Fat Grafting & Facial Implants

Atraumatic extraction to maximise viable adipocyte yield

Fat is harvested using a low-pressure, atraumatic aspiration technique — employing small-calibre, blunt-tipped harvesting cannulas that minimise mechanical disruption to the fat lobules and their associated stromal vascular fraction. Donor site selection prioritises areas where the fat is dense, well-vascularised, and reliably abundant: the lower abdomen and inner thighs are preferred, with the periumbilical and flank regions used as secondary sites where required.

High-vacuum suction is deliberately avoided during harvest, as it generates shear forces that damage adipocyte membranes and reduce long-term survival of the graft. A low, controlled negative pressure is applied manually or with a regulated system to produce a fat aspirate of high cellular viability.

Separation and purification to prepare the graft

Following harvest, the fat aspirate is processed by centrifugation at standardised parameters to separate the purified fat from the oil, blood, and aqueous components of the aspirate. The centrifuge protocol is calibrated to maximise the concentration of viable adipocytes and stromal vascular fraction cells while minimising the presence of disrupted cells, free oil, and inflammatory debris — all of which reduce graft survival and increase the risk of cyst formation or oil necrosis.

The middle layer of the centrifuged aspirate — the purified, condensed fat — is carefully isolated for use. This preparation step is not cosmetic: the purity and viability of the processed fat directly determines the predictability and longevity of the final result.

Bespoke sizing for each facial sub-region

The processed fat is filtered to produce preparations of specific particle sizes, matched to the tissue characteristics and volumetric requirements of each target region. This is one of the most clinically important and often overlooked dimensions of fat grafting technique — a particle that is appropriate for deep structural volumisation of the cheek is far too large and unpredictable for injection into the delicate periorbital or perioral tissues.

1200-micron (standard structural fat): used for regions requiring durable structural volume, where a larger particle size provides better projection and long-term contour. Applied to the deep cheek compartments and the deep tear trough.

600-micron (nanofat): processed through a 600-micron filter to produce a fine, emulsified preparation rich in stromal vascular fraction, regenerative cells, and growth factors. Used in the lips, perioral region, and anterior neck where the primary goal is tissue quality support, fine-line softening, and biologic regeneration rather than structural volume addition.

The cheeks are among the first areas to show volume loss with age. As the deep fat pads of the midface deflate, the cheekbone loses its projection, hollowing develops beneath the eyes, and the lines from nose to mouth deepen.

Fat grafting to this region restores three-dimensional volume to the cheek and midface. The smooth transition from lower eyelid to upper cheek is re-established, and the structural changes of age are softened from beneath.

Most often performed alongside a deep plane face and neck lift, where lifting the descended tissues and restoring lost volume work together to produce a complete result. May also be performed on its own in younger patients with early volume loss who do not yet require a lift.

The skin beneath the eye is the thinnest on the face. The tolerance for any irregularity is low, and the area calls for a careful, conservative approach.

Fat is placed deep — restoring the underlying volume that creates the hollow and reducing the shadowing that produces the appearance of dark circles. Sitting beneath the muscle layer, the grafted fat receives a reliable blood supply and the result remains smooth.

Frequently combined with lower eyelid surgery. The two procedures address different dimensions of periorbital ageing: the eyelid surgery corrects fat herniation and contour, the fat graft restores the volume deficit underneath.

In the lips and around the mouth, the goal shifts. Less about adding structural volume, more about supporting the quality of the skin and tissue itself.

Nanofat — fat processed to a finer consistency — is placed across the lips, the surrounding skin, and the vermilion border. The regenerative cells contained within the processed fat work on the tissue over weeks to months. Fine lines soften, texture and colour soften, and a subtle vitality returns to the area.

A natural complement to lip lift surgery and other procedures that address the position or shape of the lip, where the structural work and the tissue work each play a distinct role.

The neck rarely receives treatment in isolation, but it often shows ageing more visibly than any other area. Fine horizontal lines, loss of texture, and a softening of skin quality can persist even after a structural neck lift.

Nanofat applied across the anterior neck and submental area supports the quality of the skin itself. Texture, fine wrinkling, and overall vitality of the neck skin all respond to the regenerative cells within the processed fat.

Performed as a complement to a neck lift. The combination addresses both the deeper structural changes and the surface quality of the skin in a single procedure.

Chin augmentation with a silicone implant provides a precise, predictable increase in chin projection and the cervicomental angle — changes that directly affect profile balance and the visual relationship between the chin, lip, and nasal tip. Silicone chin implants are placed through a small submental incision and positioned in the sub-periosteal plane, where they sit securely and are structurally stablely contoured. Chin implants are offered alongside and as an alternative to sliding genioplasty (osseous chin repositioning), with the choice between the two based on whether correction is primarily of projection alone, or requires changes in vertical height or lateral position as well.

