general, fat and muscle mass retention from the upper chin to the forehead causes a more youthful appearance. A study of any of the women's magazines will show you that aging begins by hollowing beneath the eyes, across the upper cheekbone, in the "hollows" beneath the cheekbone, and around the mouth and lips, which thin and wrinkle.
Where is the fat taken (harvested)?
In women, usually from the inner knees, inner thighs, lower abdomen, or hips. In men, often from the lower abdomen or waist area. Only about 150 cc are removed, and only about 60 cc are injected for full facial rejuvenation, less for more specific areas. This amount makes little difference in the appearance of most of the "donor" areas. (disappointing news to some of our patients)
Why are these areas used for fat harvesting?
The idea is to take the fat from areas which do not significantly change with diet or exercise, your "problem areas." This fat will change the least with future body weight changes or aging, and will give the best and most long-lasting result in the face. In other words, contrary to conventional wisdom, we want this fat to last no matter how your body changes, so that your face will continue to look more youthful, no matter how much weight you lose below the neck, for whatever reasons. (Remember, facial aging above the chin line is caused by a loss of fat beneath the skin and muscle - not a gain) We want to restore and retain that volume, to maintain a more youthful appearance.
How long will the results last?
With good skin care, no smoking, and limited sun exposure, the results should last at least 7-10 years. Some patients will require two treatments for full facial rejuvenation.
Should I lose weight before FAMI?
This is not necessary. If you actually plan to lose more than 20-30 pounds, you may wish to wait until much of the weight is gone before having FAMI.
Should I lose weight after FAMI?
If you plan to lose any more than 5-10% of your body weight after FAMI, don't waste your time with the surgery, you'll just "undo" the results. When you get to the lowest weight which you will reasonably achieve (or plan to achieve), then think about facial fat transfer. I will refuse to operate on patients who are below certain weight minimums.
Is there an ideal age to have FAMI?
No. Any age between 30 and 75+ may benefit from a combination of these procedures.
What can I realistically expect as a final result after FAMI?
I tell patients to expect a 50% improvement. Most will have closer to a 75% improvement. Some patients require a second surgery to achieve maximal rejuvenation. If you will be satisfied with a 50% improvement, you should be very happy with the results. If you expect perfection, or a 100% improvement, this is not the procedure (nor am I the surgeon) for you.
When can I return to work after FAMI?
Most patients should be able to return to work within 5-7 work days, assuming that they realize that some bruising ands swelling will remain. After 2-3 days, you will be comfortable enough to perform most tasks at work or at home, but swollen and, probably, bruised. You will feel much better than you look for 7-14 days. If your appearance is not a significant issue while you work (at home, computer, office without public contact), allow 2-3 days. If you are "in the public eye," are very concerned about your appearance, or do not want anyone to know that you had surgery, allow at least 5-8 business days for a return to work. Every patient will be different, but you certainly will be able to work at home after 2-3 days.
How soon can I return to normal activity after FAMI?
Do not scrub or manipulate your face for 4 days. You may walk the next day. Desk work can be resumed within 2-3 days. We ask that you do no heavy lifting, grunting, or groaning for 5 days after the surgery. Conservative aerobic activity can be resumed after 7 days. Sexual activity, lifting, running, bowling, jogging, and other strenuous activity should be avoided for 10 days. Strenuous exercise can be resumed about 14 days after the surgery.
Is it really safe to do FAMI in the office?
Yes. In fact, the recovery period is much easier after office surgery than it usually is after systemic anesthesia or hospital surgery.
What are the risks of FAMI? Are they less than a facelift?
All surgery has some risk. In a small incision facelift, the risks are reduced for multiple reasons. Anesthesia is less severe, allowing a faster recovery time and less risk. In facial fat grafting, no incisions or sutures are used, and there is no tissue dissection. Because of this, injury to surrounding structures is much less likely. In any cosmetic surgery, the most "desirable" complication (no complication is desirable) is that the surgeon performs slightly less surgery than might be planned, in a safe and controlled manner. While more surgery or "touch-ups" can always be done later, it is impossible to go back and "do less," and very difficult to "undo" what has been done.
What are the alternatives to FAMI?
