I had an analogous fat transfer to the upper cheeks and orbital region. The fat feels hard like a rock underneath the skin. Is this normal? Should I massage it? I can also feel uneven areas on the outmost region of the cheeks. Does hardness indicate that the fat cells died in the process? What should I expect from here?
Hi Kung Fu Geisha,
One of the great and amazing features of fat transfer when performed properly is that the fat takes on the characteristics of the tissue that it is implanted over. That is when over the soft tissue of the cheek, it feels soft; when over the bones of the cheek it feels hard like bone.
It is not normal to feel distinct hard lumps or masses after fat transfer. You should return to your surgeon for evaluation. Good luck and be well.
Dr. P
After Autologous Fat Transfer to the face, it is not unusual to have firmness in the area of injection that may persist for several weeks. The trauma of the injection through a large-gauge needle may stimulate an inflammatory response, as well as the possibility of some bleeding into the tissues during and after the injections were performed. Gentle massage and elevation of the affected areas seems to help. When your doctor allows it, you may benefit from a non-steroidal anti-inflammatory medication, and possibly ultrasound treatments, to help diminish the swelling, hardness, and inflammation. Because of the excellent blood supply of the facial recipient area, fat necrosis is less likely, unless an overzealous amount of fat was injected into an area with inadequate circulation to allow re-vascularization of the graft. Even then, the non-viable fat is likely to liquify and eventually dissipate without long-term lumpiness.
Early after surgery, almost every graft becomes firm to some extent. This is due to the healing around the graft and the metabolism away of, or encapsulation of, dead tissue.
With fat injection, many of the cells die before they are even injected. I believe this is inherent in the fat injection process where living cells are harvested under a vacuum and then injected. Our histoloogy studies have also confirmed this.
So in the first several months after surgery, this is normal.
If at six months or more after surgery, hard palpable lumps are present, it is possible that cells from the fat injection have died and have been walled off (encapsulated). If they are bothersome, they can be removed surgically. Otherwise, they are often left alone.
Contact the doctor
