I just saw a patient who I did fat grafting to the face on a few years ago. She had a fabulous result, which lasted for years. She showed me photos of herself a few months ago, still looking full and radiant.
And then she did a microcurrent device on her face which is supposed to help tone the muscles and improve and lift the skin. She did that treatment four times over the course of a few months.
And now her fat is gone.
She showed me many photos of her before she started the treatment and after. There is a clear difference. And she asked me did this device kill the fat?
The answer is maybe. This is my opinion. I think it is an informed, educated opinion after years of being a plastic surgeon, years and years of reading journal articles and doing surgeries, and a decade of doing fat grafting to the face. I have been hesitant to ever blog about this, as the big companies may not like my opinion, but I keep seeing patients who are dealing with the effects of doing these noninvasive procedures, and they didn’t know. No one ever warned them that there may be a downside to doing these noninvasive skin lifting and tightening procedures. So in the hopes I may save one of you in the future:
NONINVASIVE PROCEDURES WHICH TIGHTEN THE SKIN MAY CAUSE LOSS OF SUPERFICIAL FACIAL FAT.
This includes Coolsculpt (which is trying to get rid of fat), Ulthera, Thermi, Renuvion, NuFace. I am sure there are others. The issue for me with all of these is that the “tightening” they cause is temporary, but the fat loss is permanent. I spend so. much. time. trying to get fat back into the face, as you lose it with aging, and fat stem cells help the quality of the overlying skin.
I looked at getting Ulthera, It was sleek, noninvasive, and offered me the holy grail of tightening the forehead to raise the eyebrows and tightening the neck. I desperately wanted something to bridge the easy noninvasive procedures and the bigger browlift or facelift surgeries. But when I did the demo for Ulthera, I could see on the ultrasound the fat under the skin. I asked, “how are you not getting rid of the subcutaneous fat when you apply the ultrasound?” The rep answered, “You are.” I asked “How much fat do you think you lose when you do a treatment?” He answered, “likely for a whole face, 15cc of fat.” 15 cc of fat is an ENORMOUS amount of fat to lose. If the tightening and lift were permanent, maybe it would be worth it. But the tightening is NOT permanent. The fat loss though is. So I see women come in 1-2 years after these treatments with a rapid big increase in skin crepey-ness, which I attribute to the destruction of the subcutaneous fat. That fat just under the skin is the most precious fat. It is what nourishes and puffs out the skin. It is the most critical fat to preserve.
Again, let me repeat:
The skin tightening is TEMPORARY. The fat loss is PERMANENT.
There are also injectables (Sculptra, radiesse) and threadlifts which cause likely scarring in the deeper tissue. This is like throwing clay in my soil, so if I do fat transfer in the future, the fat will not survive in those areas. Anything which is dissolvable, or stimulates collagen production, causes scar in the deeper tissue. Scar = clay in my soil = things don’t grow when you plant them there.
If you want to do fat grafting to the face at any point in the future, I do not recommend Sculptra or threadlifts.
These are my opinions. Read my blogs. I try to be transparent and base my advice on science and experience. I am not here to sell you. I think more people don’t advocate for fat grafting as it is low tech, or they aren’t surgeons so they don’t do fat grafting, or they have misunderstandings of fat grafting (it will be lumpy, or uneven, or other not true things). There is no company “selling” fat grafting to promote it unlike many of these well funded companies. There is lots of science to support fat grafting’s efficacy though.
In conclusion: The adage “seems to good to be true” is real. Be wary of noninvasive treatments which give short term fixes and long term issues.