How Can you Tell that Fat has Actually Survived the Transfer? Biopsies?

I am trying to fix some bad fat atrophy on my face and am looking into fat transfer. After reading lots of reports I can't find anything that shows any proof of fat survival. Have there been biopsies or other tests to show the transferred fat survives after transplantation? Or is microsurgery a better option?

Doctor Answers 10

Fat survival after fat grafting is seen in the appearance

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Hi there-

You would know that the fat grafted has survived by appreciating the long term change in your appearance...

To better answer your question, however, you should know that there have actually been several well structured and responsible reports of surgeons needing to operate on an area grafted with fat long periods after the grafting procedure (for various reasons) and finding a healthy, living layer of fat where there would normally not be one.

There is no question the technique works, particularly when done by someone who knows what they're doing...

A few words of caution...

  • Unsuspecting fat grafting patients who didn't do their homework or chose their surgeon poorly have paid heavy prices- including loss of their lives.
  • Avoid any surgeon that uses shifty marketing to attract you, like using a catchy name for their liposuction technique or promising you "stem cells" will be used. This behavior should cause you to seriously question their morals and ethics.
  • NEVER choose a surgeon because they are offering you the most attractive price. You are investigating a professional service in which your health and long term happiness are in the balance- and just as with any other professional, the best ones are not likely to be the least expensive.

Fat Transfer Survival

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One way to confirm that fat has survived is through photos. Look at before and after images up to twelve months after surgery.

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

There are many fat grafting before and after photos on websites of plastic surgeons who regularly perform fat grafting, including my own that can show results of fat grafting after many months and years.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 121 reviews

Proof of fat survival

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There is no doubt that grafted fat survives long-term. This has been proven with imaging studies as well with the fact that occasionally patients have over-correction problems where the fat needs to be removed.

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 229 reviews

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Survival of Grafted Fat

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I have done tissue contouring with fat for many years and have a significant gallery of before and after photographs that demonstrate effective, long term results. Invasive procedures such as a biopsy are not necessary. Medical studies using an MRI examination have verified the presence of fat after sculpting with the patients own fat .

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 42 reviews

Survival of transferred fat?

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  There have been multiple studies suggesting long term survival of transferred fat.  Certainly, not all of the transferred cells survive but enough do that there is lasting improvement.  But biopsies to demonstrate fat survival aren't necessary.  If there is a significant change as a result of the procedure, this is all of the proof that you need.  As they say, the proof is in the pudding.

Lawrence Kass, MD
Saint Petersburg Oculoplastic Surgeon
4.9 out of 5 stars 137 reviews

How do we know that grafted fat survives

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There have been several studies looking into fat graft survival. Quite recent MRI studies have shown the persistence of grafted fat in the face. The take isn't 100%, but using proper placement volumes reliable results can be obtained. Certainly, a secondary touch up procedure may be indicated after an initial fat transfer has fully healed (in up to 18 months).

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 22 reviews

How To Tell If The Transferred Fat Survived

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The most common method for evaluating the survival of fat after a fat transfer is evaluating the clinical result.  It may take a few months for all of the swelling to resolve but once you reach that point, if there is increased fullness and the tissues are soft and not painful, then it is very likely your fat grafts have survived.  There have been studies performed using MRI and biopsies to determine the extent of fat graft survival but these are studies and not practical in most patients.

Fa grafting is very much in its infancy as a cosmetic and reconstructive technique.  There are many ways to harvest, process, and transfer the fat and at this point, no one can truly say that their system is the best or the only way to perform fat transfers.  Many fat transfers do require multiple procedures to obtain the optimal result and is something worth talking with your plastic surgeon before you proceed.

Hope this helps and good luck.

Herluf G. Lund, Jr, MD
Saint Louis Plastic Surgeon
4.7 out of 5 stars 87 reviews

Fat graft

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Long term results and MRI are proof enough that fat does stay. There are evidence by biobsy in the litarature that proof fat does stay. You may need more than one session of fat transfer.

I am not sure why you are thinking of microsurgery for fat transfer? In the past microsurgical transfer of the omentum was used for REOMBERG disease( Hemi facial atrophy). However that fell out of favor because it fall down very easily


Samir Shureih, MD
Baltimore Plastic Surgeon

Fat Graft Survival

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Most commonly, the clinical result can tell if the fat survived. If the volume of the treated area is maintained after the swelling has resolved and if the area is soft and not tender, then the fat has probably survived. Biopsies and MRI can be done but it is not practical to do so just to determine if the fat survived.

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
4.9 out of 5 stars 74 reviews

Several ways to assess fat survival after transfer

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There are several ways to assess fat survival. Post operative photos are standard, and taken from different angles, usually at 2 to 6 months. Biopsies are not done usually. A second transfer is often needed, depending on the area treated. I have found adding a product called Selphyl improves fat survival and now use it routinely.

Harrison C. Putman III, MD
Peoria Facial Plastic Surgeon
4.7 out of 5 stars 13 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.