ABSTRACT
Although autologous fat transfer (AFT) has been described in the literature for
over 100 years, as a rejuvenating procedure it has waxed and waned in popu-
larity. As recently as 20 years ago, the subject of facial volumizing was limited
to a relatively small group of cosmetic surgeons advocating AFT for true facial
rejuvenation. In this century, facial volume restoration with both AFT and
synthetic fillers is enjoying a renaissance. Several trends have changed the
landscape in the 21st century: an awareness that a rhytidectomy is not truly
rejuvenating without volume replacement, an increasing demand by the public
for non-invasive cosmetic procedures, and an increasing availability of synthetic
products with consequent direct marketing to the public for facial volume res-
toration. Thus, not only have cosmetic surgeons revised their approach to reju-
venation, but the general public has also gained sophistication as well. Aging
baby boomers remain in the competitive workforce for longer periods of time
and desire discrete, natural outcomes and minimal downtimes. They want to
avoid the overdone look of facial surgery as well as the prolonged recovery time.
Consequently, in the United States, the number of nonsurgical procedures rose
from approximately 1 million to more than 9 million from 1997 to 2005 (1). Soft
tissue filler procedures increased 39% over the same period of time. Despite the
slowing economy, the number of nonsurgical procedures rose to 10.4 million by
2008. Although AFT is nearly the ideal volumizer, having no allergenic
potential, being readily available in most patients, and having an over 100-year
track record of safety, it is still a more invasive procedure. On the other hand,
newer synthetic fillers are threatening AFT as the preferred volumizer because of
their ease of use, minimal downtime, and improved and predictable longevity.
This chapter explores the current state of AFT as well as the use of newer
synthetic fillers currently available for correcting facial volume loss.
