Fat Transfer vs. Fillers: How to Choose

Speaker 1 (00:07):
You're listening to The La Jolla Cosmetic Podcast.

Monique Ramsey (00:15):
Welcome, everyone, to The La Jolla Cosmetic Podcast. I'm your hostess, Monique Ramsey. And today, we're going to talk about fat or filler, specifically talking about fat or filler for your face. So Dr. Riedler is here with us today. Welcome back to the podcast.

Dr. Riedler (00:32):
Hi, thanks for having me.

Monique Ramsey (00:34):
So what problems are we trying to solve when we ask this question of fat and filler, which is better? Why would someone choose one or the other? Or why would you choose one or the other?

Dr. Riedler (00:47):
So fillers and fat transfer have the same overall goal of adding youthful volume to the face in a way that looks natural. What happens as we age, it's a very complex process, but one of the big parts of facial aging is volume loss. So a youthful look depends on having the right amount of fat in the right places. And then as we age, changes take place, including we just lose fat in areas like the temples, cheeks, around the eyes, and then also the fat pads start to sag. So that redistributes the fat from the upper face to the lower face, making a more youthful heart-shaped face turn into a more square-shaped face.

(01:36):
And one thing that we often see is that the areas of fat tend to become farther apart. So instead of a smooth contour, continuous layer of fat, you start to see the outline of the orbital rim around the eyes. You start to see the hollow temples and the cheekbones because you're losing the fat. So the underlying bony structure is starting to appear and it looks kind of hollow or gaunt. So fat transfer and fillers can work to effectively restore that lost volume, it just is really a case-by-case basis, what's going to work best.

Monique Ramsey (02:17):
So you're talking about fat wasting away or dropping and creating shadows. So when you're trying to fill that face and create that more heart-shaped youthful face, how do you know whether you're really better off with fat or how do you know if you're better off with filler?

Dr. Riedler (02:40):
It really depends on the person's specific goals and anatomy and age and what you're trying to treat in terms of the facial structure and volume. So in terms of fat, the benefits are that it's really good for somebody who is maybe a little older, at least age 35, and has at least early signs of facial aging or volume loss and would benefit from restoring volume in multiple areas, or even somebody who doesn't have any aging signs but just has not very much facial fat or is a marathon runner and just feels like they look hollow or gaunt or wants to change the contour. Fat transfer is a good option for those types of people because it's a good long-term solution and the fat can be used in multiple areas and can also improve the quality of the skin because of the stem cells that are present within the fat.

Monique Ramsey (03:49):
Oh, interesting. Which is not something a filler would have.

Dr. Riedler (03:52):
No.

Monique Ramsey (03:53):
Right.

Dr. Riedler (03:54):
Not something a filler would have. But then filler has its own benefits too, so it is less recovery time. They're both minimally invasive, but filler's easier in that it's just a quick in-office procedure that takes 15 minutes to an hour. And it is preferable. Fillers are preferable in certain areas like in the lips or the nose or certain areas where you want more firm structure or definition that fat doesn't necessarily provide. And if you're kind of new to the aesthetic world and want to try something out, want something that might not last forever and see if you like it, kind of try it on before you commit to it. So they both have their own benefits and their own ideal candidates depending on what you're trying to treat.

Monique Ramsey (04:49):
Now, if you're really thin, then I would guess, but I could be wrong, how do you go get fat from somebody to put in their face if they're really thin? How do you find it and where do you find it? Or is it better to have a person who has maybe an extra five pounds or 10 to then have... You got to harvest it, right?

Dr. Riedler (05:14):
So we don't really need a lot of fat and most people, even if they're normal weight and not overweight or don't have a few extra pounds to lose, most people have some fat they don't need somewhere on their body. So, for example, I have some patients who are fitness instructors who have tight abs and really no extra abdominal fat, but they have some fat in their inner or outer thighs that we can use for fat transfer because you're right, it often is the thinner people who don't have a whole lot of extra fat to spare who could benefit from the fat transfer. But that said, everybody loses fat in their face regardless of their overall body weight. I have yet to really have a patient that we couldn't find enough fat from, but I have had to look in more than one place.

