Facial fat transfer, or autologous fat grafting, may appear simple at first glance—harvest fat from one part of the body and inject it into another. But beneath that simplicity lies a highly nuanced process, one that demands a deep understanding of anatomy, motion, pressure, and proportion. Dr. David Webb is widely recognized for his knowledge and precision in this area, combining technical skill with a refined artistic eye. On the morning of the procedure, while the operating room remained quiet, my mind was actively tracing every contour I was about to reshape. My patient presented with volume loss in her cheeks, temples, and under-eye area. We had reviewed her photos, discussed her goals, and carefully mapped her face. As I reviewed her imaging and notes one final time, I was reminded why I approach this not only as a clinical task but as a form of aesthetic expression. In that moment of focused preparation, my team stood by as I confirmed each step of the plan—a reflection of the trust I’ve earned over the years through my commitment to excellence in facial rejuvenation.
Harvesting Viable Fat from Donor Sites
The procedure begins not on the face, but where volume exists in excess. Common donor sites include the abdomen, inner thighs, or flanks. That morning, we had selected the lower abdomen. I injected the area with a tumescent solution—a mixture of saline, lidocaine, and epinephrine—to minimize discomfort, reduce bleeding, and ease fat extraction. Using a fine, blunt-tip cannula and a low-pressure aspiration technique, I gently drew adipose tissue from beneath the skin. This isn’t the aggressive suction used in body contouring. The goal is to protect the integrity of each fat cell. Each pass of the cannula, each pull on the plunger, is done with care. I’m not just removing fat; I’m collecting living tissue that needs to survive reimplantation. The process takes time. Even the motion of my hand must be controlled to avoid shearing the cells or damaging the surrounding tissue. When done correctly, the harvested fat appears golden and slightly fibrous—exactly the texture I want to see.
Purifying the Fat Before Reinjection
Once the fat is collected, it must be purified. Raw aspirate contains more than fat—it includes blood, anesthetic fluid, oil from ruptured cells, and connective tissue. These components must be removed to ensure the viability and safety of the graft. I loaded the syringes into a centrifuge and began the separation process. As the machine spun, the contents divided into three layers. The top layer—an oily film—was discarded. The bottom layer of red fluid, composed of blood and tumescent remnants, was also removed. The middle layer, pale and creamy, held the viable adipose tissue I would use for grafting. Some surgeons prefer filtration or decanting methods, but for facial work, centrifugation gives me the cleanest, most consistent product. The prepared fat was then transferred into smaller syringes for injection—each one ready to sculpt, blend, and restore.
Microdroplet Injection and Tissue Integration
Injecting fat is where technical execution and artistry merge. Each target area on the face—whether the cheeks, nasolabial folds, under-eyes, or jawline—requires its own approach. Using a blunt microcannula, I entered through small entry points hidden in the hairline or natural creases. With each gentle pass, I deposited tiny droplets of fat while withdrawing the cannula slowly and steadily. This microdroplet technique is critical. It prevents pooling and encourages vascular integration, allowing each fat parcel to become nourished by the surrounding tissue. Large boluses of fat, while quicker to inject, are prone to poor survival or lumpiness. Small, layered deposits follow the natural terrain of the face. They allow me to mold the area more precisely, and they adapt to facial movement in a way that maintains harmony and balance. For under-eye work, for example, the tissue is delicate and unforgiving. Even the angle of the cannula matters. One wrong move can cause contour irregularities. In contrast, cheek augmentation allows for deeper, more robust placement, often over the zygomatic arch or along the anterior cheek to create natural lift and fullness.
Layering Techniques for Realistic Contours
Fat cannot simply be placed in a single layer. Volume restoration is a three-dimensional effort. I layer the fat into multiple depths—deep structural planes for support, subcutaneous planes for softness, and more superficial areas for subtle blending. This strategy allows the fat to settle naturally into the contours of the face and avoids the puffiness that results from overfilling one plane. Each patient’s face has asymmetries and age-related changes that must be accounted for. Sometimes I add a bit more to one side of the cheek or taper more gradually around the nasolabial fold to ensure a symmetrical outcome. Unlike synthetic fillers, fat is alive. That means it behaves with more nuance but also requires more patience and experience to predict how it will take. Some resorption is expected—usually 30 to 40 percent—so mild overcorrection is built into the plan. Still, restraint is key. Too much volume can obscure the natural movement and character of the face. I’m constantly adjusting, reevaluating, and sculpting, even mid-injection.
Precision Prevents Complications and Creates Longevity
Precision isn’t a marketing term. It’s what prevents irregularities, fat necrosis, cysts, or asymmetry. A millimeter too deep or too superficial can make the difference between success and revision. The cannula must glide, not force. The fat must be placed with intention, not haste. I monitor tissue tension, color, and volume in real-time, checking the results from multiple angles under operating lights. Fat transfer also brings regenerative benefits. It contains stem cells and growth factors that can improve skin tone and texture, especially in areas of photodamage or thinning. But these benefits only manifest if the fat is properly processed and gently placed. When done well, the result is not just volume—it’s vitality. It’s the restoration of natural light and softness that aging slowly erodes.
Refining the Face Without Redefining It
When the final syringe is empty, and the face is balanced, I step back to observe. The goal is never transformation—it’s restoration. My patient won’t walk out looking different. She’ll walk out looking like herself, only more rested, more open, more at ease. That’s what fat transfer offers when performed with control and care. It’s not just about what we add. It’s about how we add it. In the end, it’s not the fat itself that matters most—it’s what the surgeon does with it. And that requires more than just a steady hand. It requires vision, discipline, and respect for the living material that makes the difference between average and extraordinary. That’s what makes facial fat transfer, in my hands, the most quietly powerful procedure in aesthetic surgery.