Have a little extra fat that you would like to rid yourself of? Of course—many of us do! Let’s just imagine that you have it taken out, but then what? What is the fate of your extricated fat? Historically, it was disposed of; never to be seen again. And we cheer, “Goodbye unwanted fat!!!!” But is it really unwanted? Maybe. . . at least from where it was taken. However, have you also noticed your face isn’t as full as it was when you were a younger version of yourself? Breasts not as full as you prefer? Eyes looking a little tired and hollow? Well, perhaps that fat we removed could be used to fill in a deflated area somewhere else on your body. If these thoughts have ever crossed your mind, then the good news is—it can!
Fat grafting (or fat transfer) is a procedure that has been gaining popularity in recent years and has added to the plastic surgeons methods for treating patient’s problem areas. It is an old, time-tested technique having been described from the 19th century on, previously with modest results. But with newer technology and refinements in techniques, results are now often impressive. The basic concept is to harvest fat from an unwanted area (such as the abdomen, flanks, or thighs), clean and purify the fat cells, and then re-inject them into another area on the body that needs volume enhancement all during one procedure. This procedure can permanently improve the shape and volume of certain areas and/or improve the appearance of lines and wrinkles in others and is an alternative to man-made substances such as implants or fillers.
As with all cosmetic procedures, you first meet with your plastic surgeon to determine if you are a good candidate. Once the area(s) of unwanted fat and area(s) that will receive the fat injection are chosen by the patient and surgeon, photographs are taken. Your surgeon may deem it necessary for you to obtain medical clearance from your primary doctor prior to surgery. Fat transfer can be performed under local anesthesia for small areas, sedation or “twilight” for somewhat larger areas or patients who don’t want to be awake, or general anesthesia where you are completely asleep. On the day of surgery your surgeon will mark the areas for harvest and treatment, then you are taken to the operating room. Once your anesthesia is in effect, your surgeon will make small incisions (2-3 millimeters) in the area from which the fat will be removed. Fluid is injected in the fat beneath the skin to help decrease bruising and pain and then your surgeon performs sterile fat removal using their preference of liposuction technique. Once adequate fat removal is obtained for the desired cosmetic result, the fat is washed and cleaned to remove unwanted fluid and blood, leaving shiny, yellow fat cells. Again, small incisions are made in inconspicuous areas where the fat will be injected. The harvested fat cells are then sterilely injected into these areas using special instruments called cannulas.
After surgery, you go home the same day in a special garment that is worn for the first few weeks after surgery to help reduce swelling (your doctor will determine specifically how long this needs to be worn). You can expect to have some swelling and bruising that typically will resolve after a few weeks. Depending on the extent of your surgery, you may be able to return to work after a day or two or may need to take more time off depending on your job and size of your surgery. You should walk frequently starting the day after your surgery to help with swelling and to prevent blood clots. As with any surgery, there is a risk of infection but the incidence of infection after this procedure is very low. Some commonly asked questions are addressed below. To see if you are a good candidate for fat grafting, call us and make an appointment for a consultation.
How long does the transferred fat remain? Unlike fillers (e.g. hyaluronic acid, calcium hydroxylapatite) that must be repeated every 6-12 months, fat is permanent filler. However, not all of the transferred fat cells survive. Surgeons will often over-fill the treated areas, expecting that a percentage of the fat may not survive. If needed, additional sessions of fat grafting can be performed every few months to further fill an area to achieve the desired fill level. This is especially true for areas that require a large volume of fat for treatment, such as the breast or buttocks. The other main advantage to using fat, is that it is your own tissue—there is no risk of rejecting the tissue and the risk of infection again is very low.
What areas can be treated? Many areas for treatment have been described. These include the area around the eyes, temporal region, cheeks, jaw line, smile lines, lips, breasts, buttocks, hands, and other areas with contour defects and scars. Treatment of the breasts deserves special mention as this is a somewhat controversial topic. Fat grafting can be used to treat the breast for several concerns—contour irregularities after previous surgery such as lumpectomy, to aid in reconstruction of the breast after cancer with or without the addition of an implant or flap of your own tissue, or for cosmetic augmentation. The main point of controversy has been how fat grafting to the breast affects detection of breast cancer, in that the grafted fat occasionally develops into findings on mammogram (calcifications) that can appear similar to those seen in breast cancer. Although we continue to learn how to distinguish these findings from those seen in breast cancer, if it is identified on mammogram a breast biopsy may be required. You should speak to your surgeon to discuss the available plastic surgery literature on use of fat grafting in the breast as there is always new information available.
What are the risks of fat grafting? In addition to the bleeding, bruising, and infection described above, there are additional risks that require mention. Over or under correction, irregularity, and/or asymmetry can occur and patients with very thin skin could experience some clumping or palpability to injected fat. These may require additional procedures for correction if not resolved with massage. Although uncommon, injury to structures such as nerves that are adjacent to treatment areas could occur. As with any other injected material around the eye, great care must be taken as injury to the eye or sight could occur. Similarly, injection near blood vessels poses a small risk of small deposits of fat being injected into the vessel (known as fat embolism). These risks have been significantly reduced with the introduction of special blunt, fat injection cannulas. Finally, the risks of liposuction must also be considered—bleeding, bruising, infection, and contour irregularities/asymmetry. You should always discuss the risks of this and any procedure with your Boca Raton plastic surgeon, as this brief discussion is not a substitute nor intended to be all-inclusive.