Jaw angle implants augment the posterior mandible to increase facial width, build the posterior jaw and add to the three-dimensional structure of the lower facial skeleton. Placed in the sub-periosteal plane through intraoral incisions, they are well suited to patients seeking a more defined, angular lower face and those in whom the natural jaw angle is deficient in projection or width.

Silicone cheek implants restore or add to skeletal cheekbone projection, addressing the flattening of the malar region that accompanies ageing or that is constitutionally present. Paranasal implants augment the pyriform aperture region, providing support to the nasal base and the upper lip — a change of particular relevance in patients with midface deficiency where the loss of skeletal support contributes to lip and nasal base ptosis.

Fat that successfully integrates is permanent — it becomes a living part of the recipient tissue and behaves as the patient’s own fat. The challenge is that not all transferred fat survives: the typical take rate is 30 to 60 percent, which is why Dr Sparks’ technique focuses on maximising cell viability through atraumatic harvest, careful centrifuge processing, and precise infiltration. The fat that does survive is permanent and continues to age naturally with the face.

Fat grafting and dermal fillers address similar concerns but differ fundamentally in their mechanism, longevity, and appropriate applications. Fillers are temporary, reversible, and highly appropriate for targeted volumisation in areas where a trial period is desirable or the volume needed is modest. Fat grafting is permanent, requires a surgical setting, and provides more durable volume for patients seeking sustained volume restoration — particularly in the context of other facial surgical procedures. The most appropriate choice depends on the patient’s anatomy, goals, and the degree of change being sought, and is discussed in detail during consultation.

Particle size directly influences the behaviour of the transferred fat in the recipient tissue. Larger particles provide structural volume and projection in deep, well-vascularised tissue beds — but are inappropriate in thin-skinned or highly mobile zones where they can produce visible irregularity. Smaller nanofat particles at 600 microns deliver a regenerative effect rather than structural volume, supporting skin quality, softening fine lines, and supporting tissue vitality through the stromal vascular fraction cells they contain. Matching the particle size to the region being treated is one of the most important technical decisions in fat grafting.

Fat is harvested through very small access incisions — typically 2 to 3 millimetres — placed in concealed locations such as the umbilical fold, the inner aspect of the thigh, or within the natural creases of the lower abdomen. These incisions heal to near-invisible scars in the vast majority of patients.

Yes — and it is most commonly performed in this context. Fat grafting is a natural adjunct to facelift surgery, rhinoplasty, lower blepharoplasty, and lip surgery, where the structural changes of each procedure are complemented by the volumetric and regenerative changes provided by targeted fat placement. In Dr Sparks’ practice, the question is not whether fat grafting should accompany facial surgery, but which regions and which particle size are most appropriate for each individual patient.

No. Nanofat is processed autologous fat — the patient’s own fat cells and their associated stromal vascular fraction, regenerative cells, and growth factors — filtered to 600 microns. Platelet-rich plasma (PRP) is derived from the patient’s blood and contains platelets and growth factors but no fat-derived regenerative cells. The two are distinct preparations with overlapping but not identical mechanisms of action.

Silicone implants are soft, pre-formed, and reversible — they sit in a surgical pocket and can be removed or exchanged if required. Medpor® implants are made from porous polyethylene and integrate with the surrounding tissue through fibrovascular ingrowth, providing superior long-term stability but making revision more demanding. Dr Sparks selects the material based on the region being augmented and the clinical requirements of the case.

Silicone implants can be removed or exchanged relatively straightforwardly if desired. Medpor® implants, due to their tissue integration, are more demanding to revise and this is considered carefully in the pre-operative planning. As with all implant-based procedures, the possibility of revision is discussed openly before proceeding.

A chin implant adds projection and definition by placing an alloplastic material in front of the existing chin bone. A sliding genioplasty repositions the chin bone itself, allowing three-dimensional correction of projection, height, and lateral deviation. Chin implants are most appropriate for patients seeking purely anterior augmentation of modest degree; sliding genioplasty is preferred for significant projection change, vertical correction, or asymmetry. The choice between the two is discussed on the basis of the individual anatomy and goals.

Facial implants are designed to be long-term or permanent. They do not require replacement on a schedule and do not degrade over time in the manner of injectable fillers. Silicone implants may be removed or replaced if desired; Medpor® implants, once integrated, are considered permanent. All considerations regarding longevity, revision, and implant-specific risks are discussed during consultation.

Yes — and this combination is often the most complete approach to facial volume restoration. Implants address the skeletal foundation, while fat grafting restores the soft tissue envelope that overlies it. The combination addresses both the bony and soft tissue dimensions of the volume concern simultaneously.