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.
Here is one patient’s experience with fat grafting posted to RealSelf:
Fat is great when used JUDICIOUSLY and CONSERVATIVELY, but too much of a good thing becomes a nightmare and deeply regrettable. Make sure your surgeon listens, draws up precise operative plans beforehand and makes plenty of time for you and your concerns. Do NOT take it lightly.
I couldn’t agree more with this patient’s response to her experience with fat grafting. Just like breast implants, or liposuction, or browlifts, too much of a good thing is not at all a good thing. And cosmetic surgery (and this includes the preparation for surgery) of any kind without attention to detail and a focus on natural-appearing results will leave patients feeling disappointed at best and feeling disfigured at worst. Now regarding whether or not fat grafting is a surgically sound concept…
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.
These are just words to describe the same thing. unfortunately, sometimes we get too many marketing words out there that really mean very little.
A composite fat graft utilizes a pieces of fat which is harvested from another body area and placed into a defect-the fat is transferred intact.
Fat injection uses fat that has been removed by liposuction, treated, and injected as an emulsification consisting of fat cells.
Both procedures work and are accepted techniques.
However, in my experience, the injected fat cells, I presume because many are injured during processing and injection and because the injection is a blind procedure, often appear lumpy, and often need to be repeated. I find the composite graft can be more accurately placed and the survival of the graft more easily predicted.
Essentially, the terms refer to the same thing. Usually these days, fat is removed by liposuction, cleaned, and prepared to graft into a recipient area. The most common technique to do that is with special needles and syringes. So the fat is injected as a "graft". The graft refers to the fact that the fat cells are moved to another area without thier blood supply in tact, and must wait for a new blood supply to develop and sustain them.
This is also the problem with fat grafts. It is unpredictible how much of the fat will survive, though most or at least a good proportion will die and resorb, making re-treatments frequently needed.
Fat grafting is the same thing as fat injection. Grafting is a term used in plastic surgery when tissue is taken from one place and transferred to another and then it is allowed to heal in place. The healing depends on the ability of this transferred tissue to survive long enough until new blood vessels are formed to provide blood supply, oxygen, and nutrients to this transferred or grafted tissue.
Fat injection is a more descriptive term for the same thing, as the fat is actually injected into the target areas, in the process of fat grafting.
Martin Jugenburg, MD
Only the terminology is different; the procedure is the same. Not all fat lives in the new environment, some may and some will be dissolved by your body. There is no guarantee as to how much fat will remain and often it is done as a series of several sessions even after a facelift.
This is a minor semantic and technical distinction.
Fat injection is a method of fat grafting.
Let me explain. Fat grafting literally means taling fat from one part of your body and transplanting it to a new location. The transferred fat (the "graft") needs to survive in it's new location and this process is referred to as the "take" of the graft.
The transferred fat can be achieved using:
- pearl grafting (cutting into small pearl sized pieces)
- lumbrical grafts (cutting the fat into cigar shaped pieces)
- dermal fat grafts (combining the fat with protions of the skin - dermis)
Surgeons may disagree on the best methods of grafting as well as the methods of processing the fat prior to transfer.
In Medicine, a graft is the the transplanting of a portion of bone marrow fat, skin or bone from one area to another. The vast majority of fat harvested elsewhere is placed in the recipient area by injecting in. It is usually placed in small tunnels where is is more apt to be nourished and survive the harvest and grafting. Less commonly small pieces of fat are placed directly without injection.
In your case the fat transfer / grafting will most likely be by injection.
I hope this was helpful.
Peter A Aldea, MD, FACS
Fat grafting is the same as fat injection. As the mechanism of aging involve loss of facial volume,fat injection is becoming a common practice with or without face lift surgery.
Some of the injected fat could be absorbed,however with good surgical technique the majority will survive.The key in fat grafting is to avoid injecting too much or too superficial. Best of luck !
Fat grafting and fat transfer and fat injections are all the same thing. Some fat is removed from desired areas and then treated and injected into the areas that need the volume.
It can be permanent and it will be, but not all the injected fat stays. Different surgeons will quote you different percentages of how much stays. The bottom line is that you may need repeat injection to get the desired long term result that you may be looking for.