Is it normal for the doctor to push the fat out of the injection site with his hands?

The advantage to tumescent liposuction is that it can provide analgesia (pain relief) for up to 18 hours.
When you experienced pain it may simply have been the anesthetic wearing off. Occassionally when nerves "wake up" they are more painful. Think about what it feels like when you sit on your nerves in your leg and it falls asleep; it can be very painful when it wakes up.
Alternatively, it could be irriation of nerves which occurs more commonly with ultrasonic liposuction. Occasionally, when this persists beyond the first week and is disabling, I have prescribed medications such as lyrica which we use for painful nerves in diabetics.
I would continue to wear your compression garments as advised and take pain medication as recommended.
Fat grafting is like any other grafting or transplanting process. I like to give analogies, so here is one. If you want to grow a tomato plant, the instructions always tell you to put in 2-3 seeds per hole. Why? Because some die. Sometimes you get 3 plants, sometimes 2, sometimes 1 and sometimes none. Same goes for fat injection. We generally put in 2-3 time what we need, knowing that some of it will not grow. Rarely all or none of it survives but usually a portion. If you want to know how much wait and see. That's the best answer I can give.
Hopefully this helps!!

 

It’s not unusual for patients to
experience pain, swelling and discomfort following tumescent liposuction.  The burning sensation that you describe
is frequently seen when sensory nerves are bruised or stretched during the
procedure.  This is usually a
transient phenomena and resolves with time. 

It’s important to remember that
tumescent liposuction recovery varies from patient to patient.  We generally recommend that patients
take a week off from work following this procedure.  Occasionally, patients are able to return to work even
sooner.  Patients usually resume
all of their normal activities within six weeks following surgery without
restrictions.

We feel that exercise facilitates
recovery and because of this, we encourage physical activity.  Although swelling may still be present
six weeks following surgery, the majority of patients have effectively returned
to normal activity.

A variety of fat grafting
techniques exist.  If you have
concerns about the particular technique utilized by your surgeon a discussion
is warranted.

 

Tumescent liposuction is a very easy procedure to undergo with minimal pain and quick recovery. Most patients are back to work in only 2 days and up walking around right after the procedure. There is minimal bruising and dramatic results. It is so safe now that we have eliminated the need for general anesthesia. Another big advantage is that because we can stand the patients up and have them move into all sorts of positions, it allows us the get much better results by far as compared to gen. anesthesia liposuction since we can see what needs to be sculpted much better. Sincerely,

David Hansen,MD

Fat transfer or fat grafting is the process of performing liposuction and harversting the fat for contouring use instead of discarding it.  The key component of grafting fat is making sure the recipient skin area is elastic enough or undermined a little so it can stretch out during the process of filling it with fat. 


Pain after 6 weeks is something to be concerned about however your pain seems seems to be during the first day after surgery.  I try to remind my patients that despite whatever advertisements you may have heard, liposuction, after the numbing medicine has worn off, is never painless- you have passed a metal instrument under your skin a number of times!  It will hurt at some point and I would not be alarmed. 

There a variety of techniques used for fat transfer, and without observing the procedure itself, it would be hard to comment and give accurate information.  If the fat survives from 2-6 months, then you have a good chance of keeping the fat.

One day after surgery if very early to start worrying about the results.  Also, without knowing all the specifics of your surgery and seeing your pre-op photographs, it really is impossible to give you specific advice.  Typically with liposuction you can expect a moderate about of bruising and swelling which resolves over a few weeks.  During the healing process you may feel slight tingling or itching which is due to the skin healing.  If you are concerned about your recovery, I suggest that you talk with your surgeon.  Hopefully you were treated by a board certified plastic surgeon.  If not, I would suggest that you see the care of a board certified plastic surgeon in the future.  Good luck.

A burning or tingling sensation after tumescent liposuction is not uncommon.  In fact, most patients experience some degree of altered sensation in the area that was liposuctioned for several days or weeks after the procedure.  Regarding the technique used for your liposuction and fat grafting, it is unclear if this was standard procedure or not.  While traditional liposuction and fat grafting (i.e. fat transfer) involves the actual removal of fat from the body with cannulas, collecting and processing the fat outside of the body, and reinjection into the areas of concern, there are limited instances when surgeons may perform "liposhifting" to push fat from an area where traditional liposuction was performed to an immediately adjacent area, and vice versa.  Regardless of procedure performed, you will not see the final results for several months.    

Most importanty, however, is to ensure that your surgery, and any future plastic surgery or revisions, is performed by a plastic surgeon that is certified by the American Board of Plastic Surgery and a member of the American Society of Plastic Surgeons.  You can go to each of these organizations' websites to find a list of legitimate members. 

I am not familiar with a technique that manipulates the fat and then pushes it to a new location.  In most cases of fat transfer the fat is removed and then replace using small cannulas. 

Tumescent liposuction involves the use of large, dilute volumes of lidocaine and epinephrine into the treated areas.  I leave the adit sites (the openings in the skin from which cannulas remove the fat) open to drain excess fluid present in the tissues following the procedures.  It is also normal for a patient to experience an increase in urination in the day or so following the procedure and your kidneys help to filter the excess fluid.  Fat may be transfered from an areas of excess fat deposits to areas of indentation.  It is up to the surgeon whether fat is removed in a sterile manner, treated and reinjected into those areas versus using "liposhifting" to move fat with the use of the cannula.

Patients are typically swollen for 2--4 weeks following the procedure.  The skin undergoes some contraction around 1-2 months following liposuction, in which the skin may feel more "firm" to the touch.  I counsel patients that final results should not be expected until approximately 3 months following the procedure.

Most of what you describe is normal in a liposuction procedure. The manipulation of fat from one area to the other without removing it from the body is a bit different (but not wrong). It is possible that by not sucking the fat out, processing it, and reinjecting it, that the fat cells were less traumatize and therefore may have better survival. One day after surgery is much to early to judge - give it at least 2-3 months.