Fat Grafting (Fat Transfer) Information

Introduction: Finding A Use For Your Excess Fat
What Is Facial Fat Rejuvenation (Fat Grafting)?
Are You A Candidate For Facial Fat Rejuvenation?
What Areas Are Usually Treated?
What To Expect At Your Consultation
Preparing For Your Procedure
How This Procedure Is Performed
The Road To Recovery
Risks And Complications Of Facial Fat Rejuvenation?
The Least You Need To Know
References
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Introduction: Finding A Use For Your Excess Fat
Well eating all that southern food is paying off now!! ha ha! See? The wise one plans ahead! I was skeptical at first with my research for fat transfer to lips then I found that after speaking to patients of fat grafting that it really does work. I am even planning on a little fat transfer to my under eye area, cheeks (upper cheek bone area), maybe the temples and lips. And believe me I have some in storage -- and if it were possible I am willing to donate half of my fat stores -- any takers?

The good news is with proper extraction methods as well as meticulous transfer techniques, fat transfer is pretty permanent. No need to have tear trough implants nowadays, if you acquire the services of the right doctor and your facial woes just might practically eradicate themselves.

What Is Facial Fat Rejuvenation (Fat Grafting)?
Facial Fat Rejuvenation, more commonly known as Fat Grafting, free fat transfer, autologous fat grafting/transfer/transplantation, liposculpture, lipostructure, volume restoration, micro-lipoinjection, fat injections, f/g and even the "Space Lift®." Fat Grafting or Fat Transfer will be used from here on out, and it is the method of the extraction of your own fat cells to replace fat or augment with fat where you may need or want it. Waste not, want not, eh?

Well does it work? Well that is controversial. If performed correctly -- yes. There are many variables:

fat cell removal techniques
handling techniques after removal
spinning/emulsions/serums
re-implantation techniques
patient's metabolism
patient aftercare of treatment area
vascularity (blood vessel formation to the fat cell)
hyperbaric oxygen therapy treatments (HBOT)

Am I going to try it? YES, Of course I am. And I can hardly contain myself! I will post the story and photos as soon as it is performed. Maybe some intra-operative photos too if I can persuade the attending surgeon.

Are You A Candidate For Facial Fat Rejuvenation?
When we age our underlying collagen and elastic begin to break down and wrinkles emerge. This along with facial fat loss, brings about a haggard, hollow or even skeletal look. If you are not overly skinny, with a major metabolism and have a little extra fat somewhere on your body to spare you may be a good candidate but only if:

you have realistic expectations
do not have underlying medical disorders
blood clotting problems
you are emotionally stable to undergo a procedure
you are not doing this solely to make others like you
doing this for yourself

Even after all this, only a qualified surgeon will determine if you are capable of having a procedure and that your individual case will benefit from fat transfer.

What Areas Are Usually Treated?
Almost all areas of the face can be treated but there are the usual requested treatment sites:

correction of "hollow" eyes, visible vessels resulting in dark circles, as well as visible tear troughs
correction after aggressive removal of undereye fat fads from lower blepharoplasty
temple areas
upper malar
sub malar
chin
lips (it isn't a defining filler though)
jawline
forehead
inbetween the brow
facial scars
lower cheek after aggressive buccal fat extraction
area between upper lip and nose
bridge of the nose
and anywhere else fat is needed or wanted

What To Expect At Your Consultation
After checking several surgeons' backgrounds and credentials, you will make appointments for consultations. You will meet with these surgeons and discuss your goals and you will disclose all information regarding your health; if you smoke, what medications or vitamins you presently take. This is very important. Visit the Aspirin & Supplement List for more information. Your skin will be examined and the elasticity will be determined. You will discuss your complaints and concerns and discuss the various techniques available to you. Your surgeon will explain the technique, removal and reimplantation methods that may be most appropriate for you. The surgeon should discuss the Risks associated with fat grafting with you as well. There really are very slight risks and complications involved but they should be disclosed regardless.

You will also discuss the available anesthesia that will be used for your procedure. Most fat transfer procedures are performed under local only although some docs may use an oral sedative to ease tension as well. Either way, discuss this beforehand. Please read the All About Anesthesia Page for more information. General Anesthesia is a little extreme in my humble opinion for such a minor procedure unless it is going to last for an hour or more, but if this is the case, do read the anesthesia page.

