Will ALT flap [fat,small muscle] surgery have volume loss over time?

Thank you for your question regarding the ALT (anterolateral thigh) flap procedure for half-face atrophy. It’s understandable that you’re concerned about how the flap will evolve over time, including volume loss, swelling, numbness, and skin color changes.

In general, volume loss after ALT flap surgery ranges from about 5 to 25%, which is relatively low compared to fat transfer procedures. ALT flaps are highly vascularized, which means they typically have a high survival rate and maintain more of their original volume.

Here’s a general timeline of what you can expect:

One month post-op: You’ll still have swelling, but this will begin to subside.
Two months post-op: About 80% of the swelling should be gone.
Three months post-op: Almost all of the swelling should have resolved, and the final volume will be more apparent.
As for numbness, this is common in the early weeks after surgery. Most patients experience numbness for about 4 to 6 weeks, after which sensation gradually returns.

Regarding skin color, the flap may appear darker at first due to increased blood flow, possibly looking purple or bruised. After a few days, the skin should "perk up" and start to resemble the color of your original thigh tissue. By day one, the color should be around 90 to 95% similar to the donor site (thigh).

I encourage you to trust the healing process and communicate with your plasgic surgeon about any concerns. The ALT flap is a reliable option with good outcomes for treating conditions like facial atrophy.

Sincerely,
Dr. Katzen

In terms of the volume loss, there should be minimal to none in the fat portion of the flap beyond reduction in normal postoperative edema. However, the muscle will atrophy significantly over time, so much of the volume resulting from the muscle will decrease. Theoretically speaking, you should not expect much in terms of the change of the color of the skin, however with sun exposure and normal living many times the color does change slightly.

Your question isn’t clear and your situation sounds highly complex.
I suggest you follow up with your provider and ask them to respond to all your questions and concerns before your procedure.
After you’ve done that, and you’ve confirmed that the provider selection is appropriate and the best for your needs, you need to simply have faith in the process.
Best,
Mats Hagstrom, MD