Surgical Fat Transfer
Fat Transfer Also known as fat grafting or fat injection
A fat grafting procedure, or fat injection, transfers fat from areas in which you have excess fat, such as the outer thighs, and injects it into areas that may be lacking in volume, such as your face, hands, breasts or buttocks. This safe, long-lasting, well-tolerated procedure produces natural-looking results. Every year, thousands of people undergo successful fat grafting and are pleased with the results.
When to Consider Fat Transfer If you have facial areas that appear creased and sunken If you desire more permanent correction than is provided by temporary fillers If you wish to improve your body contour, revise scars, fill bodily depressions and rejuvenate your hands and face For use in breast reconstruction, to fill in contour irregularities or hide obvious signs of breast implants Considerations Pros Autologous fat (from your own body), as opposed to dermal fillers, replaces “like with like,” reducing the chance of allergic reactions to foreign substances. Fat transfer results are natural, long lasting and safe. Fat transfer is a noninvasive method for achieving facial rejuvenation.
Cons It is time consuming to prepare fat tissue before transferring it, compared to dermal fillers, which are prepackaged. Though longer lasting than dermal fillers, fat transfer costs more. For augmentation, you may require multiple sessions to achieve your desired breast or buttock size. These are the top three pros and cons to weigh when considering fat transfer. If you wish to focus on what is unique to you, please consult with your aesthetic plastic surgeon.
Are you a good candidate for a fat transfer?
The purpose of fat grafting is to augment or fill in volume-deficient areas. Commonly grafted, or injected, areas include the hands, face (including the lips), depressions in the skin (following liposuction and scarring) and the breast and buttock (for augmentation). Of course, you must have donor sites from which fat can be taken. It is important that you do not have any circulation problems, either from a medical condition or smoking.
Facial fat transfer: If you have facial creases, such as laugh lines, smile lines, and crow’s-feet, fat can be removed from your abdomen, thighs, or other areas and be injected into your face. Acne scars and sunken areas of the face, lips, and cheeks can also be filled in. Your plastic surgeon can even use grafted fat to minimize lines between your nose and mouth, correct skin depressions or indentations and minimize forehead wrinkles.
Breast augmentation: If you desire a modest increase in breast size, you are a good candidate for fat grafting to the breast, but your breasts should already have a nice shape and good skin tone. If you have poor skin, sagging breasts, or want a significant increase in breast size, breast augmentation with fat transfer is not for you. The problem with only using fat for breast enhancement lies in getting large volumes of fat to predictably “take.”
Breast implants plus fat grafting: If your breast shape needs optimizing during a breast implant procedure, fat grafting can be useful. If you have residual breast irregularities after undergoing breast augmentation with implants, the irregularities can be filled in with fat to produce a smooth contour and an optimal shape.
Breast reconstruction with fat grafting: If you have breast defects following lumpectomy for breast cancer, fat grafting is an effective method for filling in these defects. Fat grafting is also an option for total breast reconstruction following mastectomy; however, to achieve sufficient breast volume, this is usually a multistage process that requires at least two to four sequential fat grafting procedures.
Buttock augmentation with fat grafting: Many people who desire a fuller, more rounded buttock will opt for a “Brazilian butt lift,” which uses fat transfer to provide a more curvaceous buttock without the use of an implant. Liposuction is commonly used to both sculpt the surrounding area and collect the autologous fat to be injected.
Hand rejuvenation with fat grafting: Fat grafting into your hands is effective for adding volume, “plumping up” wrinkled areas, covering underlying vessels and tendons and improving the quality of your skin over time.
If you are in good general health, have a positive attitude and realistic expectations, you are most likely a good candidate for this procedure.
Detailed Procedural Info How is a fat transfer procedure performed? Fat is harvested from one part of your body, washed and purified, and then carefully reinjected with specially designed needles into the areas that need augmentation. It may be necessary to repeat the fat grafting procedure several times to achieve the desired result. Fat grafting can be explained as a three-stage process: (1) harvesting (2) purification and transfer and (3) placement.
Harvesting: You and your surgeon will select a site for fat removal and will inject it with a local anesthetic. Your surgeon will then create a small incision in the area for fat removal and, using a sterile technique, insert a cannula connected to a syringe to carefully extract fat (liposuction).
Purification and transfer: Once enough fat is obtained from the donor area, your surgeon will process it to prepare the fat cells for transfer to small syringes that will be used for fat injection. Purification may require the use of a centrifuge to spin the fat or a filtration process to remove impurities prior to injection.
Placement: The area designated to receive the graft will then be prepared. Your surgeon will insert a needle or cannula into the incision point of the site being augmented. The injection needle is usually passed in and out of the areas to be augmented multiple times. Each time the needle or cannula is withdrawn, a line of fatty tissue parcels is carefully deposited in natural tissue planes. This process is repeated until the desired correction has been achieved, creating a grid of grafted fat. Some surgeons recommend massaging the grafted areas to create a satisfactory contour. Others prefer to rely on the placement technique to create the appropriate contour. The surgeon may also place a dressing or bandage over the grafted area.
