Dermal Fillers

A lower eyelid fat transfer is a powerful tool in facial rejuvenation procedure that can provide natural-looking results in the hands of a skilled surgeon, as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smiley.


While dermal fillers can also correct the hollowed lower lid or deep tear trough, which is the transition between the thin-skinned eyelid and the thick-skinned cheek, fat transfer is perceived to be superior particularly if the goal is to achieve near permanent results.


The fat graft that persists about a year postop is expected to last a lifetime (or at least 10 years). Most surgeons aim to achieve a survival rate of 50-70 percent; it is important to note that some of the grafts will “perish” in the first few months of injection and so it might be necessary to slightly over-correct.


Dermal fillers, meanwhile, typically require 2-3 touch-ups every year because they are made of biodegradable material that the surrounding tissue gradually absorbs.


Dr. Smiley has recently performed lower eyelid fat transfer in a female patient with deep tear trough caused by soft tissue atrophy or “shrinkage” caused by the aging process. The procedure entails proper handling and injection of fat to achieve smooth, near permanent results.


lower eyelid fat transfer


The patient described has been considered as a good candidate for lower eyelid fat transfer “as a stand-alone” procedure (without simultaneous skin excision) because she only had very mild tissue laxity.


However, some patients can benefit more if their fat transfer is combined with the “standard” eyelid surgery (blepharoplasty) particularly if there is noticeable loose skin; this is achieved by placing the incisions at the natural upper lid crease or very close to the lower lash margin so the resulting scars are inconspicuous.


The celebrity plastic surgeon says one of the challenges or caveats of lower eyelid fat transfer is the risk of lumpiness because it deals with an area whose skin is markedly thin. To achieve smooth result, he highlights the importance of meticulous injection in which very small amounts of grafts (less than 0.1 cc) are introduced, as opposed to dumping them all at once.


The aforementioned technique, which is called structural fat grafting, also ensures spaces between each graft and thus allows blood vessels ingrowth needed for its long-term survival. Without this vascularization process, the body will eventually absorb the fat.

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Liposuction and fat transfer cost is highly variable due to factors such as the donor and recipient site, amount of transferred fat, clinic location, professional/surgeon fee, among others.


While liposuction and fat transfer has many uses in cosmetic and reconstructive plastic surgery, its application is widely popular in Brazilian butt lift (i.e., buttock augmentation via fat injection) and facial rejuvenation surgery.


liposuction and fat transfer cost

According to, an online forum dedicated to popular plastic surgery procedures, the average cost of Brazilian butt lift is $6,550. Nonetheless, some patients may have to pay for a hefty price tag (as high as $14,000) if their surgeons cater to high-profile people or their clinic is located at a posh district.


But the truth is, the average cost of Brazilian butt lift may greatly vary even among patients treated by the same doctor because others may require just two liposuction areas, while some entail up to six “donor” sites.


To further shed light on the issue, one Brazilian butt lift patient treated by leading Beverly Hills plastic surgeon Dr. Tarick Smiley paid about $6,000 for liposuction and fat transfer that involved collecting donor fats from the lower back, flanks, inner thighs, and bra rolls.


The vast majority of patients will need at least two liposuction sites to collect an adequate amount that will be injected into their backside. However, women on the thinner side may need more donor sites to harvest enough volume to deliver the desired results.


But in facial rejuvenation via fat transfer, the volume of fat required is no more than a few teaspoons; hence, the viable donor sites are almost always not an issue.


A fat transfer involving the face—i.e., flat cheeks, laugh lines, and deep tear trough—can run as low as $3,500, or as high as $11,000. The hefty price tag almost always comes with simultaneous procedures such as facelift, neck lift, eyelid lift, or brow lift.


The upfront cost when fat transfer for facial rejuvenation is used instead of dermal fillers (Restylane and Juvederm) is higher, although in the long run the patient may actually save more because fat grafts that “survive” in the first 3-6 months are expected to be near permanent.


Traditional fillers, on the other hand, typically require 2-3 touch-ups every year.


Meanwhile, some doctors have also started offering fat transfer to replace breast implants; however, the amount of augmentation is rather limited, i.e., not more than a cup size.


