Facial fat has become the latest victim of our culture’s toxic obsession with downsizing. Generous cheeks are routinely pruned by buccal-extracting scalpels and scissors. And vital convexities—rounded temples, smooth orbits—are sinking under the weight of diet drugs, the unwitting casualties of “Ozempic face.”

RIP, full, vibrant visages. Your ripeness is gone, but not forgotten—thanks to the barrage of voluptuous befores and angular afters on TikTok. These visual obituaries memorialize fat loss in its various forms, from the subtle emergence of quiet contours to the jarring onset of harsh hollows. We pay respects from our screens, witnessing the collective winnowing of faces (famous and otherwise)—but perhaps failing to appreciate what’s truly been lost.

One of the body’s most precious natural resources, fat, doesn’t merely influence face shape or impart a cherubic pinchability. “It contributes to a healthy, youthful look,” Catherine Chang, a board-certified plastic surgeon in Beverly Hills, says. At a bare minimum, fat lends plumpness and structure to the skin, preventing crepiness and folds, and conceals the underlying architecture of the face—the ligaments and bony crevices that can read as old when exposed. “There’s a smoothness to youth that a deflated face can’t have, because it’s all hills and valleys,” board-certified Los Angeles plastic surgeon Jason Roostaeian explains.

More From Harper’s BAZAAR

 

Love or hate your facial fat, time will eventually whittle it, without your input or permission. In fact, after age 30, we lose around three cc’s of facial fat per year, Chang says. This isn’t always a bad thing, mind you. According to Haideh Hirmand, a board-certified plastic surgeon in New York City, 9 out of 10 women she consults with about facial fat grafting, a procedure that shuffles fat from areas of excess to regions in need, say they liked their faces most in their early 40s, just as they were starting to look more sculpted, before they became plainly gaunt in their 50s.

But some folks are aiming to stave off the midlife meltdown altogether. “I have a bunch of younger patients, in their 30s and even 20s, asking for fat grafting as opposed to filler,” Chang says. They join a swell of people (of all ages) desiring a natural alternative to the synthetic gels they’ve grown weary of having injected. Other surgeons are also seeing fat’s appeal broaden and transcend generational confines. “My typical fat-grafting patient has changed over time,” Hirmand tells us. “It used to be the older person, and we’d combine [the treatment] with a face-lift, but now it encompasses multiple age groups.”

The Beauty Benefits of Facial Fat

The trend presents a curious paradox: Alongside the throngs of people pursuing contouring procedures, like buccal fat reduction, there’s a burgeoning clutch aiming to boost their fat reserves—and frequently they’re one and the same. “The patient who requests buccal fat removal will also want to add fat to their cheeks or tear troughs,” says board-certified nurse practitioner Jennifer Hollander, who runs the nonsurgical side of facial plastic surgeon Ben Talei’s Beverly Hills practice. “They view fat as a permanent fix and imagine it to be less problematic [than filler] over time.”

Folks are growing wise to the benefits of fat, which exists at various levels of the face. Just below the skin (attached to it) is our subcutaneous fat, which “provides a ‘gliding’ plane for the skin to move over underlying structures,” board-certified New York City plastic surgeon Oren Tepper explains. Deeper down, we have fat pads nestled into distinct compartments, he says; they “play a more structural, supportive, and protective role.”

The buccal fat pad is somewhat of a unique entity, as it has both superficial and deeper components that extend from the cheeks (near the corners of the mouth) back toward the angle of the jaw and up into the temples.

In our prime, these different types of fat provide plush padding, allowing one area of the face to blend seamlessly into the next. Take the eyelid-cheek junction, for example, which Roostaeian finds “so important for a youthful look.” Over time, as our tissues thin and drop, a sort of segmentation occurs. The once-fluid, imperceptible transition between the lower lids and upper cheeks now bears “a harsh border,” Roostaeian says, which can breed hollows, bags, and a tired appearance. With further sagging, fat collects in the nasolabial folds and the jowls, fragmenting the continuous canvas of the face to Picasso-like effect.

