Q: Dear Doctor: I’m a 47 yr. old white male in good health. A few years ago I went to India to have a jaw augmentation that was done by lipo injection which was absorbed in a short period of time. I’m looking for a better and lasting result. I would like to know if you think implants would produce a better and more permanent result?
A: The use of fat injections in the past decade has gained in popularity and effectiveness for many plastic surgery problems. The appeal of using your own tissue to create a ‘redistribution effect’ is undeniable. Since most people have some (or a lot) of fat to give, it is not surprising that the technique is being widely used. As part of that widening use effect, it is inevitable that some will use it for uses that are not biologically sound. Fat as a tissue graft has real value for soft tissue augmentation but it is ill-conceived to use it as a bone-based graft. It will fare very poorly as a replacement for chin, cheek or jaw angle implants. The reason is in understanding how implants actually work. They function as a spacer on top of the bone to provide a push to the overlying soft tissues. It takes a fair amount of sustained pressure to hold the overlying soft tissues outward. A non-resorbable synthetic implant can maintain that effect. A soft tissue graft, like fat, will resorb under that kind of pressure.
Advocates may argue that the fat graft is put into the soft tissue and not the bone and therefore has a basis for being effective. Results like you have obtained provide all the evidence you need to counter those claims. Bone-based synthetic implants are simple and effective for facial bone augmentation even if they are not your own tissue.
Dr. Barry Eppley