Are Fat Transfer Results Permanent?
- Asked by Ang47 in Sacramento, CA
- 4 years ago
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American Society of Plastic Surgeons official position
"Current Applications and Safety of Autologous Fat Grafts: A Report of the ASPS Fat Graft Task Force" from Feb 2009
The results therefore might vary depending on the surgeons technique and experience with the procedure.
The important factors in improving viability are:
1 Harvesting technique using low suction
2 Graft preparation should include minimal exposure to air and avoidance of mechanical damage. Live Fat cells should be separated from blood, serum and damaged fat cells via centrifugation. How you centrifuge is also important.
3 Injection technique is very important using multiple passes injecting minute amounts at each pass.
It is a time consuming and tedious procedure and any shortcut will lead to decreased cell viability. If the surgeon takes the time to do it carefully, clinical results will be satisfactory.
I do a lot of fat grafting to various areas of the body. I have performed hundreds of fat grafting procedures and the results have been long lasting. Two patients have come back for follow up sessions, but not because the fat didn't take from the first procedure. They actually gained weight so they could have more even more prominent buttocks!
Fat Grafting, Fat Transfer Resorption can be a Problem with Fat Grafts, Ask your Plastic Surgeon about their experience with fat
For patients seeking permanent enhancement of soft tissue volume, the ideal material to use would obviously be something that is naturally-occurring and not rejected by the body or treated by the immune system as a foreign material. Whether the goal is to restore volume to an area such as the lips or the cheeks, or to fill in a crease or depression such as the nasolabial folds or marionette lines, the ideal material is quite clearly the material that one wishes was there in greater abundance in the first place: YOUR OWN FAT.
For transferred fat to truly qualify as a 'graft' the following must happen: living tissue must be transferred to a new location, and that tissue must gain a blood supply at the new location which provides oxygen and nutrients which allow it to persist indefinitely as living tissue. We know that with appropriate instrumentation and technique this is achievable, so one of the opinions expressed in this thread that "most of the cells from fat injection are dead " is simply untrue (and structural fat grafting, to be clear, does not involve 'injection' of fat). MRI studies have shown that with appropriate technique grafted fat persists long-term as living, vascularized tissue in the recipient site.
It is also well-established that adult human fatty tissue contains stem cells that have the capacity to repair damaged or injured tissues, and stem cells can be concentrated during the fat harvesting process. This effect has applications in both cosmetic and reconstructive surgery. Fat grafting is now being used, for example, as a means to stimulate the repair of chronic, non-healing wounds. Several centers have reported on fat grafting immediately below non-healing chronic wounds resulting from radiation therapy for cancer, with rapid improvement and eventual healing of wounds for which no other wound treatment was successful. The development of stem cell therapies involving the harvesting and processing of viable human fatty tissue is one of the hottest topics in both clinical and experimental medicine today.
When performed correctly fat grafting actually has the capacity to heal, revitalize and rejuvenate the local tissues at the recipient site. I have treated a number of patients with facial fat atrophy following overly aggressive 'non-invasive' rejuvenation treatments including Thermage, Fraxel and IPL. Most of these patients report not only an aesthetically pleasing and permanent improvement in facial soft tissue volume, but also an improvement in the quality and vitality of their facial skin.
I perform extensive facial fat grafting during most of my facial rejuvenation procedures, and it is the very first thing I do - before making any incisions to lift the brows, eyelids, face or neck. Fat grafting allows me to obtain results that are simply not possible with conventional, subtractive surgical techniques alone. Patients frequently return for grafting of additional areas after their initial experience with strucutral fat grafting. To characterize it as the pointless and potentially harmful placement of non-viable tissue is an opinion only, and it is an opinion with which quite a number of plastic surgeons who successfully rejuvenate faces (and breasts and bodies) with fat grafting would vehemently disagree, myself included.
Solid fat/fascia and fat dermis grafts are another means by which facial soft tissue volume may be significantly and permanently enhanced. As with fat grafting, survival of the grafted tissue is variable and some of the graft material is reabsorbed. As with fat grafting, potential complications such as infection and cyst formation are possible. And as with fat grafting, appropriate preoperative planning and surgical technique are required in order to obtain ideal and lasting results. In my opinion structural fat grafting is more versatile, as fat can be easily and rapidly added to any tissue plane (level); and it has the added benefit of the ‘stem cell effect’ which is difficult to quantify but unquestionably present in many cases.
Both structural fat grafting and fascia-fat (or dermis-fat) grafting can be competently performed (or not) by Board-certified plastic surgeons. Neither should be trademarked or considered proprietary.
