Fat Transfer: Q&A

Ask a Question

Why is Fat Transfer a Low Rated Procedure on RealSelf?

Fat transfer or grafting has slid into one of the lowest rated plastic surgery procedures on RealSelf. Under 40% of consumers say fat transfer was "Worth it". Why is this the case? Is there something wrong with the procedure, patient selection, doctor technique?

Tags:

complication popularity results

Comment on this

30 Doctor Answers | Asked by anon

Doctor Answers (30)
Community Comments (1)

+19

Dissatisfaction with fat injections

At some point, we as plastic surgeons must be realistic. Patients are not, in large part, happy with fat injection results. Why are they not happy with fat injection? Fat injection grafts are aspirated through a syringe, centrifuged and then injected. Most of the cells from fat injection are dead when they are first injected into the patient. Study after study, using many different methods (metabolic and cellular) have confirmed this. We all learned from our professors that graft survival... more

+17

Fat Grafting: the good, the bad and the ugly

Obviously it appears as though there are as many opinions on fat grafting as there are plastic surgeons, and this must be profoundly confusing to prospective patients. A number of physicians responding in this thread have made dogmatic statements about various procedures that may very well represent their own personal experience and preferences, but that do not necessarily provide interested laypersons with a balanced and accurate view of the options currently available for restoring... more

Michael Law, MD

17 reviews

Raleigh-Durham Plastic Surgeon

michaellawmd.com

+15

Why is fat transfer the lowest rated procedure on RealSelf?

Great question! Let us begin with the understanding there are many factors that can effect the outcome of ANY surgery. In Fat grafting I will list, in no order, what are the reasons the risk/benefit ratios are SOOOOOO LOW! 1. The procedure is very surgeon dependent. The surgeon MUST have vast experience with Fat grafting. The best Plastic Surgeon doing fat grafting in the US is Dr S. Coleman of New York. After taking his courses and personal conversations with him, the one thing I find... more

Many reasons for dissatisfaction with fat transer

I think that fat transfer is a great procedure - when done in an appropriate area, by an experienced physician, with appropriate patient expectations. After looking at the reviews a few problems struck me as being common to many of them. First, there did not appear to be appropriate patient expectations. While fat is a permanent solution for facial fillers, it can take several applications to obtain the desired results. An excellent article in the Archives of Facial Plastic Surgery from... more

D.J. Verret, MD

3 reviews

Dallas Facial Plastic Surgeon

innovationsfps.com

It is actually 79% but I think the numbers may be somewhat misleading

If you go to the Brazilian Butt Lift Questions. There is usually a picture on the right hand side that asks "Was It Worth It?" The percentage for this procedure is actually 79% I think part of the problem is that on the ranking system list, it doesn't specify Brazilian Buttocks Lift, it only lists Fat transfer. Fat Transfer can include any other body part that the fat is transferred to, such as the face or breast. I have performed hundreds of Brazilian Buttocks Augmentations and... more

Fat transfer works!

One of the interesting things you see is that procedures will be very popular on RealSelf and then they will begin to drop off the charts. I think this is sometimes related to the fact that when procedures first come out they are performed by people well qualified to do them. Once a procedure has shown some popularity all kinds of doctors (some with little or no training) will begin to offer those procedures as they try to cash in on the profits. This is when people begin... more

Why is fat transfer rated low on RealSelf?

Hi there, While it is not possible for me to say exactly why those who were unhappy after their fat transfer procedures were displeased, I can give you a few general thoughts... Fat transfer procedures are probably among the most technique dependent procedures in plastic surgery right now. Everything from the way the fat is harvested, to the way it is processed, to how it is grafted into its new location seems to affect the chances of success. There also seems to be some variability... more

Fat transfer is a process, not a single procedure.

