25 October 2016Last updated

Features | Health

How to get a power pout

In just about an hour, your gaunt and aged face can take on a full, youthful look, thanks to Robin Hood surgery – a trendy 
image-enhancing procedure that is fast becoming popular across the world, reports Sarah Gibbons

By Sarah Gibbons
3 Jun 2016 | 12:00 am
  • Source:Supplied Image 1 of 2
  • Source:Supplied Image 2 of 2

It has been labelled the Robin Hood surgery – taking from the rich to give to the poor – and if its recent surge in popularity is anything to go by, this new image-enhancing procedure is set to become as legendary as the heroic outlaw.

Fat grafting, popular among the rich and famous in Beverly Hills, is fast becoming the go-to procedure for a wide range of women (and increasingly men) to rejuvenate their appearance without the scars associated with a full facelift.

It is also considered a permanent natural fix, over artificial fillers such as Botox that offer a temporary reprieve to facial lines but need topping up on a regular basis to maintain the desired effect.

So how does this ‘miracle cure’ actually work?

In a nutshell, a plastic surgeon takes fat from an area of the patient’s body – such as the abdomen or thighs – and then injects it into the facial muscles. The fat volumises the face, which restores the patient’s appearance to a younger version of itself.

The two-in-one op sees fat gone from an area where the patient doesn’t need it, and transferred to an area that does. ‘I take fat from where the person hates it the most. I call it Robin Hood surgery – steal it from the rich areas and give it to the poor,’ says Beverly Hills plastic surgeon Dr Lawrence M Koplin. ‘This tends to be long-lasting in the facial area where it’s injected.

‘The fat is from the patient’s own self and freely available – you pay for the mining but not the diamonds!’

Typically a surgeon harvests two tablespoons (30cc) of fat via a liposuction technique to inject into the face. In a US clinic, 1cc of filler costs $800 (about Dh2,940) so fat transfer is a much more cost-effective solution at between $4,000 and $6,000.

Dr Koplin has performed this natural fat transfer procedure on a number of high-profile celebrities who wish to remain anonymous.

He says a further benefit of this type of treatment over artificial fillers is that the fat is being transplanted into the same patient, so there is no chance of the body rejecting it for being a foreign material.

However, he says the procedure does come with one warning to patients prior to undergoing the initial fat harvesting: ‘If you gain weight in the future, the fat is gained too in the new area.’

Increasingly popular are demands for fuller lips or a ‘power pout’. But surgeons say this process of recycling fat from one area of the body to another is not appropriate for such a look.

Dr Koplin says: ‘If you’re born with full lips that have decreased in volume over the years, fat transfer can be used to restore the look with the proviso that if you gain weight, your lips will also grow, but fat doesn’t want to go into congenitally thin lips.’
The use of fat grafting is not a particularly new phenomenon, but Dr Koplin and some fellow plastic surgeons increasingly offer an enhanced procedure using stem cells from the fat.

French surgeon Dr Roger Amar, who pioneered the use of Fat Autograft Muscle Injections (Fami) almost 20 years ago, says: ‘A typical patient is a gaunt-faced woman in her 40s who exercises and diets, has a super body but a prematurely aged face.

‘The facial expression is made of 30 muscles, which retract with age, and the bones recede leaving wrinkles and a gaunt look.

‘By placing fat in the upper third of our face we produce an uplift effect that reshapes the face to the more youthful years.

‘We put the cells of the same person into the muscle to restore the shape of the muscles, and when you restore all the structure of the feature of the face, you rejuvenate.’

Dr Amar, who runs a clinic in Marbella, Spain, and operates at the exclusive Cadogan Clinic in Knightsbridge, London, underwent Fami himself in 2006, operated on by his own son, and declared the result a success.

And as the procedure is undertaken using local anaesthetic rather than the general anaesthetic required for a traditional surgical facelift, there is less bruising from the injections, replacing the need for cuts and subsequent scars.

The patient is able to return to work within a week or 10 days – twice as quick as those who opt for a facelift.

The non-surgical facelift is a procedure performed on a near-daily basis in Dubai by plastic surgeon 
twin brothers Dr Maurizio and Dr Roberto Viel.

Says Dr Roberto: ‘It’s a pretty straightforward procedure to enhance what the patient has naturally without transforming them completely.

‘You harvest fat with liposuction using a small cannula and syringe. 
It’s then prepared to be injected into the face in the area needing to be volumised.

‘The whole process takes about an hour.’

They collect more fat than they need to inject and freeze it as they prefer to conduct the volumisation process over several sessions, building up the face until the patient is happy rather than risk extreme results in the initial transfer. Also, they need to allow for some absorption of the fat into the site.
Dr Roberto says: ‘The amount of fat put in each area is always more than needed. The reason for this is that we know that initially about 40–50 per cent will be absorbed by the body, and the rest will stay.

‘We always keep some of the patient’s fat in our fat bank freezer. Therefore if in the future you need more rejuvenation to an area, we already have the fat ready to apply.

‘Most patients need around two to three sessions, but by having the fat stored in our fat bank there is no need to harvest it again.

‘Pathological studies have shown that we can still use the fat for up to two years after harvesting. The cells of the adipose tissue [fat] maintain all their anatomical and physiological properties for this duration.

‘We also offer a newer technique to minimise fat absorption using stem cells. We enrich the fat graft with the use of stem cells.

‘This procedure takes place in two stages. In the first we collect a small amount of fat that is sent to the laboratory, which works to extract the stem cells.

‘After about two weeks we take more fat and inject it in the standard way, mixed with stem cells. The survival of the fat is better this way.’

While fat grafting is a permanent solution to tackle the ageing effect on the face, he adds: ‘Gravity and the ageing process mean the face will change again – it’s inevitable. That’s why we need to keep an eye on the patient and reassess every few years how to maintain their youthful looks.’

Cica Huston-Fleiner, Surgical Director at Dr Lawrence M Koplin’s practice in Beverly Hills, California, on her experience:


‘I had my first natural fat transfer at the age of 52 but some of our patients are a lot younger for various reasons.

‘This was my idea since I love the natural fat transfer look as opposed to artificial fillers. Fillers look fake and do not move with your face, it’s like a giant glob with scar tissue that forms around it. Fat is what used to be there and looks very natural.

‘I have had natural fat transfer to my bilateral temples, bilateral lower eyes, marionette lines and just a tiny bit on my lower bottom lip.

‘The first picture below is just natural fat transfer, lower eyes, and the second one is when I had my face/neck lift along with natural fat transfer. You can tell that my skin looks better from the fat and it only gets better as time goes by because of the stem cells that are in your fat.

‘Would I recommend it to others? Yes, the power of natural fat transfer is beyond amazing.’

By Sarah Gibbons

By Sarah Gibbons