Because of the rather marginal results from breast augmentation via fat transfer, many surgeons view it as just an ancillary procedure of breast implant or breast reconstructive surgery. Its primary use is to add more soft tissue coverage to hide implant rippling and minimize palpability.

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Can Sculptra buttock augmentation provide the same results as the Brazilian butt lift? This is arguably the most common question of patients who want to reshape their backside but have very low body fat percentage to make butt augmentation via fat transfer a viable option.


While Sculptra and other lab-made fillers can add volume to almost any part of the body, leading Beverly Hills plastic surgeon Dr. Tarick Smiley says that Brazilian butt lift remains the gold standard because it gives the surgeon more control over the projection, shape, and size of the buttocks.


sculptra buttock augmentation

In essence, Brazilian butt lift is a buttock augmentation via fat grafting in which excess fats are removed from various donor sites (usually the lower back, hip-flank region, back rolls, and frontal abdomen) and later re-injected into the patient’s backside.


The celebrity plastic surgeon regularly posts Snapchat videos showing how the Brazilian butt lift is accomplished and thus may help viewers (or would-be patients) form “reasonable” expectations and goals.


The problem with Sculptra, he says, is one will need multiple procedures performed several weeks apart just to achieve a “conservative” amount of augmentation; hence, patients seeking for more drastic results will have to adjust their expectations. Furthermore, it may cost as high as $30,000 on top of the fact that the results can only last an average of five years, says Dr. Smiley.


The average cost of Brazilian butt lift, meanwhile, is between $5,000 and $9,000; its highly variable pricing is due to factors such as liposuction or donor sites, clinic location, doctor’s fee, and operating room fee.


With blood supply ingrowth within and around the fat grafts, the results of Brazilian butt lift are near permanent, Dr. Smiley further explains.


Sculptra and other traditional fillers are best reserved for treating small areas such as the laugh lines, deep tear trough, flat or gaunt cheeks, and thinning lips, says Dr. Smiley.


Should the patient elect to have Sculptra buttock augmentation, Dr. Smiley says that while the filler is FDA-approved for facial volume loss, injecting it into the backside is an off-label procedure.

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Dermal fillers or fat transfer: Which one provides better results?


These two treatments (both are injected into the soft tissue) are also referred to as volumizers as they replace facial volume loss that results in nasolabial folds (laugh lines), flat cheeks, deep tear trough, and thinning lips.


dermal fillers or fat transfer

Photo Credit: Ambro at

In order to answer which one provides better results, dermal fillers or fat transfer, several factors are taken into account such as the treatment site, cosmetic goals, and use of ancillary procedures such as facelift, if there is any.


Leading Los Angeles plastic surgeon Dr. Tarick Smiley says that despite of the more natural effects of fat transfer, under certain circumstances the use of dermal fillers might be a better option.


For instance, the thinning lips are best treated by dermal fillers, particularly hyaluronic acid-based products like Restylane. Because the “site” constantly moves (while eating, speaking, yawning, etc.), the fat grafts may not settle properly or gain their new blood supply to become a permanent fixture.


And since the effects of dermal fillers are just temporary, usually 4-6 months, they are ideal for patients who want to see first the effects of volumizers before resorting to more permanent treatments like fat transfer or even facial implants.


Nonetheless, most patients with facial volume loss are good candidates for fat transfer in which a small amount of fats, not more than a few teaspoons, is collected from the donor sites, usually the tummy and hips, says Dr. Smiley.


The celebrity plastic surgeon even treats fat transfer as an integral part of facelift surgery. With a multifaceted approach in which the sagging skin and gaunt appearance are treated simultaneously, he believes that the results look more natural and are more “stable.”


“Stable” results mean that the face is less susceptible to the effects of continuous aging. Dr. Smiley warns that failure to address the loss of volume in the lower eyelid could lead to an abrupt transition between the lid and upper cheek, which can present itself right after surgery or years down the road.


Fat transfer and facelift are best performed simultaneously so the patient will only experience recovery once, he explains.


Because the results of fat transfer are near permanent (studies have suggested that on average they can last 8-10 years), in the long run they are cheaper than having regular dermal fillers injections.

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African American facelift involves a unique set of challenges due to the patient’s susceptibility to keloids or aggressive scarring. For this reason, a more proactive scar treatment approach in the first few weeks becomes particularly important to prevent any reminder of plastic surgery.