I think fat transfer is low rated because patients do not understand that it is not a single operation but is rather an ongoing process of possible several to many operations. Fat is a weak flimsy tissue and 50% of the time does not survive the transfer process. Yes, 50%. Hopefully this is explained to patients because a lack of understanding this could lead to unhappiness. I have done over a thousand fat transfer operations and doctor and patient must be happy... more

Fat grafting and satisfaction rates

As we understand more about facial balance and importance of adding more volume to the face during facelift procedures, we realize that we do not have a perfect filling material. We can use one of the available hyaluronic acid fillers, like Juvederm or Restylane, however, they do not last for a long time, especially in deeper layers. Also they can be quite expensive. The is an ideal filling agents, however, problem with fat is that the... more

Fat grafting and managing expectations

Fat, as explained, is a delicate tissue (despite how easy it is to gain and hard to lose) and it is nearly impossible to predict the amount of survival following transfer. An oversimplified analogy may help: If you take 3 seeds and plant them in the ground, it is unlikley that you will get 3 plants consistently. Some times you will get 1, sometimes 2, sometimes 3 and sometimes none. If it is hard for us to predict then it becomes even more difficult to anticipate a result and relate that to... more

Otto Joseph Placik, MD

32 reviews

Chicago Plastic Surgeon

Problems with fat transfers

As Dr. Moelleken explained in another posting, the problems with fat grafting are several. First, it requires a surgical procdure to harvest the fat. Then the fat must be processed and nobody knows exactly the best way to do this. There is much voodoo in this! Finally, fat cannot be injected right under the skin and not all fat survives where you put it. This unpredicaable outcome is problematic. With all the off the shelf fillers available, the fat transfers have gone way down. more

Fat Transfer is a valuable technique but less predictable

As of today Fat Transfer satisfaction is rated 52% satisfaction rate. I think the number vaires from location to location and definitely by the skill of the surgeon and technique used. As a general response to your question -The main reason fat transfer is a low rated procedure on RealSelf is that there is less predictable results vs fillers or an implants depending on the area. For example let's weigh the pros and cons of Fillers vs Fat Grafting. Pro: Fat Transfer by... more

It's all about expectations.

Like every procedure we do, ultimately the only thing that is important is that the patient's expectations are met or exceeded. Fat grafting absolutely works if done properly, but is a totally different operation to breast implants and as such patients must have different expectations. Generally fat grafting works for patients who want smaller augmentations, unless they are prepared to consider staged procedures. We recommend that all our breast augmentation patients bank their fat in... more

Fat transfer and patient satisfaction

I am surprised to hear that fat transfer is not ranked highly with patients. I use it for breast reconstruction patients with contour deformities or to augment a flap reconstruction and find that it is an excellent tool. I am careful to counsel patients beforehand and explain that the results may be modest because it depends on the amount of vascularised tissue that you have to accomodate the graft.

Manage Expectations for Fat Grafting

Fat grafting has been done my practitioners for many years. Even though there is a history there are tremendous variations in the execution of the techniques and therefore the results. Fat grafting is a very delicate procedure and must encompass everything possible to preserve the viability of the fragile fat cell. Transferring any autologous tissue should be done with care and fat transfer is no exception. The success of the procedure is based of patient... more

Fat Injections can be very successful

Although fat injections are not done as much in my practice lately since "off-the-shelf" volumizing fillers and collagen stimulants are available, there are patients who like to use their own products and not a laboratory-synthesized chemical. The fat injections have lasted for many years in some, not all, patients. It has a very natural feel most of the time. The disadvantage is that it is too thick for fine work, bruising can be more common than with thinner fillers, and there... more

Why is Fat Transfer a Low Rated Procedure on RealSelf

Fat transfers have a good take with longevity when done correctly. I perform liposuction first and collect the fat in a filtration system. This system filters the fat which I then centrifuge and place in tiny syringes for injections. The fat is then injected into the soft tissue. The patients are quite happy with their results.

Fat transfer

Being one of the first surgeons in the United States doing liposuction has allowed me to be performing fat transfer procedures for many years before its popularity began. I find that patients have a very high level of satisfaction with their results. It may be the difference in surgeons or technique. I take the fat out with a small needle aspirated syringe and then spin the fat in special tubes in a centrifuge to separate it from the other fluids and then use this pure fat for injection. A... more

Michael Elam, MD

82 reviews

Orange County Facial Plastic Surgeon

michaelelammd.com

Fat transfer is not the magic bullet we wish it were!