You will then discuss your pre-operative instructions and speak about the recovery period instructions and what to expect in the weeks ahead. You may be given prescriptions for antibiotics, pain relievers, anti-flammatory drugs and perhaps a box or directions for gaining a box of Arnica montana. Your surgeon may or may not advise you of the benefits of Arnica montana for swelling and bruising. Would you like to learn of the benefits of Arnica montana?

Preparing For Your Procedure
You will be given a pre-operative information packet that explains everything you should do and know before your surgery date. The packet should include all the medications you should not take for up to 2 weeks before your procedure. These medications will include, but are not limited to, aspirin containing products. Would you like to view a typical Medication & Supplements List?

It is quite possible that you will have preliminary blood work performed. This is normally an extra out-of-pocket expense that the patient must participate in to check your white and red blood cell count (complete blood count, CBC) which ultimately alerts the surgeon to disease or disorders beforehand. So many things to do... so little time. Your procedure will be here before you know it so relax.

How This Procedure Is Performed
If going for just fat grafting and depending upon your surgeon you may be given an oral sedative (valium) and may receive injections of sterile saline, Lidocaine, and possibly epinephrine as a vasoconstrictor and bicarbonate (to neutralize the acidity of the preservative in the Lidocaine) in your treatment area(s) and your donor site. If you are having liposuction for body contouring you will probably be under IV sedation or other and can have the fat harvested during your procedure although usually the liposuction/fat removal is removed with more suction pressure than 1/2 atm. Thereby traumatizing the fat cells. If the fat cells membranes are destroyed during the removal then fat cell survival is compromised. But if the removal can be performed without rupturing the membrane with the use of a special 3mm titanium cannula then liposuction is perfectly fine.

If primarily for fat grafting, the fat will more than likely be removed with a local anesthetic only although some surgeons may prefer performing the procedure under an oral sedative, light IV sedation or "Twilight." Do know that even still, some surgeons may prefer General anesthesia. Please see the All About Anesthesia page to better understand the effects and types of available anesthesia.

This fat will be removed from the donor site (usually the buttocks, abdomen, inner knee or the saddle bags) with a small hypodermic needle using 1/2 atm. (atmosphere) or special cannula with limited suction as so not to damage the membrane of the fat cell. The fat is then spun in a centrifuge to remove excess fluids and the damaged fat cells are picked out and only whole, undamaged fat cells would be used. But don't count on this with all docs. The fat is then injected with the use of a separate smaller hypodermic either just under the wrinkle or deep with the muscle in some areas as their is a higher vascularity within the muscle increasing the longevity of the fat graft. With very superficial use of large amount of fat -- lumpiness can occur.

To increase longevity, some surgeons spin a vial of your own blood to remove proteins, excess fluid (water), add vitamin C to this mixture to create a PlasmaGel® type, oxygen rich serum, some even add albumin [: serum albumin : a crystallizable albumin or mixture of albumins that normally constitutes more than half of the protein in blood serum, that serves to maintain the osmotic pressure of the blood (or fat cells), and that is used in transfusions esp. for the treatment of shock] The use of PlasmaGel® or albumin sort of shrinks the fat cells or toughens their membrane to prohibit membrane destruction during re-implantation and less trauma to the fat cell.

The Road To Recovery
You shouldn't wear cosmetics until at least the day after. You may be swollen and pink so it may be in your best interest to take off the rest of the day. If you were given any type of sedative you should have someone drive you home.

Some patients report mild to even above moderate bruising although swelling can be pretty pronounced. Most of the swelling may last anywhere from 24 to 48 hours; although the swelling should completely be gone in 2 weeks. Take your temperature! Regularly! An elevated Temperature could mean an infection. Take those antibiotics ON TIME. And don't forget if you are taking birth control that some antibiotics can interfere so in the event that you do have relations, use another form of protection as well.

