Over the last 10 years the advancements in facial rejuvenation have been impressive. For a number of years, skin resurfacing with lasers and peels were the number one choice when it came to facial rejuvenation. Nowadays the options extend from muscle relaxation via neurotoxins such as Botox to surgeons adding volume to refresh the face. In addition to wrinkling and gravity, volume loss to the face has become increasingly recognised as an important component of the ageing process. And this facial volume can now be restored with either office-based fillers or facial fat grafting. 

One option for facial volume restoration is performed in an office setting for ease and convenience using off-the-shelf materials such as hyaluronic acid as a direct filler. Hyaluronic acid is preferred for injections around the eyes to smooth the eyelid cheek junction and the lips. No lumps or bumps should occur with appropriate application and, because it is the consistency of caulking material, it can provide shape.  

Another option is a polymer of lactic acid (Sculptra), which acts as an inflammatory material that induces collagen synthesis to create a guided tissue volume additive over time. While these procedures are easy and safe, it takes experienced hands, eyes and judgement to achieve the best outcomes. 

Fat grafting is another source of filler material to restore volume to the face, with the fat being harvested from the patient’s abdomen or the thighs. This technique causes some pressure sensation compared with the small, sharp needle used to inject off-the-shelf fillers. The advantage of fat is that it is cheaper to obtain than manufactured materials and, in most cases, there is a relatively unlimited supply. 

Using a gentle hand-harvesting method, purification process and microdroplet injection technique, fat grafting has been shown to improve durability compared with older techniques that could compromise transplanted fat longevity. Fat is soft and does not exert force on the skin in the same way as fillers and grafted fat has a much higher blood supply so that survival is improved and the results are smoother. 

Elise Bevan, a solicitor in the clinical negligence team at Penningtons Manches, said: “Every industry conference has a significant discussion about the techniques and the science behind the results, with just about every region of the body applicable to its uses, including face, breast, hand, buttock and other contour deformities. For the early stages of facial rejuvenation, much of the volume restoration is performed with off-the-shelf filler agents but fat grafting also appeals to many prospective patients as it is minimally invasive and does not require any traditional facial incisions. It would seem that fat grafting has assumed a more prominent role in surgeon’s ability to combat the signs of ageing. So when do you use fat vs fillers? It depends. It’s a case-by-case decision to determine the best for each patient.”