Promoted Local Answer
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 can be Permanent - Don't Overfill - View LOTS of photos fro evidence
Fat grafting can be permanent. Fat grafting has become quite popular, and unfortunately many doctors without expertise are performing fat grafting. I often see faces that are over-filled with an unnatural and distorted look. For this reason you need to find a plastic surgeon with significant experience and expertise with fat grafting. The results can and should be natural looking. Please see link below to my before and after fat grafting gallery
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
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.
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.
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.
Are Fat Transfer Results Permanent?
Fat transfers have taken us a long way from the old adage of “getting old was gravity pulling down on your face”. The current thinking is that patients lose volume in their face in soft tissue and bone and they need to have this volume replaced to rejuvenate the face. Many patients have an ample supply of fat to be used as donor sites for the fat transfers. After the fat is harvested, it is centrifuged and concentrated, and then the associated liquid is drained and the resultant concentrated fat is placed in a small syringe to be injected. I use it in the face during face lifts and these fat injections are a godsend to rejuvenate the face. The effect is quite permanent in the patient. Likewise if a butt augmentation is desired the fat specimen is inserted into the deficiencies of the buttocks.
Fat Transfer Results Are Long Lasting
Fat Cells that survive the transfer process continue to live like other fat cells. Therfore the results are long lasting. The problem is not all transferred fat survives the process. In the face for example it has been estimated that up to 60% will survive. Of most interest is that the fat that does survive behaves as if it was still in the donor site. Therefore as the surrounding native fat tends to atrophy the transferred fat will not. Over time you will notice that the area may not be as full as it once was, but more than likely it is because of the native fat atrophy rather than the transferred fat.
Is fat transfer permanent?
I think there are several camps out there when it comes to fat transfer, so it depends who you ask. I have always been a strong believer in fat transfer, and have over 15 years experience with the procedure. I believe fat volume loss is probably the #1 factor in facial aging for most people, and therefore it logically follows we should replace the fat loss. As others have said, it is very technique dependent (both on the surgeon's expertise and how he/she does the procedure), from what part of the body the fat is harvested, and to where on the face it is transferred. These are a lot of variables, and that is why doctors have many opinions on the success and longevity of the procedure. Perhaps the most important point is that the doctor have a good idea of what he/she can achieve, and then adequately discuss this with the patient at their preoperative consultation to set up appropriate expectations.
Most recently is the discovery that fat holds the highest concentration of stem cells in the body, and these are also transferred to the recipient site. These stem cells take on the properties of the surrounding tissues, and so you can imagine the potential future possibilities of what we will be doing in the next 5-10 years to rejuvenate facial skin. Very exciting!
Yes, I do believe I can achieve very long lasting (years) results with fat transfer. I have seen in many times in my patients.
Yoash R. Enzer, MD
Fat grafting is permanent with appropriate technique
Fat grafting is an excellent option for facial rejuvenation. Once the fat takes, it will survive just like it did before, but only in a different place, so it will behave like normal fat getting larger or smaller as you lose or gain weight. However fat grafting is very technique sensitive, and surgeons who do not pay attention to each aspect of the process may not get consitent results. Every component of the procedure from fat harvesting, to fat purification, and the actual micrografting, can make a difference. With careful attention to every step, anywhere from 70-90% take of the injected fat can be expected to survive with each injection. We have installed the first Liquid Gold mini fat bank in the US, and with just one liposuction procedure we are able to successfully store enough fat to allow most people a lifetime of fat for facial rejuvenation purposes. Because the actual amount of fat that takes is not 100% predictable, I prefer not to place any more fat at the initial procedure then looks good. I do not overgraft, as if a high percentage takes then one will have to much. Having fat banked makes it easy to simply add a little more fat as needed without another liposuction procedure. We simply thaw a small amount of fat when needed, and inject it just like any other filler.
How Permanent is Fat Transfer?
The technique of fat transfer has been improved with the use of delicate transfer of fat with low pressure removal with handheld syringes, centrifuge to remove excess fluid and injection with blunt tipped needles which inject tiny amounts allowing for better in growth of blood supply. With proper technique, called the "Coleman technique" fat transfer will have excellent long term survival. Use of liposuction machines and thick injections will have the opposite effect.