I lost of the fat in my uppper cheeks. Not quite sure how or why it happened but it was after my Rhinoplasty. I want a permanent solution to fix this. I am considering fat transfer but I keep hearing different stories as to whether it is permanent or not. Is there proof that it is permanent or not?
Is Fat Transfer Permanent?
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Fat Grafting Can be Permanent
There is a wide range of techniques, instrumentation and experience among the surgeons that perform this surgical procedure. Because of the tremendous variability in all of these factors, there is tremendous variability in fat grafting results. To perform fat grafting successfully and reproducibly a surgeon must employ careful preoperative planning, appropriate instrumentation and meticulous surgical technique. It is not something you can 'rush through' or spend just a few minutes on during a larger surgical procedure. The unfortunate reality is that not everyone who performs fat grafting is willing to put in the level of education, training, investment in instrumentation and operative effort required to produce aesthetically ideal results.
One must also have an aesthetic vision for ideal and youthful-appearing facial fullness. Just like traditional facelift surgery can be overdone or performed incorrectly to produce an unnaturally tight, pulled, 'windswept' look, fat grafting can be overdone to produce an excessively full and even bizarre postoperative appearance. Too much fat grafted into any area (or any fat placed where it doesn't belong) looks unnatural. It's analogous to breast augmentation results: if the surgeons selects an appropriate implant volume and positions the implants correctly, the patient gets a beautiful, natural-appearing breast enhancement. If the surgeons stuffs a pair of 500cc implants behind the breasts of an average-sized patient, then that patient ends up with a cartoonish 'boob job'. I think many of the unfavorable results in fat grafting are from the overzealous placement of excessive amounts of fat, which may have been the inevitable response to the recent paradigm shift in aesthetic facial surgery: away from the 'wind tunnel look', and towards the restoration of soft tissue volume.
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.
Longevity of Fat Transfer
I work as an aesthetic facial plastics surgical tech and I have seen many procedures and many situations. I feel Fat Transfer is the best option to go with because the outcome can offer many results that the traditional incision procedures does not. For instance, as described on our web site volumizing will eliminate the extra skin and fill any unwanted wrinkles and lines. If you go with the traditional face lift all that is accomplished is tightening. When we age we experience muscle and bone loss loosing volume. The youthful appearance is much contributed by the volume. Fat transfer brings back the volume taking off over ten years or more. The procedure is a lot less invasive and the only cutting and sutures are limited to 2-3 centimeters where the fat was harvested. To answer your question, the longevity really depends on the quality of the fat that is being harvested. We have areas on our bodies that are harder to lose the fat such as the hips, love handles, stomach, or even under the arms. Fat from these areas will improve the survival rate. We have seen fat survive 10-16 years.
Some of it may be permanent. The key words here are “some” and “may.” You are correct in that many dispute whether the transferred fat is permanent. This is an area where a consultation with a Board Certified Plastic Surgeon can offer some advice. I recommend you get a Sculptura consult and evaluate that product with a Board Certified Plastic Surgeon. This works well, and lasts roughly 2 years, and may be a very good fat alternative.
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Is fat tranfer permanent?
Great question. Think of micro fat transplantation as a way of putting living cells in one area of your body to another, similar to a skin graft. Once the fat cells get new blood supply in their new location they become a living entity. As one ages, however, we tend to lose volume in our face and so it is not uncommon to require additional procedure later on to make up for these losses.
Fat grafting permanence
There are several studies that have shown that fat transfer is permanent, though there isn't 100% take of the initial fat placed. The fat grafts that survive are permanent but they do undergo aging changes like the natural facial fat. The thing is that after the procedure you would always have more volume in the face than you would otherwise, even taking into account continued natural aging and fat loss.
Fat transfer: permanent of not
As you can see there are different opinions among surgeons on the matter. Technically any part of your body whether its a skin graft, an organ, or fat that is moved from one are to another and establishes blood supply should be permanent. Once you do a skin graft the skin graft is permanent and does not have to be repeated. With fat grafting we must understand that as we age the volume of fat in our body changes and this happens to both the fat that was grafted as well as the remaining fat in our body. This is also the case if we gain or loose weight.
So the answer to you question is yes fat grafting is permanent but you may want more down the road as the aging process continues.
All the best,
Fat transfer is permanent.
30 years ago I got tired of surgeons saying it was not permanent. I had a patient that let me inject one hand with fat and we waited 2 years. You could see the difference across the room. The problem is creating symmetry and one must over inject at first since about 50% will be absorbed.
Fat transfer is a permanent solution however a portion of the fat that is grafted intially is lost. To simplify between 20 to 50% of what is placed is lost. The residual is permanent.
The survial of a fat graft is highly dependent on technique. From where the fat is harvested, which intruments are used in the harvest, the amount of time the fat is exposed to air, and how the fat is processed prior to transfer is crucial. It's the difference between a long lasting smooth contour, and either a short lived graft or worse, the creation of a firm nodule. I have been performing fat grafting fow many years, and have found the need for revisions rare.
Fat Transfer Certainly Can be Permanent
Fat transfer is the grafting of fat. All grafts, if they take, are permanent. Since fat cells are fragile and susceptible to death from lack of oxygen, the grafting is technically difficult and unforgiving. When fat grafting began to become popular again some 10 years ago, there was a wide range of techniques and experience with individuals performing the surgery, and so results varied widely. Modern micro-fat grafting techniques performed by experienced surgeons today can provide grafting that survives and is permanent. Be sure to look into the experience of your surgeon and their success rate with the surgery.
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.