The goal of your aesthetic plastic surgeon and the entire staff is to help you achieve the most beautiful and natural-looking results, as well as to make your surgical experience as easy and comfortable as possible.
What are my options? Your own fat may be used to alter your body contour, revise scars, fill depressions created by liposuction or cancer surgery and rejuvenate your hands and face. Common sites for obtaining fat include the abdomen and the flanks (love handles), posterior arms and the hips and thighs. The options your plastic surgeon will discuss with you are:
Which areas will benefit from fat transfer? Which areas are best for fat removal? Whether any other procedures are appropriate? Drawing of Fat Being Harvested from Buttocks A
Drawing of fat being injected into lips B
Fat can be harvested from areas like the thighs and buttocks. Fat can then injected into the lips (pictured) and elsewhere on the face. What will my fat transfer incisions and scars be like? Your only scars may result from liposuction, which is used to remove fat from the donor site.
Because liposuction incisions are small, the scars are also small and are placed in hidden areas. Sometimes depending on the location of fat deposits on your body, the incisions cannot be hidden. The amount or degree of scarring depends on the surgeon’s technique and your genetic tendencies. Most liposuction scars fade and are barely perceptible over time. Visible scars are more likely when large liposuction cannulas are used and in patients who have darkly pigmented skin. There are two types of marks that can remain on the skin after liposuction. One is a true scar, and the other is known as dyschromia, a dark (hyperpigmented) or light (hypopigmented) spot on the skin. Selecting a Surgeon Select a surgeon you can trust It’s important to choose your surgeon based on:
Education, training and certification Experience with fat grafting Your comfort level with him or her Members of the American Society for Aesthetic Plastic Surgery are experienced and qualified to perform your aesthetic procedure. Learn how to select a surgeon.
After finding a board-certified plastic surgeon in your area who is experienced in performing fat transfer, you will need to make an office appointment for your consultation. Generally, because of the in-depth nature of the consultation, there is a cost associated with the initial visit, which is sometimes deducted from the price of the procedure.
Your initial consultation appointment During your initial consultation, you will have the opportunity to discuss what you want to achieve. Your surgeon will evaluate you as a candidate for fat grafting and clarify what fat grafting can do for you. Once the surgeon understands your goals, he or she may suggest additional or related procedures. It is important to be completely honest during the consultation. Bring several photos of yourself at an earlier age; they may serve as a good point of reference for discussing your goals. It’s a good idea to be fully prepared to answer these questions:
Do you have any medical conditions or drug allergies? Are you being treated for any medical conditions? Have you had any previous surgeries? What are your current medications and vitamin and herbal supplements? What is your current use of alcohol, tobacco and recreational drugs? What is your history with any noninvasive cosmetic procedures? What outcome do you expect from the surgery? What is your chief motivation in undergoing fat transfer? Your surgeon may also:
Ask you to look in a mirror and point out exactly what you would like to see improved. Take photos for your medical record, measure your face and use computer imaging to show you improvements you can expect. Evaluate your health status, including pre-existing health conditions or risk factors. Evaluate the elasticity of your skin. Discuss your options and recommend a course of treatment. Discuss likely outcomes, including risks or potential complications. Discuss the type of anesthesia that will be used. Your treatment plan Based on your goals, physical characteristics, and the surgeon’s years of training and experience, your surgeon will share recommendations and information with you, including:
An approach to your procedure, including the type of procedure or combination of procedures. The outcomes that you can anticipate. Your financial investment for the procedure. Associated risks and complications. Options for anesthesia and surgery location. What is needed to prepare for the surgery. What you can expect to experience after surgery. The doctor will also share before and after photos of cases similar to yours and answer any questions, so you can make the most informed and intelligent decision. Questions to ask your aesthetic plastic surgeon It is important for you to take an active role in your surgery, so please use this list of questions as a starting point for your initial consultation.
Am I a good candidate for fat grafting? Are the results I am seeking reasonable and realistic? Do you have fat grafting before-and-after photos I can look at for this procedure? How many fat grafting procedures have you performed, and in what areas of the body? Where will you perform my fat grafting surgery, and how long will it take? Will my scars be visible? What kind of anesthesia do you recommend for me? What will be the costs associated with my procedure? What will you expect of me to get the best results? What kind of recovery period can I expect and when can I resume normal activities? What are the risks and complications associated with my procedure? What are my options if the cosmetic outcome of my fat grafting procedure does not meet the goals we agreed on? Preparing for Your Procedure How do I prepare for a fat transfer procedure? Your surgeon will provide thorough preoperative instructions, answer any questions you may have, take a detailed medical history, and perform a physical exam to determine your fitness for this procedure.