Alternatives to any surgery are always present, and we will be glad to discuss any or all of them with you. Your goals for facial improvement are critical factors. If you wish to improve the texture of the skin, or lessen fine wrinkles, a facelift is not the best option. If you wish to eliminate the creases from the nostrils to the corners of the mouth (naso-labial folds), the facelift may soften them, but will not completely remove them. A facelift will not affect the upper one third of the face, the eyelids, or the brow. Any facelift procedure primarily improves the lower one half of the face, the neck, the jaw line, and the lower cheeks. Facial exercisers, exercises, and stimulators are sold on cable TV, and can cause a mild improvement and tightening of the facial features. Lotions, potions, micro-dermabrasion, peels, and CO2 laser resurfacing can create wonderful changes in the skin texture and color, but will not remove excess fat, tighten the muscles and skin of the lower face and neck, or add volume to the facial structures. Sometimes facial liposuction alone (or with a chin augmentation) can create wonderful changes for relatively younger patients with good skin. Many facial "filler substances" are used, including collagen, Gortex, Alloderm, and other materials. Your own fat is, by far, the most natural, leeast expensive, and safest of any substance used to restore lost facial volume.
Who Is A Good Candidate for FAMI?
Many people, with diet and exercise, age with a thinner face. Shrinkage of the muscles is the primary manifestation of aging, and, after some time, a "skeletonization" of the face occurs. For these patients, a facelift produces a mask look. Restoring the volume of the atrophied muscles is an obvious method of rejuvenation. Diffusely augmenting the volume of muscles in the forehead, cheeks, mouth, chin, and jawline restores the youth and its fuller face. The aging process produces hollows and depressions in the face, with "skeletonization" of the frontal, cheek, and chin areas.
Why have some people (and even doctors) told me that fat grafting doesn't work?
The non-medical public sometimes remembers the first transient results of fat grafting and "fat filling." These techniques of the seventies and eighties gave inconsistent results. This procedure did not respect the facial vascular paths and gave long-lasting bruising, swelling, and subsequently, unpredictable, asymmetric results. This bloodless technique places grafts into the facial muscles, with symmetric and long lasting results.
What is actually done in a "traditional facelift?"
An incision is made from the top of the ear, in front of the ear, around the ear lobe, and into the neck skin, usually at least 6- 8 inches in total length. The face is dissected from the ear to the corners of the mouth, down into the neck, and behind the ears. Significant amounts of skin are removed, and the facial structures are pulled tighter. Some surgeons also perform liposuction, and may also include a chin implant and eyelid surgery. Some surgeons also perform laser skin resurfacing at the same time. This often requires 4-6 hours or more of surgery, and is usually done with general anesthesia. Some surgeons (one locally) feel that better results are obtained when the facial skin is "stretched" with hooks for several days before the surgery, with patients wearing this apparatus prior to the actual surgery. While the results can be very good in any facelift surgery, for many patients, much of the risk, expense, and extensive surgery involved may be unnecessary.
Should I be concerned if my surgeon is not a "board certified plastic surgeon?" Can other specialists perform skillful facial fat grafting?
Other specialists routinely perform very skillful fat grafting. While "board certified plastic surgeons" are usually very competent, this is no guarantee that they are any better or worse than any other cosmetic surgeon. This is a topic complicated by politics, economics, ego, and marketing. Many "plastic surgeons" (and their associations) would have us believe that all cosmetic and reconstructive surgery of any kind must be performed by their small "guild," or the patient is at great risk. This is untrue. For the most part, it is an attempt to maintain "market share" in cosmetic surgery. By all means, investigate your surgeon, learn what his/her education is, what their experience is, and whether or not they are board certified in a specialty. The "plastic surgical lobby" would have us believe that all plastic surgical residencies teach all methods of cosmetic surgery. This is untrue. They would also have us believe that a surgeon is not capable if he/she has not done a "plastic surgery" residency. This is untrue. In fact, when most of the current plastic surgeons were in residency, many of the current cosmetic surgical procedures did not yet exist , and, therefore, could not have been learned in their residencies. How did they learn them? The same way that we all did, in multiple short courses, training with experts in surgery, by study, and by doing. The surgeon who taught me tumescent liposuction (he invented it in 1987) is a dermatologist. Yet California plastic surgeons contend that he should not be allowed to perform tumescent liposuction (a procedure which he invented and has taught worldwide, to plastic surgeons and others) because he is not a "plastic surgeon." That is ridiculous. I am board certified in ophthalmology, and as a cosmetic and reconstructive surgeon, have performed over 14,000 cosmetic and reconstructive surgeries in the last 21 years, more than almost any plastic surgeons. I am also a Fellow of the American Academy of Cosmetic Surgery. Yet some plastic surgeons contend that I should not be doing eyelid surgery, because I did not do a "plastic surgical residency." This is both ridiculous and illogical. Should I be doing facial fat grafting (FAMI)? You must judge for yourself. I have attended "live" facial fat grafting courses and I was taught FAMI by its inventor. I have performed over 50 FAMI surgeries at Trillim, have presented a FAMI paper to my collegues in an international meeting of the American Academy of Cosmetic Surgery, and presented the first live surgery FAMI course in Korea, in Seoul in 2005. Ultimately, you must be comfortable with your surgeon and his/her capabilities. Ask as many questions as you can, be very curious. You deserve answers to your questions, professionalism, candor, and adequate time to make an informed decision. Beware of any surgeon who attempts to rush you into a decision, or who claims that he/she never has complications.
