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How Does Fat Transfer Work?

How does fat transfer (fat grafting) work? What is the fat transfer procedure like?

Doctor Answers (34)

Fat Transfer, Microfat Grafting

+9
Fat grafting has been performed by plastic surgeons for decades. There is no question that fat is the ideal material for soft tissue augmentation, and that the results obtained with fat grafting are the most natural-appearing, when performed by a plastic surgeon with expertise using the ideal instrumentation. See link below to my gallery of before and after fat grafting patients.

. However, one problem with this procedure in years past has been resorption (breakdown) of the grafted fat, so that the resulting improvement is not permanent. The grafted fat must gain its own blood supply in its new location in order to persist long-term, and this generally is not possible when large amounts are injected at once and when specialized instrumentation and techniques are not employed.
A relatively new technique has been developed called structural fat grafting, in which small amounts (less than 0.1 cc at a time) of fat are carefully microinjected in a series of discrete layers to gradually 'build' new soft tissue structure. As there is space between each microinjection, new blood vessels are able to grow into the grafted fat, allowing it to persist. If this process of blood vessel ingrowth (neovascularization) does not occur, then the injected tissue cannot truly be considered a 'graft' and is instead just another 'soft tissue filler' of limited duration.
This is a procedure that requires specialized training and specialized surgical instruments, as well as patience and attention to detail on the part of the surgeon. When performed properly, permanent improvements in facial plastic surgery are possible. If enough fat resorption occurs following a fat grafting procedure such that the desired result is not achieved, a second 'touch-up' procedure can easily be performed to augment the result obtained from the first injection.


Raleigh-Durham Plastic Surgeon
4.5 out of 5 stars 40 reviews

Fat transfer is a biologic graft

+3

Fat injection ("fat transfer") vs. LiveFill Doctors will tell you that fat is taken from one area and placed in another area, and the cells survive. I will attempt to show you how this is not a complete picture. My evidence is based on studies I have performed, presented at national meetings (ASAPS and ASPS) and published (PRS) and on other studies in the literature. I have studied 3-D CT scans to measure long term volume retention. I have studied the histology of fat injection vs. LiveFill. I prefer the technique LiveFill, which uses only living tissue for transplantation.

Fat injection technique involves aspiration(through a liposuction canula) of fat into a syringe. The fat is generally placed in a centrifuge, to spin out the blood and broken cells. The remainder is then injected through a needle into the area to be filled. The problem is this. Fat cells are delicate tissues with a thin membrane, within a delicate living framework inside the body. When they are sucked out, centrifuged and then injected again, many of those cells have their walls broken and die. Estimates of the number of living cells is 5-25% in good studies using scientific techniques to assess the number of surviving cells. That means that most of the cells are dead. In some studies measuring metabolism, almost all the cells are dead. Dead cells do not resurrect. Most of them are eaten away by the body's macrophages over time. When you look at the cells on a microscopic level of fat injections, you see many macrophages eating away dead fat cells. You also see large pools of dead fat and fatty cysts. There is a chronic inflammatory reaction around the injected cells. This in my opinion accounts for fat cells disappearing over time, or disappearing when pressure is applied to them (rupture of fatty cysts).

LiveFill, on the other hand, consists of all living cells. They are not processed. They are placed through keyholes into hollow areas of the face. Long term histology shows that blood vessels have grown into the cells. There is no chronic inflammatory reaction.

The reason for this is simple. Live cells are placed into the area of facial hollowness, not mostly dead cells. The result to the patient's experience: LiveFill lasts better and more predictably than fat injection. The more active and athletic a patient, the better, because their circulation and blood supply is superior to patients who are sedentary. LiveFill grafts are not placed in great excess because the survival is so much higher. We do not see the massive swelling seen with fat injection, probably because the body does not have to contend with a massive amount of dead cells and free fatty acids being injected into an area.

