Question

In looking through the site I don't see that this has been asked recently. Has facial fat grafting surgery improved over the years? Is it a good option or do the concerns outweigh the benefits? Also, Does plain old Medicare pay for this procedure? I had Sculptra injections years ago but I needed more than the 6 packets to make a noticeable difference and therefore wasn't able to get the additional treatments.

Answer

Hello and thanks for posting.

Facial fat grafting has improved over the years. However, it still is far from perfect, and results vary tremendously from patient to patient.

The ideal situation is that the doctor does liposuction to gather the appropriate amount of quality fat, injects the right amount into the right places on the face, the optimal amount of fat survives in the correct places, and the long-term outcome is excellent. In the real world patients that I see, this rarely happens. There may be some ascertainment bias - it may simply be that the patients who had terrific long-term results never show up in my office. But I doubt it.

I actually saw a new HIV patient for facial fillers earlier this week. She had facial fat grafting for lipoatrophy 13 years before. She showed my immediate post-op photos and her face was swollen like a melon. This is expected because the surgeon uses extra fat with the expectation that some of it will not survive. She said the dramatic swelling took about 2 weeks to subside. She then said her results were ok. Then over the last 5 years she developed more facial volume loss and she ended up with very unnatural facial contours because the surviving fat grafted regions stuck out and moved in strange way when she spoke. When I handed her the mirror to look at her face to discuss treatment options, she would not take the mirror and instead became tearful because she was so unhappy with her facial appearance.

Now, this vignette involves fat grafting from 13 years ago. But I see patients who had fat grafting 2 years ago and the grafted fat simply disappeared. Or some of the fat survived and they look lumpy-bumpy.

The good news is that facial fillers can be used to mitigate fat grafting that has not worked out well.

Liposuction and autologous fat grafting is not covered by Medicare. Galderma now owns Sculptra, so now is the time for activists to lobby the new company to change the stingy and illogical patient access program that Valeant put in place.

Good luck!