X talks with Dr. Woffles Wu about the potential pitfalls and fallacies of autologous facial fat injections
“I’m sorry, I can’t help you,” said the plastic surgeon while shaking his head. John* nods tearfully as he is led out the door.
John, in his thirties had everything going for him. He was successful. He had his own business. He was relatively handsome. All he had was but a flaw – his vanity. Seeing the first signs of aging, he sought a solution short of surgery that offered results with minimal downtime. He was recommended the use of a fat injections by a doctor. Fat was extracted from his tummy and injected into his cheeks and around his eyes to fill in lines and add volume to his face. It backfired disastrously. Because the fat was from his tummy, it still ‘acted’ like fat from his tummy. Except that fat was now on his face. Whenever he gained weight, his face did too. Even worse, the gain wasn’t symmetrical, leading to a lopsided, misshapen look.
Today, he resembles a deformed human chipmunk. Huge lumps of fat sag from his cheeks and his eyes are tiny slits amidst islands of flab. The procedure is irreversible. He’s sought the wisdom of dozens of plastic surgeons. None are able to help him. None could.
John is but one of a growing number of patients who have undergone autologous facial fat injections and are now paying the price. Forever.
Fat injections, or more formally, autologous (meaning from your own body) fat injections are a surgical procedure that involves removing fat from the thighs or abdomen of the patient via liposuction, purifying it and then reinjecting it into the body. This is primarily done on the face though other areas such as the breasts also see use. As fillers go, fat is excellent when a large amount of fillers is required, such as that in certain reconstructive surgery cases or when the face has lost a large amount volume due to age or disease. Another advantage is that it has no risk of rejection by the body. Because it is the patient’s own fat, it’s almost practically free barring the cost to suck it out. Fat injections are often conducted when a patient undergoes liposuction, killing two birds with one stone. Unfortunately, that’s only the tip of the iceberg.
Because of its purportedly safe nature, all manner of people are jumping on the bandwagon to offer fat injections. Many of who do so aren’t even qualified to conduct it in the first place. “Now it has come to the point that even dermatologists, General Practitioners, even paediatricians – doctors that are not even in the aesthetic field are jumping onto the bandwagon and using the tools of fat injections and liposuction and operating indiscriminately,” says Dr. Wu.
“The danger I see as a plastic surgeon today is that fat injections are being touted as the panacea, the answer for all volume solutions in the face. This is because of the seductive reasoning behind it that it cannot be rejected by the body and this recent idea that if you transplant fat cells you also transplant stem cells and that these stem cells cause a degree of rejuvenation to the surrounding skin and the tendons as well,” says renowned Singapore Plastic Surgeon Dr. Woffles Wu.
“The irony is that G.Ps who are just coming into the aesthetic game are calling it the next best thing to sliced bread and injecting it into all the patients. This isn’t just a local phenomenon. It is being multiplied and replicated across Asia and the world over and we as plastic surgeons are seeing more and more complications from this procedure,” says Dr. Wu.
“I have stopped using fat injections for many years,” says Dr. Wu, “ I prefer to use synthetic fillers and I am quite scared of fat injections now. I have had 15 years of experience with fat injections and there is a reason I don’t do it anymore. Certainly not the way we were taught back then”
“Fat injections are not as safe and simple as it seems,” adds Dr. Wu. “There are many, many dangers that are not talked about, that are swept under the carpet and the number of unhappy patients from fat injections are huge and they’re growing by the day,” adds Dr. Wu. Many are uninformed of the potential risks and complications and fed lines about how easy and safe it is to use – most of which are fallacies.
The first major fallacy of fat injections is that they are easy to remove. On the contrary, fat injections are anything but easy to remove. “The fact is – you can’t suck it out. It’s not easy to suck out. I think it’s next to impossible,” says Dr. Wu. It takes several days to bond to surrounding tissue after it has been implanted, and once it happens it’s irreversible. “The fat is already incorporated into the tissue and it’s just too tough to remove.”He adds that even a skilled plastic surgeon would likely end up with aesthetic problems when attempting to remove it from the face such as pits, craters and contour irregularities. To add insult to injury, an unskilled surgeon could cause problems elsewhere by leaving craters in the donor site when removing the fat for implantation, leaving someone’s thighs or tummy looking like a bungled archeological dig. He sums it up, ”They’re screwed for life – it’s not a joke,” says Dr. Wu.
Another potential complication that’s glossed over is that the results are unpredictable. Once the fat is placed in the recipient site, the fat can either dissolve and be reabsorbed by the body or it can take, which means the fat graft survives. Depending on the skill of the surgeon, this rate runs from anywhere from 70% to 90%. This implanted fat is unpredictable and could stay static or even grow in volume. You can put fat into the face of a patient and one side can disappear and the other side could grow which could make a face totally asymmetrical which forces the surgeon to do a second procedure to balance things up. “When the face starts growing uncontrollably, this becomes a real problem,” says Dr. Wu. He explains that fat cells, regardless of where they are grafted to still retain their ‘programming’.