Transplantation biology is complex, and the above represents a very simplified version of the articles and presentations that are available to the discerning patient. I hope this helps.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 92 reviews

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How fat transfer works

+2

Fat grafting is a relatively simple idea: harvest fat cells from your own body (autograft) and use these same fat cells as filler where needed (the face, for example). The procedure is not too difficult, and takes only a few hours. Under local anesthesia, your doctor will remove these fat cells with a specialized syringe from either the abdomen, thighs, or buttocks. Next, your doctor must isolate the harvested fat cells from the other fluids that were initially collected from the harvest site by centrifuging (spinning very quickly) the collected tissue. The doctor can now use the isolated fat cells to inject them under the facial skin, for instance, into areas where filler is needed. One main issue you should take into account when considering fat grafting is the high incidence of reabsorption of the fat cells back into the body and out of the specific areas where filler is needed, leaving you with poorer results than expected.
 

Kenneth Bermudez, MD
San Francisco Plastic Surgeon
5.0 out of 5 stars 6 reviews

Fat transfer

+2

Fat transfer is an office surgical procedure. It involves harvesting the fat by gentle liposuction. The harvested fat is then carefully cleaned, then centrifuged to separate it from the anesthetic solution and debris, then placed into smaller syringes for injection. The one or two tiny incisions made to introduce the cannula to harvest the fat require no sutures. Injection of the fat into the site to be enhanced is the second of the two steps in the fat transfer process. The area on your body usually, the face or buttocks, to be improved is anesthetized with local anesthetic prior to fat injection. The freshly harvested and centrifuged fat is then carefully injected into the desired area. Fat transfer is injected in small pearls of fat in a layered pattern to assure the survival of the graft.

Samir Shureih, MD
Baltimore Plastic Surgeon

Fat transfer is an excellent method for replacing fat...

+2

Fat transfer is an excellent method for replacing fat lost in the face with age and filling in sunken areas of the face.

Fat is harvested from the thighs or the abdomen. Depending on the technique used, it is then spun down in a centrifuge to remove excess water and other fluid. The fat is then placed into a syringe and reinjected into the desired location.

The procedure can be done with local anesthesia or if the patient desires, with more conscious sedation or general anesthesia.

D.J. Verret, MD
Dallas Facial Plastic Surgeon
4.0 out of 5 stars 12 reviews

Fat Transfer and fat grafting...

+2

It seems that just about every month we hear about a new filler that has come out on the market. These fillers continue to improve in safety and efficacy.

However, one of the best fillers remains to be the patient's own fat cells.

Fat grafting is the process in which fat from a part of the patient's body is harvested, processed (cleaned), and then placed in another part of the body.

Fat can be placed all over the body, such as the face for facial rejuvenation, the breast for the correction of contour deformities or irregularities, and the gluteal region for butt augmentation.

Fat grafting is a wonderful technique, but some caveats must be understood..

Not all of the fat that is transferred will remain permanently. Anywhere from 20 to 50% may be resorbed by the body. This could result in irregularities or the need for another fat grafting in the future.

Patient's should also understand that fat grafting is very much an art. The best way for a patient to get the result they are seeking is to communicate your goals in depth with your plastic surgeon and work with a plastic surgeon who has a great deal of experience with fat grafting. This way, they will be able to understand your goals and produce a consistent result.

Best...

Dr. Pazmino

Pat Pazmino, MD
Miami Plastic Surgeon
4.5 out of 5 stars 65 reviews

How Does Fat Transfer Work?

+1

You perform a small liposuction on an area to harvest the fat. You then remove the blood, serum, and saline from the fat. Then you inject the fat into the desired area.

Kurtis Martin, MD
Cincinnati Plastic Surgeon
5.0 out of 5 stars 25 reviews

Fat transfer fat grafting

+1

First, the fat is harvested via the liposuction technique where the fat is bypassed and collected in a sterile container, cleaned and washed with sterile saline and kept cold until ready to graft. Fat grafting is done with thin, blunt cannulas to the desired areas through small needle size incision that typically heals without a scar. 

Pamela Gallagher, MD
Long Island Plastic Surgeon
5.0 out of 5 stars 5 reviews

Fat grafting to the face - Los Angeles

+1

Great question. Simply speaking, fat grafting allows us to take small amounts of viable fat from the body and transfer the fat to the face in order to add volume and rejuvenate the face. Raffy Karamanoukian Los Angeles

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
5.0 out of 5 stars 47 reviews

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.