Fat loss can also rob skin of firmness. Some patients complain of drooping after aggressive buccal fat removal. Others are seeing unexpected laxity after rapidly losing weight on the diabetes drug semaglutide (a.k.a. Ozempic/Wegovy). “About 30 percent of my patients have started using Ozempic, and they commonly say they look deflated or they’re noticing laxity in their face, because they lost a lot of that fat and support of the skin,” Chang tells us.

Steeped in stem cells, fat also “plays a big role in the health of the skin,” Hirmand notes. Doctors have long used fat grafting following cancer treatment to help reverse radiation damage in the skin—to enhance elasticity and promote vascularity. More recent studies have elucidated fat’s regenerative powers, she adds, finding that “within a few weeks of fat transfer, sun-damaged elastin networks are replaced with normal patterns.” In clinical practice, she goes on to say, “we know that if we replenish the subcutaneous fat, we see skin effects—pigmentation and texture improve, and the skin looks a little thicker and more luminous.” This is a big draw for younger fat seekers, hoping to recapture lost radiance.

Hirmand also points to an “underrated relationship between the volume in the face and the action of the muscles.” The degree of tension in facial muscles has been shown to increase as the face gets slimmer with age, she says, and this changes the way the face moves. “When we volume-augment certain areas, like around the mouth, we restore more youthful motion,” she says, which may put less strain on the skin.

What Happens During Facial Fat Grafting?

When performed as a standalone procedure (separate from a lift), facial fat grafting is a fairly minor surgical affair that can be done awake or under light sedation, according to Tepper.

Harvesting fat for the face can be painstaking work. First, the areas of the body to be liposuctioned are marked and filled with tumescent fluid (to anesthetize them and reduce bleeding). Surgeons then make tiny entry points for their cannulas. The doctors we speak to like to harvest fat by hand (rather than using suctioning devices), since this more delicate technique allows a greater number of fat cells to survive. The process involves specialized cannulas that slowly extract very fine parcels of fat, which are most appropriate for the face.

Once removed, the fat is purified and processed into even smaller bits. When manipulated just enough to shrink and separate the globules while keeping the fat cells mostly intact, this material becomes microfat. It has the substance required to deliver volume when reinjected.

When microfat is broken down further, the individual fat cells burst, yielding “the milieu of the fat without the mature cells in it,” Hirmand explains. Rife with stem cells, growth factors, and exosomes, this liquid is known as nanofat, or adipose-derived serum. It’s used for regenerative purposes—to upgrade the health of the skin—and can also work wonders on fine lines around the mouth and eyes. (Microfat contains these same fat-derived goodies, but again, its main job is to lend fullness.)

Doctors transfer the refined fat into small syringes and inject it into depleted areas, like the cheeks, eyelids, and temples. Most avoid the nose (so as not to enlarge it) and go easy on the jawline, for fear of adding bulk. Other iffy areas for fat are the lips and neck. Some surgeons will treat them, while others worry about complications, like lumps. “You really have to know what type of fat to use and how much to place,” Chang says. When boosting the lips, for instance, she’s super conservative. “And I always make it clear that fat can’t change the shape of the lips,” she stresses. “It’s not like filler, where we can make microadjustments, increasing the height of the Cupid’s bow or flaring the outer corners.”

Fat Versus Filler

Hyaluronic acid (HA) fillers may outshine fat in the detail department, but fat woos patients with the promise of natural volume. “A lot of people are coming in saying, ‘I don’t want filler—I want something that comes from my own body,’” Chang reports. And in certain cases, when it’s used specifically to address volume loss, fat can offer a more authentic look, “because it’s a little softer and more pliable, and tends to move better with the face,” she adds.

