FAMI Uncovered

By: Ruth Kerrison
Created on 25th March 2010

The FAMI technique was pioneered by Dr Roger Amar in the mid nineties, and has successfully been rejuvenating faces ever since. But how much do we really understand about the procedure? Cosmetic Surgery & Aesthetics Guide answers some of the most frequently asked questions about FAMI

Facial rejuvenation has come a long way since the eighties, when ‘wind tunnel effect' facelifts were pretty much the be all and end all. Since then, Botox and fillers have come on to the scene to eliminate wrinkles. But recently we've come to realise that doesn't mean anything if you don't restore lost volume to the face. Which is where FAMI comes in.

FAMI is not the only volumising treatment, but there are many things which make it unique. We have compiled a list of the
most commonly asked questions about this wonder treatment and hunted down the answers to put you in the picture about FAMI.

What does FAMI stand for?
The acronym stands for Facial Autografting Muscle Injection.

How does FAMI work?
The FAMI technique is an innovative approach that helps restore some of the underlying defects that are responsible for the appearance of ageing. It rejuvenates the face by implanting the patient's own adult mesenchymal stem cells, thus restructuring the facial skeletal and subcutaneous structure to a more youthful state. FAMI restores bone, muscle, fat pads and skin in one session!

What is the main difference between FAMI and other volumising techniques?
FAMI differs from other injectable volumising treatments such as Sculptra in that it uses the patient's own fat and stem cells to restore volume to the face.

Dr Amar was the first to come up with the idea in 1997 of injecting the fat autograft into the muscles of the face, as opposed to just under the skin as in more common fat grafting procedures. By placing the fat and mesenchymal stem cells into the rich vascular bed of the muscles, their chances of survival are enhanced.

By using a person's own facial muscles as the model for graft placement, a person's natural appearance is preserved - you don't end up looking like a completely different person, as sometimes happens with ‘cut and pull' facelifting techniques.

How does FAMI compare to facelifting?
All cosmetic rejuvenation techniques come down to two basic concepts: vectors and volumes. Vectors are the direction of pull or lifting; volumes are restoration of the normal facial fullness of youth.
Facelifting focuses on lifting and  relies on placing the volume that is there in a better position. FAMI focuses on volume and relies on the filling to provide some lift. The two techniques can be complimentary as when facelifting has lifted and tightened facial contours but hasn't given a youthful look because volume is missing, FAMI can then help to restore youthful volume.

Who is a good candidate for FAMI?

Any patient with an alteration due to age, accident or birth defect can benefit from the FAMI technique. Nowadays loss of facial volume is recognised to be one of the first signs of ageing. FAMI restores the bone surfaces and the shape of the atrophied muscles to rejuvenate the face. Any patient who feels their face looks gaunt and is looking for rejuvenation without invasive surgery can benefit from FAMI.

I have had Botox injections in the past - can I still have FAMI?
Yes. Botox causes a paralysis of the facial muscles so they are unable to contract. In some cases of strong muscle contractures, Botox is used before the FAMI procedure to ensure a still face so that the implanted mesenchymal tissues will not move before they are integrated into the body.

Is FAMI a dangerous procedure?
FAMI has been shown to be a very safe procedure, with uneventful follow up in the hands of doctors specifically trained in this procedure. The utilisation of superficial skin puncture with a blunt cannula is much safer than any sharp needle or scalpel!

What sort of downtime can I expect?
As a non-invasive surgical technique, FAMI is performed under local block anesthesia with sedation in outpatient facilities. After FAMI, bruising is usually insignificant or isolated to the areas around the mouth if the patient has spoken a lot in the two days following the procedure. It can be easily hidden by a good concealer. The edema lasts for ten days. Most patients are performing routine duties after two or three days, and public or professional contact after ten days.

When will I start to see results?
Once the edema has gone down, you will start to see a rejuvenated look to your face. This will continue to improve daily for up to nine years.

How long will the results last?
After more than 5,000 muscle injections from 1996 to 2010, and after nine years of follow up, Dr Amar maintains that FAMI gives long lasting, successful and symmetrical results. The rejuvenation process keeps going for as long as the transplanted adult stem cells keep their properties - in the nine years that Dr Amar has been performing full face FAMI, only ten patients have come back for further treatment!

What will happen if I lose or gain weight after FAMI?
Once you have had FAMI, the old rule that when you lose weight it comes off your face first will no longer apply. The best way to maintain the results is to eat a normal, healthy diet, although some minor weight gain can actually improve the rejuvenated appearance of your face.

Why do so few doctors offer FAMI?
Only students of Dr Amar can perform FAMI. Few doctors know how to perform FAMI because this technique has a very steep learning curve. Expertise in facial anatomy is mandatory. It is easy for a surgeon to cut the sagging facial tissues but to inject safely deep into the face into the muscle, bone surfaces or the orbital rim requires a specialist knowledge. This knowledge cannot be found in the classical books. During the training course Dr Roger Amar imparts all his knowledge to the attendees and gives them hands-on training in how to use the instruments because specific blunt cannulae are used in this procedure. Without this specialist teaching no doctor could safely perform the FAMI technique and reach the quality of results obtained by Dr Amar and his students.

In conclusion
FAMI's benefits reach beyond the purely anti-ageing. It can help anyone who has lost facial volume as a result of illness, accident or birth defect. According to Dr Amar "only the FAMI technique can fill the need for a total rejuvenation of the skin, muscles and bones".

Case study
Treatment: FAMI
Name: Lynn Campo
Age: 57
Occupation: Acupuncturist

What prompted you to have the treatment?
For the last twelve years I have suffered from chronic neuralgia or nerve pain in the right hand side of my face. Doctors had tried to ascertain what was causing it and as a result I'd had all the teeth on that side removed but that had not stopped the pain. Through Chinese medicine and acupuncture I had relieved the pain somewhat but it could still get very bad.

Another consequence was that the nerves had stopped feeding the muscle which had resulted in muscle wastage on the right hand cheek. It was very sunken and I had about eight deep lines that I was incredibly self conscious about.

Who carried out the procedure and what was their opinion at the consultation?
I had experimented with some other treatments such as Sculptra but they had not really changed the sunken look and hadn't dealt with the pain problem. Through my research I came across FAMI and went to see Dr Roger Amar for a consultation. He believed that he could do something about both problems.

How was the experience?
I had it done at the Amar Clinic in Marbella and everyone was really friendly from Sylvia on reception to Dr Amar. I was quite nervous but they managed to calm me down. The procedure took just under four hours as first they removed the fat and then injected it into my face. After that I stayed in a hotel until my check up about three or four days later and then I returned to the UK.

I didn't need any pain relief as it was not sore but I was very swollen. In fact, the worst bit was not being able to eat because my lips were so swollen.

What have been the results?
The swelling lasts for the first couple of months and then it settles down and I'm so happy with how my face looks now - the cheek area is raised, the deep lines have been erased and there are hardly any lines anywhere else on my face.

But the big difference for me is that I'm now pain free. I believe the stem cells treatment has repaired the nerve damage. Before I was so exhausted by the constant pain but now I can achieve anything and it has given me a new lease of life. I can't thank Dr Amar enough.