Board Certified
Plastic Surgeon
Since 1989

Facial Options in Cosmetic Surgery

There are many options available for Facial procedures. Some, like fat injections, involve significant healing time while others, such as Restylane injections, require no recovery period at all. Dr. Widder describes the pros and cons of these procedures as well as other options such as the MACS facelift surgery technique.

face lift options


Q: You’ve said before that fat injection is not a good plan for buttock enhancement. 

It’s not reliable – it doesn’t stay in the butt due to the injection of large quantities of fat without blood supply.  I only do implants for the butt.  I was going to start doing fat injections for the butt a few years ago, then this happened:  I purchased all the equipment, but then I started getting patients for butt implants who had had the fat injection before by other plastic surgeons and it all or almost all disappeared.  It was a moment of truth.  I started to think about it and I saw more patients coming in with the same situation.  I decided not to do it.  I can’t sell my patients on that extensive and expensive procedure knowing it will last only 6-12 months and then after that, they’re back to their original shape.  I just couldn’t do it.

Q: Fat injection is also used for the face.  Have you had better success with that?

The purpose of fat injection for the face is to fill up concavities or depressions.  Unfortunately, it is not very reliable even in those smaller amounts.  It is being done extensively on the face, but it doesn’t always last.  I use the “MACS” facelift technique, which stands for Maximal Access Cranial Suspension.  Through this technique, I lift up the fat of the face that has descended from its youthful and natural position and I bring it up to where it belongs.  So with my facelift, I don’t really need to do a fat injection.

If you bring up the fatty tissue that has moved downward due to aging and gravity – if you move it up to areas where the patient has concavities and depressions, it fills them up.  That’s viable tissue. It has good circulation and there’s no risk of losing the fat.  So, my facelift is very effective without fat injection.

Q: Are there other instances where you might use fat injection for the face other than during a facelift? 

Yes, I sometimes do it as a separate procedure.  For example, I might use it as an injection into the nasolabial fold.  As we age, the nasolabial fold gets deeper because the cheeks descend and overlap the fold or the crease.  If a patient is not ready for a facelift personally or financially, there are different options.  You can use fat injections, or you can use a filler like Restylane.

Restylane (hyaluronic acid) lasts 6 to 8 months.  If you repeat it after 3 months, it might last 18 months. So, it lasts for a limited period of time.  The fat, on the other hand, if it survives, will last forever.  So I tell my patients about those two options. The fat is not very reliable – it might survive, it might not.  The Restylane will stay there, but for a limited amount of time.  So they think about it and make up their mind.

So far, most of my patients prefer Restylane.  They like assurance.  They might have a party or some other event to go to and they want to look good.  For example, I have a patient who is going abroad to visit family and she wants to show up looking great.  She came to have the Restylane because there’s no bruising and no downtime.  Fat injection is surgery.  You have bruising, you have swelling, and you have downtime.

Q: How do you perform a fat injection procedure?

I obtain fat from another area of the body.  I can get it from the abdomen or the inner or outer thighs, for example.  It is done with a cannula- a special blunt metal tube so you’re not causing too much trauma and bleeding.  With that instrument, I go into the area and aspirate the fat. Next, the fat is “distilled – ” blood, fluids, and other elements are separated out before the fat is injected with a thin blunt cannula to the area that needs it.  It can be injected into the upper eyelids, the tear trough, the nasolabial fold, and also the jowl area. Fat injection can be good at smoothing the jowls.  It fills out the notch and the jawline becomes more defined.

Why is fat injection more invasive than using Restylane?    

Well, you have to take the fat from somewhere and inject it. You have to use a  cannula that injures the tissue.  With Restylane, you use a very small needle, 30 gauge.  For fat injection, I use a 2 mm cannula to inject it, but,  Obviously, you, still, will have trauma to the area.  Restylane is a natural material that we have in our bodies, so the body doesn’t react to it.  With fat injection, the body doesn’t react to the live fat, but it reacts to the blood and to the ruptured fat cells as foreign bodies.  There can be inflammation and swelling and some discomfort.  Restylane is a very simple and ready-to-go injection.  You can literally go to a party after Restylane.  You can’t do that after fat injection because you are swollen and bruised.

Another issue with fat injections is that if you gain weight, the area can get lumpy.  You can wind up with too much of the good stuff.  But most of the time, I would say, 70-80% disappears, and maybe 20-30% will survive.

I take the time to give patients all of the information so they understand all of the consequences and what it all means.  I have to be honest and truthful.   I can’t talk about fat injection as if it’s a panacea because it’s not.  Restylane has its benefits, and with fat injection, if the fat survives, it’s nice.

To learn more about facelifts using Restylane or fat injection contact Dr. Widder at Widder Cosmetic and Plastic Surgery which servers the greater D.C. and Northern Virginia area. Visit Or call: (703) 506-0300

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