Monique Ramsey (06:10):
So does it really matter if it comes from your arms or your flanks or your inner thigh? Is all fat the same?

Dr. Riedler (06:17):
I've heard or read that the fat from the lower abdomen and the inner thighs is the ideal quality for fat transfer, but I think that's just anecdotal. I don't think anybody really knows for sure.

Monique Ramsey (06:34):
So then it's surgery because you have to get the fat from somewhere. Is that something that's done under local or still done under general?

Dr. Riedler (06:43):
It is a surgery, it's minimally invasive. There's one tiny incision, usually the inside of the belly button and it can be performed under general anesthesia or local. I would say most commonly, I'm performing it under general anesthesia in conjunction with other procedures like a face and neck lift or an eyelid surgery. But we also perform it alone under local or general anesthesia depending on the patient's preference.

Monique Ramsey (07:14):
Now, where can you put it? You talked about temples, but where else might be a good place when it's a fat transfer?

Dr. Riedler (07:24):
It really can be put almost anywhere in the face from top to bottom, forehead, around the eyes, the upper eyelid, kind of [inaudible 00:07:34] where it can get hollow, the lower eyelid teardrop area, again the temples, the cheeks, the jawline, the nasolabial folds here around the mouth to help the lines around the mouth. Some people might put it in the nose, some people like to put it in the lips. So pretty much anywhere you could think of, you can put it.

Monique Ramsey (07:59):
Now, is there a difference in how long a filler would last versus a fat transfer?

Dr. Riedler (08:07):
Yeah. So fat transfer, once the graft basically takes hold, once the fat has a new blood supply in its new location, it lasts basically forever. You'll continue to age the normal aging process, but it lasts forever. Anywhere between 25 and 75% of the transferred fat survives, but I would say on average about half or maybe even a little bit more. So whatever's initially transferred, it won't all be there forever, but whatever's still around at about three to four months, that will be there forever, essentially.

Monique Ramsey (08:41):
Oh, interesting. So then, in that case, do you overfill knowing that some of it won't survive?

Dr. Riedler (08:49):
Yeah. We usually do overfill knowing that maybe half of it won't survive. So in that way, it is less precise than a dermal hyaluronic acid filler. But since we're using it globally, it tends to survive pretty symmetrically and it just kind of results in feeling like you're still swollen after surgery for a couple of months.

Monique Ramsey (09:13):
Okay. Now, speaking of overfilled, I was watching a YouTube video the other day about people who are overfilled with fillers. So fillers-

Dr. Riedler (09:22):
Facial overfilled syndrome, I think, is the latest name for it.

Monique Ramsey (09:25):
Facial overfilled syndrome.

Dr. Riedler (09:27):
Yes.

Monique Ramsey (09:28):
FOS.

Dr. Riedler (09:28):
Yeah.

Monique Ramsey (09:31):
I guess the theory is some is good, more is better. So how does that happen and can that happen with fat or does fat end up looking more natural? Tell me about that.

Dr. Riedler (09:44):
I think it can happen with fat. I think it's important to have a surgeon who has a good aesthetic sense and is meticulous and careful with what they're injecting and how much and making sure they're not doing anything on autopilot, but really looking at the specific patient and what they need and what will benefit them. I think maybe more common than just getting overfilled in general would be looking unnatural or looking less like yourself because of where the fat is placed.

(10:24):
So I think one thing that can happen is that the fat can be placed to really help contour the jawline in an older patient where if you think about the aging process, the fat kind of descends and we end up with excess fat along our jawline and we get jowls. So that's not an ideal place to put it in an aging patient or an older patient who's concerned about aging changes and that can make the face look more square or masculine. So maybe a good thing for a male patient, but not maybe what a female's looking for. So it's kind of nuances like that, that really just are based on the surgeon's aesthetic sense and experience.

