Fat vs. Fillers: Which Is Best?

Woman with sultry expression

Over the past few years, autologous fat grafting (using the patient’s own fat) has gained in popularity over dermal fillers such as JUVÉDERM® and Restylane®. At my practice in Valparaiso and Schererville, Indiana, I have chosen not to offer fat transfer because I don’t believe it offers the best value to my patients. In this post, I’ll compare these procedures and explain my reasoning.

Advantages of Fat Grafting

Fat can be used anywhere a filler can be injected. Fat is an excellent filler for pitted acne scars, wrinkles, and other “divots” in the skin’s surface. It can be used in place of fillers in a variety of areas, including:

  • Lips
  • Smile lines (nasolabial folds)
  • Marionette lines
  • Back of the hands

Autologous fat is known to be the softest and most tolerated injectable material available to fill wrinkles. After all, it’s “you.” At the same time, FDA-approved fillers are tolerated by the vast majority of our Indiana plastic surgery patients; the old worries about allergic reactions are, by and large, a thing of the past.

How Fat Grafting Is Performed

Because the patient’s own fat is used in fat transfer procedures, fat must be harvested via liposuction. Because long-term survival of the grafted fat depends on the ability for the fat to “revascularize” or to nourish its blood cells, it’s customary to harvest more fat than might be needed. For example, if 3 cc of JUVÉDERM is adequate to plump a patient’s nasolabial folds (those folds between the nose and the mouth), more than 3 cc of fat must be harvested to compensate for the loss of fat cells during harvesting and the low survival rate of fat after it’s transplanted. Therefore, it’s customary that fat grafting takes place during a liposuction procedure, rather than as a stand-alone procedure. Otherwise, the cost of the operating room, anesthesiologist, and other associated expenses would far outweigh the cost of a dermal filler.

Disadvantages of Fat Grafting

Fat grafting causes more discomfort and is more time intensive than dermal filler injections.

I do not perform liposuction in my Indiana plastic surgery office under local anesthesia. First, most patients would object to any amount of liposuction under local anesthesia. Second, more fat is needed for fat transfer than can be safely done under local anesthesia.

Fat grafting is more expensive than dermal filler treatments.

Following my point above, because harvesting an adequate amount of fat requires general anesthesia or local anesthesia with sedation and O.R. fees, fat grafting is several times more expensive than correcting my patients’ facial aging or enhancing their lips with dermal fillers.

Fat is unpredictable.

We know approximately how long injections of JUVÉDERM will adequately treat certain types of facial aging. We don’t know that about fat, because an unknown amount of fat will inevitably be reabsorbed in a relatively short time, i.e., within a month or so. At times without an adequate blood supply, fat can harden and form clumps. If fillers form lumps, they can be dissolved with an enzyme.

Fat grafting requires excess fat for transfer.

Not all patients have adequate fat to use in a fat grafting procedure, while dermal fillers are compatible for nearly everyone, regardless of their body weight.

The Bottom Line

Although grafted fat can result in improvements that last indefinitely, most of our dermal filler patients don’t think it’s worth the risk when one considers the high reliability factors of FDA-approved dermal fillers. JUVÉDERM and Restylane can last up to 12 months and JUVÉDERM VOLUMA® for 2 years or longer. When technology offers more certainty with fat transfer, I may reconsider it as a viable alternative to dermal fillers. For now, however, I want my patients to have a reliable outcome, both in terms of appearance and affordability.

If you’re troubled with wrinkles or lack of volume in your face, lips, or the back of your hands, schedule a complimentary consultation with me at my Indiana plastic surgery practice by calling 800-721-3244 or completing our online contact form.

To your health & beauty,

Gus Galante, MD, FACS
Board-certified Indiana plastic surgeon



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