Your surgeon may take pre-procedure photos. Regardless of the type of surgery to be performed, hydration is very important before and after surgery for safe recovery and the best outcomes. In advance of your procedure, your surgeon will ask you to:
Stop smoking at least six weeks before the procedure to avoid poor wound healing and scarring. Avoid taking aspirin, nonsteroidal anti-inflammatory medications (NSAIDs: Advil, Motrin, Aleve) and vitamins/homeopathic regimens that can increase bleeding. Regardless of the type of procedure to be performed, hydration is very important before and after for safe recovery. Arrange for someone to drive you home after surgery and stay with you for at least the first twenty-four hours unless you and your surgeon have decided on other postoperative recovery options. (See Aftercare and Recovery). What can I expect on the day of fat transfer?
Your fat grafting procedure may be performed in an accredited hospital, a free-standing ambulatory facility, or an office-based surgical suite.
The length of your procedure depends on how much fat is removed and the number of liposuction sites. Obviously, you will need much less fat for facial filler than to augment your breasts or buttocks. You will receive medications to make you as comfortable as possible. Frequently, local anesthesia and intravenous sedation are used for patients undergoing fat transfer, although general anesthesia is sometimes desirable. For your safety during the operation, various monitors are used to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood. Your plastic surgeon will follow the surgical plan discussed with you before your fat grafting procedure. Once the procedure has begun, he or she may decide to combine various techniques or change a technique to ensure the best result. It is important that you feel comfortable and trust your doctor to make these decisions. After your procedure, you will be taken into a recovery area, where you will continue to be closely monitored. You may be wearing a compression garment at your liposuction site to help “shrink” the skin. Many patients state that the area feels sore, as if they underwent a vigorous workout. You will probably be permitted to go home after a short observation period unless you and your plastic surgeon have made other plans for your immediate postoperative recovery. Aftercare and Recovery Ask your doctor how long it will be before you can return to your normal level of activity and work following this procedure. After surgery, you and your caregiver will receive detailed instructions about your postsurgical care, including information about:
Drains, if they have been placed Normal symptoms you will experience Any potential signs of complications How will I look and feel immediately following a fat transfer? Your plastic surgeon will advise you how to care for the sites from which fat was extracted. Recovery from fat injections is variable and perception of that recovery is even more highly variable. Here is some general recovery information related to facial fat injection procedures:
The swelling and bruising during the first week are significant, and you will not be ready to see others socially or professionally. In the second week the bruising resolves, but you will still have swelling. There is great improvement in most cases between the seventh and tenth days, but you may still not be ready to go out in public. Most people who have very little time off from work take one week off, including two flanking weekends. Those who can afford two weeks off or more are even better positioned to return to work. By the third week you will begin to look more like yourself. Careful application of makeup can be helpful in camouflaging any residual signs of swelling or bruising. Once the swelling recedes, you will be able to appreciate the changes, but subtle swelling may persist for weeks. How Long Will the Results Last? You can expect the areas to which the fat was transferred to appear softer and fuller, giving you a refreshed and rejuvenated appearance. You may even notice an improvement in skin texture.
The survival of the fat and longevity of the results depend on the surgeon’s skills, how the fat was harvested and purified, and how and where it was injected. To be performed successfully, fat grafting requires a surgeon with highly developed skills based on experience and knowledge of the technique. A process called microfat grafting, although labor intensive, is the best way to ensure that the highest percentage of grafted fat will take. When done successfully, the injected fat establishes a new blood supply from your body and receives the nourishment it needs for survival. When this happens, results can and often are permanent; however, there may be a percentage of fat that does not take, which is why touchup procedures are sometimes necessary. Maintain a relationship with your aesthetic plastic surgeon For safety, as well as the most beautiful and healthy outcome, it’s important to return to your plastic surgeon’s office for follow-up evaluation at prescribed times and whenever you have any questions about your fat transfer healing and results.
Associated Costs The cost of a fat grafting procedure varies from doctor to doctor, from one geographic area to another and with the fat grafting technique that is performed.
See the national average for physician fees per procedure.
These numbers only reflect the physician/surgeon fees last year and do not include fees for the surgical facility, anesthesia, medical tests, prescriptions, surgical garments or other miscellaneous costs related to fat transfer. Because fat grafting is an elective cosmetic surgery, insurance does not cover these costs. Many surgeons offer patient financing plans to make the procedure more affordable.
Choose your surgeon based on quality, training and experience—not cost.
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Limitations and Risks Fortunately, significant complications from fat grafting are infrequent. This procedure is usually performed without any major problems.
Risks and potential complications of surgery is a subject you should discuss during your consultation. The risks in most surgeries are similar. Some of the potential complications of all surgeries are:
Adverse reaction to anesthesia Hematoma or seroma (an accumulation of blood or fluid under the skin that may require removal) Infection Changes in sensation Scarring Allergic reactions Damage to underlying structures Unsatisfactory results that may necessitate additional procedures You can help minimize certain risks by following the advice and instructions of your board-certified plastic surgeon, both before and after your fat transfer.