September 09, 2026 | Plastic Surgery News
Facial fat grafting grew 39 percent in 2025, to 34,117 procedures. Largest increase of any cosmetic surgical procedure in my specialty’s annual report. Surgeons still name hyaluronic acid fillers as their first facial tool at 69 percent, with fat second at 49 and climbing.
Here is what I told our write-up, in full.
On why patients are leaving filler
“There is certainly a tendency currently to go away from fillers and use biostimulators, or the patient’s own fat, or a donor fat graft.”
“I think we have seen that facial fillers have been quite overdone, and patients are really getting away from looking overfilled and want to look more natural. We have seen that these hyaluronic acid fillers may not dissolve completely, and they do tend to migrate. It seems like they create some kind of inflammatory response in some patients, creating nodules or inflammation. And of course, the feel of a filler is not quite like natural fat, which is squishy and soft, something whose borders you wouldn’t be able to identify the way you can with a filler.”
You can often feel where a filler ends.
On the maintenance
“Patients do want a longer lasting procedure, and they’re moving away from fillers. When patients use fillers, they see that they have to have this redone anywhere from every six months to one year. And what we’re also seeing is that not all of that filler goes away, but it’s migrating and flattening out, so it’s not giving us the volume exactly where we want it. Whereas the filler disseminates, with fat we get a little bit more structure and a softer feel, but also the benefit of much longer lasting results, especially if the patient can maintain their weight.”
“We have been using the patient’s own fat, because we have the benefit of using however much volume we really need, as the number of fat CCs does not increase the cost of the procedure, and the patient’s own fat is free.”
Filler is sold by the syringe. Fat is not sold by the cc.
On what fat does worse
This is the part I want said plainly, because it is where patients get disappointed.
“The main factor that disappoints people with fat injections is that the amount of retention is really unpredictable. Even though we know the patient is going to keep fifty to eighty percent of the volume, that percentage is quite unpredictable, so we are always overfilling. Patients that lose fifty percent of the volume we inject are sometimes disappointed, and we have to go back and inject more fat. It also depends on each person, how they assimilate the fat graft and how much of it stays.”
“The good thing is that whatever does stay is going to be quite permanent, and of course maintaining your weight is going to help with that. We know that with aging, fat will decrease in the face regardless, so it is a procedure that we probably have to repeat in the future.”
Predictable and temporary, or unpredictable and permanent. That is the real choice.
On the options that skip the harvest
“For some patients that don’t want as much downtime, we’ve been using Lipoderma, which is a donor fat graft that gives us very similar results to the patient’s own fat grafting.”
I use alloClae the same way. On Sculptra:
“We have been using Sculptra, but this does create inflammation like scarring and fibrosis.”
On whether this is just Ozempic
The report declines to say so, noting the rise “extended beyond patients who have used GLP-1 medications.” That matches my own schedule.
“I think fat grafting has been rising for many years. It’s an essential component of almost all facial procedures. I incorporate fat grafting into lower eyelid surgery, I incorporate it into all my facelifts, and I incorporate it in any facial procedure where the patient has lost a considerable amount of weight.”
“So the GLP-1 wave has certainly increased the demand, but just normal aging is comprised of loss of fat and volume in the face, as well as skin laxity and quality. So just with normal aging there was already a high demand for fat transferred to the face, and now with GLP-1s that demand has increased even further.”
Aging was already a volume problem. GLP-1s sped up a curve that existed.
Ask whoever is treating you how much they expect to retain, and whether a touch-up is included.
Ready to talk?
Call my office at (915) 590-7900, text 1-866-814-0038, or request a consultation.
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Source: American Society of Plastic Surgeons, 2025 Procedural Statistics Report. Facial fat grafting 34,117 procedures, up 39 percent, the largest percentage increase of any cosmetic surgical procedure in the report. Surgeon-reported facial rejuvenation approaches: HA fillers 69 percent, autologous fat grafting 49 percent. Commentary from Dr. Agullo’s dictation of 2026-09-07, Q&A Transcriptions/Fillers-vs-Fat-Commentary.md.
