Featured Physician: Shilesh Iyer, MD

Featured Article: Butterwick KJ, Bevin AA, Iyer S. Fat transplantation using fresh versus frozen fat: a side-by-side two-hand comparison pilot study. Dermatol Surg. 2006;32(5):640‐644. doi:10.1111/j.1524-4725.2006.32135.x

Dr. Shilesh Iyer is a board-certified dermatologist in private practice in New York City. He completed a year long intensive fellowship in cosmetic and surgical dermatology with a focus on liposuction and fat transfer techniques. During this time, he assisted in conducting clinical research to study the optimization of fat injection techniques to promote safe, effective, and cosmetically pleasing outcomes. He sits down with us today to review the biology of fat and techniques for volume restoration in areas of fat loss due to the aging process.

The Good And Bad Faces Of Fat

myDoqter: You have significant experience looking at fat, diet, and bodysculpting to lose fat but also fat injections for volume restoration to add fat back in. Can you discuss our love-hate relationship with fat?

Dr. Iyer: That’s a great question. While so many folks seem to be focused on weight loss and losing fat, it is important to understand that fat is an important component of the human body with important functions. Fat exists in two compartments: a. visceral or deep fat and b. subcutaneous or pinchable fat. The fascinating thing about fat is that it is a highly active tissue with important biological roles:

  • Exerts effects on energy and metabolism
  • Affects release of hormones and immune system mediators.
  • Contributes as a source of building blocks for cholesterol and triglyceride based molecules that are important in cellular structure.

But at this same time, excess fat can have detrimental effects. In particular, visceral fat, which is located deep in the body around internal organs, is highly metabolically active and in excess, may be a risk factor for cancers, diabetes, heart disease, increased cholesterol and stroke.

Therefore, while some fat is important and vital to our health, excess fat can be harmful. When it comes to fat, balance is key.

Fat Injections And Volumization

myDoqter: We often talk about fat reduction techniques, but can you review the rationale for why we would inject fat back into the skin?

Dr. Iyer: Accumulations of subcutaneous fat is often undesired in certain locations like the abdomen, love handles, and jowls. However, subcutaneous fat also has positive effects lending insulation and protection and it supports the skin providing volume and support for a more youthful look. Certain locations like the face and hands can look both gaunt and aged with fat loss that occurs with the normal aging process. Restoring fat to these areas can be rejuvenating and restore a pleasing youthful look.

In the article cited above, we studies certain techniques regarding harvesting fat that can be freshly injected or frozen and reinjected at a later time. Both freshly obtained fat and frozen fat can be effectively used to inject areas of volume loss. Areas that are particularly responsive are the face (cheeks, laugh lines, and marionette lines, for example) and the back of the hands. In the aging hand, loss of fat can produce severley wrinkled skin with prominence of the veins and tendons. Fat injections to the back of the hands are a nice and effective way to achieve cosmetic enhancement.

Is fat the Gold Standard For Volumization?

myDoqter: We have seen fat injections all over the media and in the movies, sometimes portrayed comically. Is this considered to be the gold standard injectable treatment?

Dr. Iyer: In a manner of speaking, you could consider fat to be the original and therefore gold standard treatment for volume restoration. However, due to the extra step of harvesting the fat through liposuction from the buttocks or abdomen, fat injections are not the most common technique for volumization. There are many pre-packaged injectable products which are hyaluronic acid based that have become the main injectable material for volumization. These products include Juvederm, Restylane, and Belotero among others. Another popular product for the hands is a product made of calcium hydroxyapatite called Radiesse and Sculptra is an alternative that is used for more global facial volumization. These products range in longevity from months to 1-2 years according to studies and the package inserts and can produce excellent results. The one advantage of fat injections in the hands of a skilled physician is potential for greater longevity on the order of a few years, although results cannot be guaranteed.

Dangers Of Injectables

myDoqter: Are injections safe? What should we know about possible side effects.

Dr. Iyer: Injectable treatments have been performed for decades now and have an excellent safety profile. The treatments were heavily researched and refined by physicians and have come to be extremely popular and rewarding procedures. There are, however, potential risks ranging from minor issues like bruising and swelling to more serious complications including injection into arteries that can cut off blood supply to the eyes or skin causing injury to those organs. Nerve injury and infections are other potential complications if treatments are not properly performed in a medical setting. It should be noted that outcomes with injectables are highly dependent on the injector’s medical training and knowledge of anatomy and science.

Three Facts On Fat Injections You Might Not Know

myDoqter: So what would be the five take home messages on fat injections you would want readers to know?

Dr. Iyer: These would be my top three tips on fat injections:

  1. Fat injections can be a pleasing and effective treatment, but make sure the injector is a physician with large scale experience with the procedure.
  2. The study presented in this blog post showed that freshly harvested fat may be more optimal in results in longevity versus frozen fat, but some doctors will freeze fat for re-injection at a later time. This provides you a way to enhance the longevity of your results with touch up treatments.
  3. Don’t forget the hands! The aging hand is often a dead give away of one’s age. Fortunately there are great options for hand rejuvenation.
fat injections for hands