“Fat retains the characteristics of its donor site. Most fat comes from the tummy and after a patient has had a fat injection procedure, there is a tendency that when the patient puts on weight, their face gains weight as well,” says Dr. Wu. Some patients, like the aforementioned John, end up facially resembling pigs because of the unpredictable nature of fat regrowth.
“It’s a horrible consequence. If you’ve seen a patient whose face has grown out of proportion, you’re going to be scared,” says Dr. Wu. This problem is exacerbated by untrained surgeons who intentionally overfill the target areas with more fat than necessary to ‘compensate’ for the percentage of fat that may not graft itself and survive. “You should never ever overfill fat,” says Dr. Wu ,”that’s when you start getting problems and horror of horrors, it’s something that doesn’t go away.”
Dr. Wu adds that fat injected around the eyes also has a tendency to calcify and form hard, ugly, uncomfortable rock-like nodules that feel and resemble pebbles. A surgeon has to remove them and after doing so, more may crop up, leading to more uncomfortable surgery.
“It’s hard to generalise, but more than 50% of my fat injection patients get some sort of problem – to me it’s a very unacceptably high figure. Perhaps I’m doing it all wrong?” says Dr. Wu. For something that’s supposedly rejection and fuss free, the potential complications are potentially as much as if not more than other fillers.
Are facial fat injections even worth doing in the first place notwithstanding the potential problems it could cause? In certain cases, yes. “I would say that even in the hands of a plastic surgeon, fat injections must be done judiciously. Its not a technique that everybody can do well, and it doesn’t mean if you’re a plastic surgeon you can do it well if you haven’t learnt the technique,” says Dr. Wu.
Many problems stem from the old technique which is still in wide use. “The old technique which was still in use 3-4 years ago used cannulas whereby large blobs of fat were injected into the face. When it is used in the cheeks, it doesn’t make much of a difference, but around the eyes, there can be a lot of unevenness and in order to implant the fat, you have to make multiple passes into the surrounding muscle which leads to a lot of swelling. This leads to significant downtime,” said Dr. Wu.
Recently, Dr. Wu has begun using fat injections once more via a new technique called the Micro Droplet Technique. In the new technique, Dr. Wu uses very small cannulas to harvest the fat and then uses very fine syringes to implant the fat in a series of micro droplets in the target areas instead of one huge wad. “Putting in very microscopic quantities seems to avoid the problem of overgrowth,” says Dr. Wu.
“It’s a technique I still use in the right patient and the patient must be fully aware of all potential complications. We do it because there are no other better or safer alternatives and there is a justified reason to do so,” says Dr. Wu. “I will still use fat injections in the correct patients – patients who are very facially depleted in cases of hemifacial (half face) atrophy where these people are born with no fat on one side of the face as well as people who have lost a lot of weight and who may need ten to fifteen vials of filler in which case using other fillers may be too expensive.”
Dr. Wu emphasises,”I want to warn patients that they should not think that it is such an easy technique that anyone can do it and anyone can get uniform results.” He elaborates that,”In my hands, 50% of the patients who’ve had fat injections under me have had some problems and it’s just too high. I don’t think I’m a lousy surgeon. I think I’m a very decent surgeon and if I’m using a technique that gives such a high rate of problems then I have to analyse who, what, why and when I should be using it.” In fact, Dr. Woffles Wu is recognised as one of the world’s 19 foremost aesthetic surgeons in the book “Aesthetic Surgery” by Taschen Books as well as being a pioneer in facial rejuvenation using Botox and Woffles Lift threads.
Dr. Wu says, “Fat injections are a dangerous technique in the hands of the untrained or those lacking sound aesthetic judgement and at the same time a very useful technique in the hands of a trained plastic surgeon. The trouble is the untrained physician, the non-cosmetic surgeons who are using the technique, making mistakes and overselling the technique without making it known to the patient the possible complications involved – this is a dangerous thing for the public. If a surgeon is going to do fat injections, they must not oversell the technique and they must inform their patients of the potential complications.” Something so potentially life changing, it’s definitely a very big deal.
For those encountering the first signs of aging or facial imperfections like scars, crows feet around the eyes and acne scars, they’re prescribed dermal fillers as an option short of a face lift. Fillers are broadly classified based on how long they remain in the body (temporary lasting a few months to permanent) and whether they are chemically synthesised or derived from animal or other living sources. As implied, fillers are an injectable compound to add volume to soft tissues. They’re effective at filling in shallow depressions like crow’s feet, naso-labial lines, wrinkles around the face as well as adding volume to sallow cheeks and to plump up lips. Also used for the back of the hands
While dermal fillers are safe when used in the right hands their use has a number of potential complications. How a person’s body takes to a filler may at times, be unpredictable. There is the possibility of an allergic reaction and rejection by the body. Another issue is the potential financial cost of using fillers. Depending on the brand, type and the amount required, a patient could incur costs that exceed that of a full facelift procedure because of the amount of filler needed.
