Fillers made from hyaluronic acid dominate the conversation about facial volume. The American Society of Plastic Surgeons counted more than 5.3 million hyaluronic acid filler treatments in the United States in 2024. They work, and they wear off, somewhere between six months and two years.
Fat grafting takes a different route. A surgeon removes fat from somewhere you have plenty of it, such as the abdomen or thighs, processes it, and places it into the face. Because the tissue is your own, the grafted fat that survives becomes part of you. The question every patient should ask is how much of it survives, and that depends on how the surgeon handles it.
One fat, three textures
At FACES+ in San Diego, Dr. Steven R. Cohen filters harvested fat into three distinct grades before it goes anywhere near the face. Each grade has a different particle size and a different purpose.
Millifat is the least filtered. Its larger parcels add structure and substantial volume, which makes it the grade for deep foundational work: rebuilding the cheek, supporting the temples, restoring the scaffolding that has thinned with age.
Microfat is refined further. It sits closer to the surface, smoothing contours and making subtler changes to facial features where a heavier graft would look lumpy.
Nanofat is the most refined of the three. At that size, the graft adds almost no volume. FACES+ uses it for skin quality, describing nanofat as a stimulus for cell production and skin regeneration that helps with fine lines and texture.
Why the layering matters
A face ages in layers. Bone recedes, deep fat pads deflate, superficial fat shifts, and skin thins. Putting one type of fat into all of those layers is a bit like painting a wall, a door frame and a picture with the same brush. Something ends up wrong.
Matching the grade to the layer lets a surgeon rebuild structure at depth, refine contour in the middle, and treat the skin at the surface in a single procedure. FACES+ calls this stratification, and it sits at the center of the practice’s regenerative fat grafting protocol.
The practice reports that the approach retains about 80 percent of added facial volume two years after treatment in patients under 55, compared with around 35 percent for conventional techniques. If you are comparing surgeons, ask for their retention figures and the age group they apply to. A number without an age range tells you little.
The regenerative part
Fat carries more than volume. It contains stromal and regenerative cells, which is why surgeons in the field have spent two decades studying fat as a tool for improving tissue quality. Cohen has worked in that area for years. He co-created Lipocube, a device for processing fat to concentrate those cells, and he serves as section editor for fat grafting and stem cells at the Aesthetic Surgery Journal.
Keep your expectations realistic. Regenerative medicine is an active research field, and results vary by patient, age and health. Grafted fat also takes time to settle, so the face you see in the first weeks is not the final result.
Who tends to benefit
Fat grafting suits patients whose main concern is hollowness rather than sagging: flattened cheeks, sunken temples, deep tear troughs, or a gaunt look after significant weight loss. FACES+ recommends it for some patients in their late thirties and forties as an alternative to a lift, and combines it with facelift surgery for patients whose faces have both lost volume and loosened.
You need enough spare fat to harvest, which rules out some very lean patients. Smoking reduces graft survival, and most surgeons will ask you to stop well before the procedure.
What to ask a surgeon
Ask whether they process fat into different grades and where each one goes. Ask what share of grafted volume their patients keep at one and two years, and whether you are likely to need a second session. Then ask whether your face needs a lift as well. The answers will tell you whether a surgeon treats fat as a filler substitute or as living tissue with its own rules.