Isn't office surgery more dangerous than hospital surgery?
In cosmetic surgery, this is often untrue. Many of the most serious complications in cosmetic surgery, especially liposuction, have occurred in the hospital, with an anesthesiologist present. This is probably because too much surgery was attempted at one time, and the hospital environment gives the doctors a "false" sense of security. Although unusual, serious complications occur when a surgeon is too aggressive, uses poor judgment, or succumbs to the wishes of the patient to "get it all done at once." I have performed over 17,000 surgeries in an office setting. Of that number, less than 10 patients in seventeen years (0.005%) have required significant alteration or postponement of the surgery for medical problems. Although my experience is no guarantee of future results, few of my patients has ever had a significant systemic complication, and none (0 of over 17,000) have required hospital admission. I deeply believe that the best treatment for complications is to try to avoid them entirely, whenever medically and humanly possible. This requires my constant, absolute willingness to deny certain patient requests, and to avoid situations of increased risk, if at all possible. For some surgeons, this is difficult, given the effects of ego, economics, and patient persuasiveness. I am completely forthright with patients regarding their suitability for surgery.
Can you freeze my fat and use it later?
We do not. It can be done, and some surgeons do it. Freezing and thawing may compromise the fat's ability to survive intact when used again, requiring over-correction and possible asymmetry. The other problems with freezing are logistical and legal. A 24/7 alarm and a "failsafe" labeling and freezing system are required. In addition, the health department of each state requires tissue banking documentation, and, in most cases, licenses. The "harvesting process" is painless, and most of us have no shortage of "donor" fat.
Is FAMI safer than a facelift and other cosmetic surgery?
Yes, in general, much safer. These are "closed injections," not open incisions with the higher risk of damaging the nerves, arteries, veins, and other important structures of the face. The injections are done with blunt cannulae, to minimize trauma.
Will the fat move after FAMI?
Many surgeons have demonstrated that, 2 days after the procedure, the fat graft is immediately anchored in the surrounding tissues by the healing process and the new blood vessels coming from the host tissue. We ask that you not touch or manipulate your face for at least 5 days after surgery.
Can FAMI be repeated?
Yes, it is an "a la carte" procedure. Some patients are so excited by the results of the first procedure that they elect to have other facial areas treated in subsequent sessions. Patients can choose the area to be treated first, then come back for more treatment in other areas. Other areas can be treated 4-6 weeks after the first treatment.
When will the results be "final?"
The swelling will subside after 2-3 weeks, and you (and perhaps those around you) will notice the natural rejuvenation, which continues to improve for at least 6-8 months.
What if I lose or gain weight?
The old rule that says that the face is the first area to be changed by weight loss is no longer the case. Conversely, when patients gain weight, it actually improves the aging process in he face (in those areas where facial fat grafting was performed.
Can FAMI be done after Botox injections?
Botox works by blocking the impulses from the nerves to facial muscles, causing a paralysis of the facial muscles, so that they are unable to contract. If the injections are repeated enough, the muscles becomes atrophied, and this region of the face loses some muscles mass. For FAMI, it is better to treat muscles that have not been injected for long periods of time. Practically, this may only be a concern in the forehead and between the eyebrows, where most of the Botox injections are done. Even then, a portion of the fat should "take."
Can fat grafting be done to other areas of the body, such as the buttock?
Yes. This is frequently done in other countries, particuarly South America. While North Americans (for whatever reason) are more concerned with extreme thiness and breat size, Europe and South America (among others) are much more interested in the shape and contour of the female posterior, or buttocks. There, fat is grafted to the buttocks routinely. I have done this procedure, and I am willing to discuss it with patientss who have sufficient donor tissue in other body areas.
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