Roostaeian seconds this, explaining that fat permeates our tissues like water saturating a sponge. And unlike filler, which he calls “a spot treatment,” fat can correct broad areas, usually without looking overdone. “We’re almost spray-painting the tissues with fat, evenly dispersing tiny bits throughout different planes,” he says.

Even better, fat doesn’t demand frequent touch-ups. Once it takes, it’s yours for keeps (about 50 percent of what’s transferred sticks around). But since we do continue to lose facial fat with age, patients may choose to repeat the treatment every seven to eight years, Tepper says.

Another boon of fat: It doesn’t bloat or shift as HAs can sometimes do. “We’re starting to see the long-term effects of filler, with pockets of malar edema [stubborn swelling under the eyes] and decreased lymphatic drainage,” Chang says. Regardless of how long an HA supposedly lasts, “there’s always a small amount that remains, and it can continue to pull in water and cause problems, especially in the tear-trough area.”

While Hollander finds filler to be a versatile accent—“wonderful for creating small changes”—she says that “even when used responsibly, it can be unpredictable,” in terms of its longevity and evolution. With repeated injections, HA (and the water it binds) can accumulate in the face, she cautions, giving “a round, puffy, heavy look.”

For all these reasons, some see fat as a remedy to the “filler fatigue” symptoms afflicting loyal HA users. Hollander is quick to note, however, that fat isn’t the only solution. One could choose to “use filler in small amounts, infrequently,” she says, or skip the filler and consider a skin-tightening treatment or surgery instead.

What Are the Risks of Facial Fat Grafting?

Like every procedure, fat grafting comes with its own set of concerns. When fat isn’t properly harvested/processed/injected, oil cysts, lumps, and infections can occur. If overdone or misplaced, fat can easily make a face look older, heftier, and saggier.

What’s more, since body fat behaves differently than facial fat, “hormonal shifts and weight gain can cause it to grow,” even after it’s been relocated to the face, Hollander notes.

You can mitigate fat-grafting risks by going to a board-certified plastic surgeon, who knows what they’re doing. This is critical, actually, because fat isn’t as easily reversible as HA filler. A qualified surgeon can also determine if you’re a good fit for the procedure. Ideal candidates are healthy nonsmokers with discernible volume loss. Placing fat where it’s not warranted can make a face look wide or chubby. Consequently, most 20-somethings don’t qualify for facial fat grafting.

In older patients, skin quality is a consideration. “If there’s moderate-to-severe laxity, I don’t think it’s wise to fat-graft the face, unless we’re putting fat in only select areas, like the upper eyelids,” Hirmand says. And certainly, if someone has bad jowling, “you don’t try to hide that with fat grafting,” Roostaeian adds. Loose skin typically requires surgical tailoring in addition to volume restoration. But if laxity is mild, “volume placed in the right areas can create a fuller, more youthful appearance,” Chang notes. Still, fat cannot cure sagging. Preexisting laxity will persist despite the influx of fat.

How Long Does It Take to Recover from Facial Fat Grafting?

The downtime following facial fat grafting can vary depending on your surgeon’s skill and technique. With careful tissue handling and the right cannulas, bruising and swelling should be fairly minimal. “My patients are usually fine to go out the next day,” Chang says.

Given the absence of incisions, there’s really no aftercare or restrictions on makeup, Tepper adds. You will have bandages covering areas where fat was taken, so you’ll need to avoid baths, hot tubs, and things of that sort until lipoed zones have fully healed.

Doctors generally allow light exercise after a couple of weeks, but may ask you to control the intensity for a few months post-op, in order to avoid burning off freshly grafted fat and blowing your investment.

How Much Does It Cost to Inject Fat into the Face?

You can expect to pay anywhere from $8,500 to $12,000-plus for comprehensive facial fat grafting with a reputable plastic surgeon in a major city (plus, a few grand extra in anesthesia and facility fees). If you’re treating only part of the face, or if your doctor practices in an area where the cost of living isn’t so steep, the procedure will likely cost less.