KEEP YOUR TREATMENT AREA AS IMMOBILE AS POSSIBLE FOR AT LEAST 3 to 4 DAYS. The stability of the newly, traumatized fat cell can be given a better 'chance at life', if you will, if you are careful not to move it around so much to give it ideal conditions for gaining proper vascularity. Just as when surgeons overstuff the inner fat cells have a very difficult time at gaining vital oxygen unless the blood vessels can grow rapidly towards the middle of the graft to increase the fat cells' lives.

EXTRA! Another great boost at survival of ANY fat or tissue transfer is Hyperbaric Oxygen Therapy (HBOT). Seriously. Persons who have compromised tissue vascularity can expect to gain increased cell life due to oxygenation of the deeper or traumatized tissues. This has been shown to help stop necrotic tissues even in the advanced stages. To read more on this therapy for complete understanding of the benefits of HBOT, please visit the Hyperbaric Oxygen Therapy page. I strongly recommend it.

Usually, although this in individualistic, about 40% of the fat may last after the first 6 to 8 months. Sometimes more if the surgeon uses a conservative "micro-droplet" technique. Most patients receive up to 4 and 5 treatments (at a discount) although the average is 3.

The effects can last anywhere from 3 months to 3 years (maybe more). It is highly technique sensitive so choose your surgeon wisely. Or you will be wasting your money. Fat transfer if done correctly can be wonderful! You may require a few more treatments but determine the cost of additional sessions beforehand. I don't really know if I am sold on freezing fat and then re-implanting it as I am not sure how the freezing and thawing really affects the delicate membrane of the fat cell. I mean if they can freeze human sperm and eggs and they actually are viable afterwards -- surely fat can survive. I mean I know it isn't like your freezer in your kitchen but for that kind of money a little freshly removed fat may just have a better chance at survival. But, try both, see what the particular surgeon says as well as speak to patients who have used both.

Risks And Complications Of Facial Fat Rejuvenation?
You could have an allergic reaction to the anesthesia if applicable or the local anesthetic that is used in the area of removal, hematoma and asymmetry. T here is a risk of infection as well the extremely rare possibility of permanent discoloration due to a ruptured superficial blood vessel at the treatment site during an injection. There is the possibility, although rare, of calcification. In this case there would be hard micro-nodules under the flesh. There is also the possibility of a distorted look, fatty cysts and fat necrosis if extreme over correction is used. Possibly intra- and post-operative bleeding, blood clots at the treatment and removal sites. Also the patient's treatment areas may be vulnerable to blood borne infections (perhaps from a dental procedure) perhaps for up to three months, according to some surgeons.

Be aware that the possibility of scar tissue is probable. I have spoken to a few people who developed excess scar tissue in their lips and around their mouth which distorted their lips and smile. I have also spoken to people who report that their vermilion border (the colored skin of the lip) has no definition after the injection -- even after a year -- of the initial injections were not placed right. Also be aware that fat embolism is a small risk. This is where fat can be injected into a blood vessel. This can be really dangerous if your doctor isn't paying attention and does this.

General disappointment is possible for may reasons, be it the decreased longevity of the graft, the improper placement or the overall outcome. Many surgeons may try to place fat into the nasolabial folds/grooves only for a temporary, yet immediate, fix. The cheeks usually must receive fat transfer as well to lift it up and out, rather than sagging and overlapping the nasolabial area. Choose your doctor carefully for the best result. Although even the best doctor can't perform miracles -- if your body doesn't take the fat transfer, there is nothing that can be done and another form of filler will be needed.

