Hollowers and saggers. That’s how TV plastic surgeon Dr. Paul David slickly explains the two paths of the aging face to Carrie Bradshaw when she finds herself (and her own aging face) unwittingly subject to his scrutiny on an episode of And Just Like That. The surgeon may have been faux, but his interpretation was not; real MDs agree that as the face ages people tend to either lose volume (hollowers) or experience increased laxity (saggers), and yes, sometimes both. “Often gravitational-related and volume-related facial aging are conflated, and they’re really physiologically and physically discrete entities,” says Sean Alemi, MD, a board-certified facial plastic surgeon based in New York. And while options to address said effects of aging like facelifts and fillers are already very much a part of the mainstream aesthetics conversation, something else is courting more of our collective attention lately: fat.
“Fat is having a resurgence,” says board-certified Beverly Hills-based facial plastic surgeon Babak Azizzadeh, MD, of the renewed interest in its usage for cosmetic procedures. Fat grafting (or fat transfer) relies on live fat cells that have been harvested (via liposuction) from one part of the body and then injected into another, most often the face. The procedure is not new—the first fat grafting was performed way back in 1893 by a German surgeon who used fat from an arm to fill out a scar near the eye, and it gained more traction with the popularity of lipo in the 1980s—but it’s experiencing a new wave of interest.