Monique Ramsey (11:16):
Now, let's say we take the fat out of my lower abdomen and we're going to put it in my face. What happens between those two things? You take it out, then what do you do with the fat before you put it in?

Dr. Riedler (11:29):
Basically what we do is either by just letting it sit upright in a test tube or syringe and letting gravity separate the different layers or speeding that process up by putting it in a centrifuge and spinning it around really fast. We separate the fat cells from the blood and fluid so that we get just fat and none of the extra stuff that we don't really want. And then in addition to that, there are ways to process it to create micro fat or nano fat, which is smaller fat lobules, essentially. And micro fat is good for areas like the tear trough where you want finer, smoother, thinner fat to transfer. And then nano fat really doesn't add volume at all. It's mainly just used for skin quality because of the stem cell aspects of it.

Monique Ramsey (12:29):
I sort of love micro fat as a concept or nano fat. Isn't that the kind of fat we all want?

Dr. Riedler (12:39):
Yes, exactly. Very popular these days.

Monique Ramsey (12:41):
Yeah, exactly. Well, I love that. So it's the same fat, it's just more how you process it to make it thinner or more liquid?

Dr. Riedler (12:49):
Yeah. We basically put it sort of through a strainer almost to get any fibrous tissue out, which I personally do with all the fat that we transfer, but then you can put it through progressively smaller strainers, essentially, to create micro fat and nano fat.

Monique Ramsey (13:08):
I love that. Okay, so now, obviously, if you have a dermal filler like JUVÉDERM, and it'll say it lasts about a year, year and a half. I know they're all slightly different depending on how thick they are and where they go. But with fat, now is that something that you might have a touch-up down the road as an additional procedure? If you say some of it is going to be gone at three to four months or a year and if somebody wants to have more, could they still use the fat? Is it stored at all or saved from the first surgery or is it better to go back in and get some new fat?

Dr. Riedler (13:47):
Yeah. So I think I've only really seen maybe one article about cryo preserving or basically freezing fat to use later. And I think they had decent results, but as far as I know, I don't think that's really caught on. I think that the cost of sending it to a special fat bank and keeping it frozen, sort of freezing your eggs or something, that is probably more expensive than just-

Monique Ramsey (14:15):
Having new fat.

Dr. Riedler (14:17):
Yeah. And I think that fresh fat is probably going to be better than frozen fat.

Monique Ramsey (14:24):
Yeah, just like everything, right?

Dr. Riedler (14:25):
Yeah, we don't know for sure, but that would be my best guess.

Monique Ramsey (14:30):
When is a dermal filler product a better choice than fat? So you said the lips, maybe the nose?

Dr. Riedler (14:37):
Yeah, the lips, the nose, places where you need a stronger, firmer product, which I think those are two of the main areas, or if you only want a temporary result because you're not sure if you're going to like it. Another good option though that is a non-surgical option is Sculptra because that works differently than a hyaluronic acid filler like JUVÉDERM or Restylane in that it stimulates our own collagen growth. So that helps improve the skin quality and thickness and also improves volume or helps restore volume in multiple areas of the face. It's targeted.

(15:25):
Usually, we'll inject it in the temples, the cheeks, the nasolabial folds, marionette lines, and that helps a lot with fine lines and overall volume. And the duration is more like with fat too because it's not going to be as much volume as with fat transfer, but once you grow your own collagen, it basically is there and you'll continue to age and lose it at 1% a year, but it's the same kind of idea as opposed to the hyaluronic acid fillers that have a definitive kind of duration.

Monique Ramsey (16:03):
Now, if somebody had, let's say they try a filler, they really like the look, and they decide, "Okay, now I really want that more permanent. I want to do a fat graft." How long do they have to wait after having that filler for you to be able to do surgery? Does it all go in the same spot or is it different lanes of the face?

