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I’d like to become a bit specific about fat transfer in the face; where I put it, why I put it there, and what my personal concepts are about use of fat transfer as the face ages. And it’s very important; it’s not just throwing it in where it looks like it might work. It’s structural concept, in fact many people call it structural fat grafting or structural fat transfer. And why is that? Well, the face ages because gravity wins and the face ages because we lose volume in our faces as we get older, almost like losing weight and clothes becoming loose. But what also happens is we lose fat in the face in very specific, strategic areas that allow descent of the facial skin and what we see as aging. Where is that mostly? It’s here, in what we call the nasal labial folds; it’s here in what we call the marionette lines; and just as importantly, it’s here in what we call the lateral chin notches. What does that mean? For some reason and we understand a lot of the reasons but not all of them, we lose fat in these areas and in other parts of the face, and what that creates is a line of weakness from the nose to the jawline. If you were to pinch the skin here in the jowl it’s thick. If you were to pinch it here right in front of the jowl it’s paper thin. For some reason loss of fat in that area creates the ability of the face to fall. Imagine if you have a piece of paper that’s creased. Well any time you bend that piece of paper its going to always bend at the crease. This is a crease that starts at the base of the nose and goes all the way down to the jawline. What that allows is for the face to descend or to fall all the way and into the neck; creates the jowl; creates the neck looseness. We may be magnificent at surgery in putting things back where we want it to be, and we may be magnificent in letting the patient look wonderful the day after surgery when we take the bandages off. The problem is gravity doesn’t stop working and loss of face fat doesn’t go away, so three months, six months after the surgery well start to see everything falling again because this is the failure point. So structural fat transfer is placing fat where it’s visually needed but it’s also like a little retaining wall, and that bit of retaining wall will hold the cheek and hold the jawline where we put it, and getting a longer natural result. What happens? Three wonderful things: Frist of all, I don’t have to pull as hard, so you get a much more natural result from that. Secondly, the fat transfer fixes what’s wrong; it fixes the sad downward turning appearance to the corners of the mouth. And the third, least known and most important component is that the lift lasts longer because the structure of the fat allows this to stay in place without dropping. I hope this is of interest to you, and I thank you for listening, I’m Dr. Lawrence Koplin.