I think the reason fat transfer has low "worth it" ratings is because fat transfer is actually of very limited utility in facial plastic surgery. In my personal experience, fat transfer produces very predictable results in the tear trough, moderately predictable results in the anterior and lateral cheek, and almost no long term results in the lower face. It is also not a valuable treatment for skin wrinkles or creases - it is good for "volume" filling only. When fat... more

Patient Satisfaction After Fat Grafting

I can only comment on fat grafting to the face. We routinely combine it with every face and necklift and like the overall added enhancement A LOT. Why? Because the face does not age 2-dimensionally (up-down; front-back) but rather in all 3 dimensions. Volume loss is always part of facial aging - often first. And us facelift surgeons learnt that we cannot lift the volume back into place although cheek and midface lifts were meant to do so. Dissatisfaction in fat grafting depends on honest... more

Is it worth it

Satisfaction is when actual result exceeds or meets expected result. the problem with fat grafting is that in the face it is a low volume fill not the dramatic puff of silicone. remember the fat is placed in small parcels of 0.1cc at a time throughout undissected tissues. the initial fullness is largely traumatic swelling and the result of 2-4 weeks which looks so good dissipates to the actual result of 12 weeks. pts remember their appearance at 4 weeks not preop so they need to... more

Naturalfill fat transfer

It is not surprising at all that fat transfer is the lowest rated procedure on this forum. Fat transfer has been a procedure attempted for over 130 years, with the first reported transfer in 1890. After reviewing the literature which encompasses hundreds of studies on fat transfer, the conclusion that can be generally drawn is that fat transfer is a procedure that is widely unpredictable. The reason behind this is that surgeons need to perform liposuction to remove the fat, and with the... more

Fat Transfer Issues

I think Dr. Moelleken's post is an excellent summary of the problem with fat transfer. Fat transfer has a variety of problems including : 1) donor site morbidity (of less concern if someone has indications for liposuction in a specific area), 2) survival of fat cells after injection (a relatively high percentage of transferred fat cells do not survive the procedure), 3) predictability of where the fat cells will survive (lumps, bumps, granulomas, etc.), 4) fat cells carry the... more

Fat transfer

Success of fat transfer is dependent on several issues incluidng fat liposuction, fat processing and fat injection and grafing. All these come down to the chosen plastic surgeon. Some are much better than others in performing successful fat transfer. It is important that the patient does his/her reseach before choosing a surgeon.

Fat transfer extemely technique dependent

Fat transfer is very technique dependent and can be used in many different areas including the face, torso and buttock, the so-called Brazillian butt lift. It is not 100% predictable and may require multiple procedures to achieve the final result. Please ask for before and after pictures to get some idea of what kind of result you can expect from your surgeon. Best, Tal Raine MD

Talmage J. Raine, MD

5 reviews

Chicago Plastic Surgeon

For best results, find out how the surgeon does the fat transfer

It is very technique dependent. Here's the link to a video explaining why, and a blogpost with some additional explanation see video

Fat transfer can work well but is very technique dependent

It is true that there is some unpredictability with fat transfer, as not all the fat will "engraft", or survive. The fat to be injected must be harvested and injected with a gentle technique using specialized instruments. It must be separated from the liquid component carefully as well. Larger volumes of fat, to augment buttocks for example, are more challenging because the amount to be harvested does not lend itself to the use of gentle, hand aspiration tools. The temptation to... more

Fat transfer lowest rated on RealSelf because it's unpredictable

Because it is UNPREDICTABLE. Fat is a living tissue which cannot be harmed when harvested, cannot be harmed in transfer and must be kept alive in the location it is placed on. As such it is extremely dependent oh HOW is it liposuctioned, prepared, placed in syringes, on the delay between harvest and grafting, on how it is placed in the areas to be grafted and on the ability of blood vessels in these areas to keep the fat grafts alive. Although there are many techniques on how to harvest,... more

Fat Grafting technique dependant

Fat grafting is very dependant on not only the technique utilized but also the practiioner, as is all Plastic Surgery.

Doctors will not see your comments on their answers. If you'd like to follow up, please go here to ask another question.

Comments (1)

Nick_Male_40 29 Jul 2012

I had fat grafting to my cheeks by a highly sought after plastic surgeon. I have to say I wish I had never done it. I see a consistency in the comments from the doctors that say patients have unrealistic expectations, but I think the doctors often set those expectations during the initial consultation. Then, when it doesn't come out quite like everyone was expecting, it's the patients issue. I realize this is skill specific, but then did everyone who rated this not get a good surgeon. Doubtful.

Ask a Question