Frequently Asked Questions - Fat Grafting
Done properly there should generally not be any palpable lumps from fat grafting. I strongly believe that the best results are achieved through placement of extremely thin “threads” of fat. Fat should never be placed in larger amounts, or the fat won’t get blood supply and won’t take. This could result in palpable lumps or “oil cysts” from decomposed clumps of fat. A tremendous amount of skill and experience is required to do successful fat grafting. This is why it is important to be sure the surgeon you are seeing has significant experience doing fat grafting. Be sure to ask to see before and after pictures and about the number of cases they do.
In some cases fat grafting to restore volume to the aging face can help put off the need for more invasive lifting procedures. Eventually however, most people develop enough skin laxity that some tightening of the skin will be needed. Facelifts are about tightening faces; fat grafting is about filling them. We very frequently do both together to get the best result.
There are situations where I might prefer an “off-the-shelf” filler such as for a small area of treatment like the lips or creases from the nose to the corner of the mouth. In general however, my preference is to use a patient’s own fat. It lasts indefinitely unlike the other fillers which have to be redone every few months or so. Fat also feels completely natural and can be used in multiple areas of the face and in much greater volume. Of course to do most facial fat grafting, an anesthetic is required with associated down time. Like everything, there are pros and cons and tradeoffs. There is also the potential beneficial “stem cell effect” from your own fat which can be a big bonus as well.
Yes, you generally can. It all depends on the amount of fat needed for the procedure. Much more fat is generally needed to do grafting of the breasts, for example, than the face. Even on thin patients I can usually find some fat to use.
Yes, it is actually possible to bank your fat just like cord blood. It cannot be stored in a regular freezer, however. There are additional costs associated with this storage. The fat can then be thawed at a future date to be used as grafting material.
We are awaiting long-term follow-up studies to determine the longevity of fat, however anecdotal reports from surgeons who have been using fat grafting for many years indicate long-term, perhaps lifetime, retention of the grafted fat. This makes sense when you think about it since this is your fat – it simply has been transferred from one part of the body to another.
Yes. We generally prefer to harvest and immediately use the fat so that the time away from oxygen is minimized. There is strong anecdotal evidence that this improves take of the grafts.
We can generally take the fat from anywhere a patient has some excess of fat or disproportion such as the abdomen, flanks or thighs.
No. Rejection implies some sort of immune reaction to a foreign substance and since the fat is your own, this is not a problem. In most cases of fat grafting we expect to only retain 50-65% of the volume we place as the final volume result. For example, if we put 450cc’s of fat into a breast we would expect to retain approximately 300cc of final volume, or about 1 ½ cup sizes of volume.
Yes it is. Fat grafting actually involves two procedures: one is the harvesting of the fat using standard liposuction techniques, and the second is the injection of the grafts. As with any surgical procedure there are potential risks. In addition to anesthetic risk, there is a risk of infection, bleeding/bruising, surface irregularity from the liposuction site, failure of the grafts to “take” and possible need for additional procedures and expense to achieve the desired result. All in all, these risks are relatively minimal, and the majority of patients have fat grafting without any problems.