The Least You Need To Know

What: Facial Fat Rejuvenation, more commonly known as Fat Grafting, free fat transfer, autologous fat grafting/transfer/transplantation, volume restoration, micro-lipoinjection, fat injections and even the "Space Lift®"
Why: to replace fat where it was lost or augment with fat where you may need or want it.
When: from the young to the mature. This procedure is so mild that it can be performed on most patients without ill effects.
Who: Research your doctor very well. Usually the top names in fat grafting unfold themselves on message boards/discussion forums and word of mouth. Fat transfer is very technique and handling sensitive.
Where: a sterile physician's office -- no salons!!
Risks: READ THEM!
incisions/scars: n/a
Anesthesia: usually performed under local anesthetic only, but may be performed with other procedures under the usual anesthesia options. Read All About Anesthesia
Duration: 30 minutes to an hour, depending upon extent of work to be done.
Pain Factor: very mild, pain meds should alleviate any discomfort. If not, call your surgeon immediately!
Swelling: Mild to moderate -- depending upon individual; I suggest arnica montana and bromelain.
Bruising: Mild to moderate -- depending upon individual. The under eyes can be very prone to bruising due to the high vascularity of the under eye area but is also dependent upon the individual. I suggest arnica montana and bromelain.
Post-operative instructions: Keep the treatment site immobile as you can. This will give the area and newly transplanted fat cells a good chance to become vascularized. New blood vessel formation within the fat transplant will increase it's longevity. Some surgeons use a pressure dressing on the removal site to prohibit or at east impede bloodclot formation. Movement or massage on this area is sometimes advised. Adhere to your surgeon's instructions. Some surgeons prescribe antibiotics. Some suggest Hyperbaric Oxygen Therapy (HBOT).
1st Post-op visit: sometimes not necessary, unless ordered by the doc, although repeat applications may be needed several weeks apart. Depending upon if the transfer took, or your doctor suggests it.
2nd Post-op visit: read above.
Return to work: usually immediately. Although you must realize you may be very swollen or bruised. Your surgeon may not want you to wear cosmetics (concealer) on the treatment site until the next day so check with him/her first.
Activity: These rules depend upon the amount of work and the surgeon. Usually with any other procedure it is: "No exercise until at least 3 weeks post-operative. Be careful not to raise your blood pressure for several weeks, you don't want to inhibit proper healing or get an infection." but since fat transfer is a mild procedure you aren't usually held to the same strict rules. Although immobilization of the treatment site may help increase the longevity of the results. Check with your surgeon!
Sun exposure: You shouldn't be exposing your face to the sun anyway! Since there are no incisions (usually) there is no need to worry about covering the area from UV exposure, but do check with your surgeon first!
End result: The results with any type of injectable are usually immediate although, the end result may never really be a set date as everyone is different and in some patients it may last and in some it may require several treatments, and even in others it make never "take." Sorry, no definite answer available.
Loss of Sensitivity: It is possible to temporarily lose sensation in the treatment area due to possible nerve damage or swelling. Long term or permanent loss of sensitivity is possible.
Anything else? Possible eyebrow and eyelash loss from medications such as antibiotics. Possible asymmetry as well.
Longevity: totally individual, some say a few weeks some say a few years. In some people the fat just doesn't stay after transplant as well as it could be the surgeon's technique that impedes the longevity. But if placed correctly, the fat could be permanent. As I have said it is technique sensitive so choose that doc wisely!
But Wait! There's More! Research as much as you can on the subject. Disclose all your medical background. If you are a smoker, if you are taking medications, or if you have any other medical concerns. B e realistic in your expectations. NO surgeon can perform miracles, he can only try and improve upon what you have beforehand. Also, ask what they do to treat the fat before transplantation. Do they use anything to maintain the osmotic pressure, do they use PlasmaGel®, do they place the fat in a centrifuge, do they use a micro-droplet technique, do they over correct, etc.?
The average prices for: fat transfer, can be anywhere from for the face $450. - $750. for about 3cc, collectively. Lips $900. - $1200. up to 3 - 4cc. but some surgeons' prices can be upwards of $3,000K. But may or may not include repeat touch ups. Ascertain what the fee includes beforehand.

References
Har-Shai, Yaron M.D., Lindenbaum, Ella S. Ph.D., Gamliel-Lazorovich, Aviva M.Sc., Beach, Dvora M. Sc., Hirshowitz, Bernard M.D., F.R.C.S. "An Integrated Approach For Increasing The Survival Of Autologous Fat Grafts In The Treatment Of Contour Defects" Plastic and Reconstructive Surgery; September, 1999, Volume 104, number 4
Smith, A. ; Katz, A.; Huang, C.; Kang, M.; Park, N.; Benhaim, P.; Lorenz, H.; Hedrick, M. "Fat Recycling: New Tissues From Liposuctioned Fat" - unknown article, Lake Buena Vista, Florida 05/13/00
Interview with Leonard Grossman, M.D. - New York

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