Fat transfer survival - what type of things cause fat cell death?

Hello and thank you for your question! Fat graft "take" or survival is something that is not an exact science. Typically, anywhere between 50-75% (average about 2/3) of fat cells transferred from one site to another will stick around permanently or "take". This is because, as a living cell, the fat cells are waiting on your body to "grow in" new small blood vessels and "feed" those cells oxygen. Those that don't get enough oxygen/nutrients will "melt away" and be resorbed by your body. Sometimes they can turn into scar tissue/fatty oils cysts as well. Typically this process happens over the first few weeks after the transfer, so that is the most important healing time period.

Things that can affect fat graft take/survival include patient factors such as overall good health (medical conditions like diabetes, autoimmune conditions, etc can impair healing), smoking status (nicotine reduces small vessel blood flow and can increase the risk of infection, wound healing issues). Prolonged direct pressure also reduces localized blood flow to an area, so this is why many advise to avoid sitting on the fat grafted areas the first few weeks. Technique factors such as how much fat is grafted in one session can also influence fat graft take - i.e. if too much fat is grafted at once, the tissues will be too "tight" and less of the fat cells will survive as they compete with each other for the available oxygen and nutrients.

To answer your specific question, intercourse itself would not cause fat cell death, but it is typically recommend to avoid strenuous physical activities for the first several weeks after surgery to improve your healing.

Thank you and good luck on your journey!

Dear BGtea44,

I instruct my patients not to sit for 2 solid weeks. We provide them a specialized pillow that our patients can sit on during that time. They can sleep on their stomachs or sides.
Fat viability depends a lot of surgeon technique. The fat has to be placed back into the buttocks as soon as possible so that it has a greater chance of survival. It has to be placed carefully so that not too much fat is placed in only one area.


Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

In our experience around 50-60% of fat transferred for buttock/hip augmentation would survive. However, that is not entirely predictable and small difference in graft take from one area to other may be seen. Extensive pressure for prolonged time, fall, localized injuries may further alter fat survival in affected areas. Hope this helps.

After a second BBL, it's important to protect the newly transferred fat—especially in the first 2–3 weeks, which is the most critical period for fat survival.
* Excessive bending, pressure, or bumping into objects can reduce fat survival, especially on the hips and buttocks where grafted fat is still establishing blood supply.
* Sexual activity that puts pressure on the buttocks or hips can also be risky early on.
To protect your results, Avoid direct pressure on grafted areas for at least 3 weeks, Sleep on your stomach or sides, Delay intercourse involving hip or glute pressure for 2–3 weeks, or until your surgeon clears you.
Gentle movement is okay, but anything that causes pressure, friction, or trauma should be minimized during early healing.
Erman AK, MD. Plastic Reconstructive & Aesthetic Surgeon.

There are a number of variables that determine how well a fat transfer procedure is going to work.
In my opinion, the two most important variables are how much tissue with the patient has to graft into.
It’s not so much how much fat is grafted as how much tissue there is to support the grafted tissue.
I referred to this as hosted tissue.
The host tissue has the support the grafted fat until the graft establishes its own blood supply.
Areas they’re very thin will not do well regardless of how much fat is grafted.
The second variable is using good technique.
This basically means Layering the fat in many layers from different angles.
Placing too much fat in a single area will increase the rate of fat necrosis.
Different doctors have different opinions in regards to the impact of movement after surgery.
In our office, we usually recommend patients minimize movement for the first three weeks, then start gradually.
I don’t think things like pressure, movement using or not using compression environments really make much of a difference.
I do encourage my patience to minimize excessive movement at first, but in comparison to patient candidacy and provider selection these are fairly minor variables.
Best,
Mats Hagstrom MD