Dr. Riedler (16:24):
It's really dependent on the individual. If somebody had filler two years ago in the temples or the cheeks and now was thinking about fat transfer, I wouldn't say they had to wait at all. And then one option if somebody had filler recently a few months ago and now it's like, "Yeah, I really like this, I want to add volume to a few places, including where I had filler," what I would probably recommend is just dissolving the hyaluronic acid filler if that's what was used before the fat transfer.

Monique Ramsey (16:57):
So how should we think about cost? I think if you were just talking about a straight fat graft, not anything else, in that case, I think it's around five or 6,000, somewhere in there.

Dr. Riedler (17:07):
Yeah, that's about right.

Monique Ramsey (17:09):
What would you say maybe, what percentage of the time when you're doing facial rejuvenation are you doing the fat grafting by itself, or is it normally in conjunction with something else?

Dr. Riedler (17:20):
Yeah. Most often, I'm doing it in conjunction with something else, whether it's a full face and neck lift and upper eyelid and brow surgery, often even if it's just lower eyelid surgery to get rid of the bags under your eyes, but then you still have hollows, so then we'll transfer a little bit of fat. So I would say maybe 90% of the time I'm doing it in conjunction with other facial rejuvenation procedures. And that's nice because it always costs less when you're doing more than one procedure, right?

Monique Ramsey (17:58):
Right. Now, what is the downtime from a fat transfer if it was basically by itself?

Dr. Riedler (18:05):
If it's by itself, really just a couple of days in terms of feeling like you can do your usual activities. Your face will be swollen, feel swollen, and that will gradually go down over a couple of months. The majority of it will go away within a few weeks. So you're not going to look 100% at three days, but you can go to the grocery store, go to work, do all your usual kind of activities.

Monique Ramsey (18:35):
So I know a lot of our patients are local, but a lot of our patients also come from other places. So if somebody doesn't live nearby and they want to come to San Diego maybe for surgery with you, are you able to do some virtual meetings with them prior to them coming?

Dr. Riedler (18:51):
Yeah, definitely. We do Zoom consults all the time and often even before we get to that point, the patient will contact one of our patient coordinators. And they're very knowledgeable and can really help out with figuring out what the patient might benefit from and even show me photos sometimes first so that they can kind of have an idea and come up with a general plan or ballpark before I even see them virtually or in person.

Monique Ramsey (19:27):
Now, I know that the patient coordinators have all kinds of hotels on their list, so if you are coming from out of town, they can help you with making arrangements for somewhere to stay nearby. And then we were talking about pricing. So financing is something that we have a lot of different options and you guys can go on our financing page on our website and it has some little calculators so that you could say, "Okay, I'm thinking of something that's $5,500 and if I put X amount down, what would my monthly payment be?" So there's a couple of different ways that you can do that, which makes it really nice because fat grafting is going to be a little bit more than having a dermal filler, but at the same time, it's going to last longer.

Dr. Riedler (20:14):
Yeah, in the short term, the fat transfer is going to cost more than fillers, but in the long term, since the fat is permanent, really, the cost ends up being lower over the course of years for the fat transfer than for fillers. So for some people, just financing it ends up saving money in the long run.

Monique Ramsey (20:36):
And sometimes there's 12 months no interest. There's all different kinds of plans. So you guys can take a look at that because that's something that's important to talk about. Cost is a factor and we don't want it to be something that holds you back. So that's why we offer so many different plans. Well, thank you, Dr. Riedler. This was really fun today. I enjoyed talking with you.

(20:57):
And for everyone in the audience, if you're listening today, we want to ask you for a special favor. If you love the La Jolla Cosmetic Podcast, if you've learned something from it, it's helped you make a decision, tell your friends, write a review of the show on Apple Podcasts or Goodpods, Spotify, wherever you're listening. We love reviews too, so we'd love to hear that. And we want to hear from you. If you have any questions for Dr. Riedler or want to have her talk about another topic, we can have her back on the show.

Dr. Riedler (21:24):
Yes, I'd love to. Yeah. Well, thank you so much and have a great rest of your day. Thank you.

Speaker 1 (21:30):
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