As with any surgical procedure take time researching your plastic surgeon. Schedule several consultation, view many photos from many patients, each from multiple perspectives (start by looking at photos on this website) and speak to former patients of any plastic surgeon you are considering
Web reference: http://www.michaellawmd.com
Are Fat Transfer Procedures Permanent?
When performed using proper techniques of harvesting fat, treating the fat, and then injecting the fat, the fat that survives is permanent living fat. The techniques of Coleman, Lam, and Glasgold have been proven to stand the test of time. The percentage of fat transferred that survives varies from about 40 to 60% with these techniques.
I have personally seen the fat transfers in my patients to be permanent. The fat that is there after 6 months will be with them for the rest of their lives. The key is choosing your fat transfer surgeon most carefully.
Good luck and be well.
Recent Fat Transfer Reviews
Fat Transfer Photos
Fat grafts have the potential to be permanent
Fat grafting has revolutionized plastic surgery. More and more uses are popping up every day. However, there is still an element of unpredictability to fag graft survival. In most cases the grafts survive. However, there is a chance that some if it will be absorbed by the body. As newer techniques are developed such as micro fat grafting, the percentage of viable fat transfers is increasing. I feel you should not over correct, since if all the fat survives, you will look over corrected. Also, if you gain weight, you will also gain weight in this transfered fat. The best plan is to put just as much as you need, with the expectation that you may need a second treatment if the first graft does not completely take. I hope this is helpful.
Web reference: http://www.fatgraft.me
Fat transfer results
We have performed experiments on the survival of Coleman aspirated fat grafts. We have published these stueies in Plastic and Reconstructive Surgery and presented them at ASAPS and ASPS meetings. We believe the initial viability to be around 20-25%. Final survival is even lower.
The issue is how viability is assessed. If you look at cells grossly, the viability is high. If however you use trypan blue exclusion techniques or metabolic studies, the number of live cells from fat injection is anywhere from 3% alive to 25% alive. That is the starting number. It goes down from there as cells either survive or do not survive.
Clinically, patients complain that fat grafting does not last, but that usually some does remain. this is consistent with our findings experimentally.
Is fat transfer results permanent?
Results of fat transfer varies depending on the location of injection, thickness of the soft tissue where fat in injected into, the skills of the surgeon, the way fat is harvested and prepared, and finally "luck". In my large experience with buttock augmentation with fat grafting, I have noticed that less than 10% of the fat goes away. In the face, this can be up to 30%.
Web reference: http://www.beautifulself.com/p_facial_fat_grafting.htm
Permanent but not totally predictible!
fat grafting can produce remarkable results in terms of volume restoration and skin quality improvements.
The rejuvenation effects cannot be matched by any artificial Injectables!
with more than a year in adult stem cells enhancement of my fat grafts ,i have seen more stability in the survival of the graft and continuous benefits in skin restoration.
my experience in stem cell enhanced face lifts has been quite exciting as well!
Fat Transfer Results Can Be Permanent
The level of survival of fat that is transferred depends on many factors, but I believe probably the most important factor is the technique and experience of the surgeon performing the fat transfer. Fat should be harvested with minimal pressure and delicate technique to minimize trauma to the fat cells, should be centrifuged to concentrate the fat and get rid of impurities, and should be re-injected into the donor site in multiple small passes in many layers to increase the chances of the fat "taking". I find the quality of fat harvested really matters, with oily fat often seen in sedentary older patients less than optimal. Fat survival also depends upon where it is reinjected, with areas of scarring less optimal, and areas of rich blood supply the best. When these criterion are consistently met, some of the fat injected should be permanent, and in some patients additional sessions will be necessary due to a bit of resorption, or patient desire for increased volume. It is hard to pinpoint a consistent percentage of fat survivability, but after hundreds of fat transfer cases, I suspect between 50-80% of fat that I re-inject survives, with the highest percentages in the face and buttocks.
Fat Is Permanent but Requires Multiple Procedures
Fat is a permanent solution for facial augmentation but beware. A certain percentage of the fat will not take with just one application and often multiple procedures are necessary to get a patient their desired results.
Fat transfers may be permanent
Permanent is a difficult word. Does that mean that even when in the grave that the fat will stay? I don't think so.
In general, most doctors report some portion of the fat will remain in the desired area for years after the procedure. Some reports have the amount of fat that survives at between 20% and 60% of that which is injected.
That leaves the physician in a dilemma:
1. Should the physicians OVERFILL the fat into the area to accomodate the loss of fat. My answer to that is a resounding no! Overfilling leads to distorted results and may cause fat to die prematurely.
2. Perhaps the physician should plan to reinject fat several times at different times.
3. Finally, the doctors can choose to use techniques that maximize fat viability as described by Dr. Rodriguez below. The viafill system is designed to maximize fat viability.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.