Scar placement is the first step to hide any surgical stigmata. Fortunately, this is possible for the vast majority of patients who can choose from different incision techniques to produce their aesthetic results.


African American facelift

Before-and-After Photos of African American Facelift Patient


While shorter incisions might be perceived as better than longer incision techniques, patients who need extensive corrections—i.e., their mid and lower face has a significant skin and tissue laxity—may have to accept the standard facelift method in which the scar typically starts from the temple (in front or behind the hairline) that goes around the inside edge of the ears and then reaches the earlobe.


Sometimes, the scar is even extended into the nape still concealed by the patient’s natural hairline for optimal concealment.


Regardless of one’s race or gender, the vast majority of facelift patients will require some type of internal reinforcement in which the soft tissue and muscle are reshaped as well, as opposed to relying solely on skin, which over times settles and droops due to the effects of gravity.


Simply put, most facelifts today are not a skin-only operation. To achieve stable results that can last for many years, experts at the California Surgical Institute suggest that all soft tissue must be taken into account during surgery.


In the past, facelifts relied on excising and tightening the loose skin, without giving much thought about the facial volume loss. This approach resulted in gaunt cheeks, upper cheek crescent, and/or hollowed lower eyelids, which could present themselves immediately or years after the surgery.


To avoid these aforementioned reminders of plastic surgery, surgeons at the California Surgical Institute address facial volume loss at the same time; this is either performed through fat transfer or dermal fillers.


Fat transfer uses the patients’ own fat cells, usually collected from their tummy, to smooth out their laugh lines, correct the deep tear troughs, and plump up their hollowed cheeks. Typically, this is performed simultaneously with facelift.


Dermal fillers such as Restylane and Juvederm, meanwhile, also work like fat transfer, although their results can only last between four and six months.


Whether fat transfer or dermal filler is used at the time of surgery, addressing soft tissue shrinkage during African American facelift means the surgeon relies less on skin pulling, thereby possibly obviating the need for longer scars.

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Restylane vs fat transfer injection: This is arguably the most common dilemma of patients seeking facial rejuvenation procedure, as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smiley.


Both materials are also referred to as volumizers since they fill in hollowed facial regions (e.g., flat cheeks and gaunt lower lids) and certain types of deep creases.


restylane vs fat transfer

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Restylane is a hyaluronic acid-based dermal filler, a naturally occurring material that gives the skin its youthful “plump” and glow, hence there is almost no risk of allergic reaction.


In essence, Restylane is derived from tissue cultivated in a laboratory, with its entire DNA removed to further eliminate risk of allergic reaction. A few comprehensive clinical studies have demonstrated its impressive safety profile, making hyaluronic acid-based volumizers more popular than collagen and other filler materials.


Fat transfer, meanwhile, also boasts impressive safety profile in the hands of a skilled injector. But compared to Restylane or any other type of dermal fillers, the technique has a higher technical difficulty due to the processes involved.


In this technique, donor fats are collected, then processed to eliminate impurities, and injected back into the body. As of this writing, there is no standardized procedure thus the survival rate of grafts may differ from doctor to doctor.


Proponents of fat transfer suggest that it provides more natural and softer results than most types of fillers because it adheres to the principle of replacing “likes with likes.” For this reason, it has become a common routine to combine this technique with facelift surgery.


The effects of fat transfer are expected to be near permanent, or at least 8-10 years, while Restylane or most types of hyaluronic acid-based fillers can only last 4-6 months. Simply put, the patient who resorts to dermal fillers must take into account the cost of maintenance.


However, fat transfer has its own caveat such as longer downtime—i.e., it will take about two weeks for most of the swelling to subside. As a result some doctors recommend dermal fillers to most of their patients unless they will have a simultaneous facelift surgery.


Dermal fillers, particularly hyaluronic acid-based products, are also ideal for first-time patients who are contemplating about the possibility of more permanent solutions like fat transfer or facial implants.


Hyaluronic acid-based products are reversible should the patient is not happy with the results. They can be immediately broken down by an injectable enzyme; however, this is not an option in fat transfer.


The issues involving Restylane vs fat transfer can be resolved by honest and transparent communication between a patient and her doctor.

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