'Fat is unpredictable, overrated, has significant complications, can grow and even distort the face'

Val Lambros, M.D., Newport Beach, Calif., said at the annual Vegas Cosmetic Surgery meeting that although he uses fat in every facelift he performs and has been using it for more than 20 years, fat proponents rarely discuss the problems this natural filler can cause in inexperienced hands.

In his presentation, “Fat is unpredictable, overrated, has significant complications, can grow and even distort the face,” Dr. Lambros emphasized and demonstrated issues that frequently arise with fat.

First, fat is unpredictable. On one hand, fat may not “take” and completely disappear. On the other, it can multiply and create an undesirable result. For example, a rookie mistake might be to overgraft fat into the face to smooth away wrinkles. But if that fat grows over time, it can make the face unnaturally big, thereby masking the natural contours. Thus, the wrinkles may be gone, but patients tend not to be happy when they no longer look like themselves, Dr. Lambros said.

Second, if fat is used in a younger person, acceptable results today may not be so in the years to come. People gain weight as they grow older, and fat behaves in the face as it did in the area in which it was harvested from, he said. Whether it was taken from the tummy, thighs or other area that tends to be more prone to weight gain, it will likely multiply with age and can negatively affect the appearance of injected portions of the face. This, Dr. Lambros said, can be particularly devastating under the eyes.

His take-home message was this: Fat is a valuable tool in the plastic surgeon’s armamentarium. Use it cautiously, however. Take the time to build experience and get comfortable with fat behavior and the various complications that potentially come with this natural filler. 

Follow our VCS 2014 coverage