Concerns & considerations: fat transfer to buttocks - condensed fat development & solutions?

Question

Seven months following the fat transfer from my belly to buttocks, the right side appears good, but the left side seems to have developed what feels like condensed fat, forming a solid mass beneath the skin. Is this potentially fat necrosis? How common is this issue, and what might be causing it? What treatment options are available? I'm concerned that removing it could result in asymmetry between my left and right buttocks.

Zoran Potparic, MD · Answer

Fat necrosis is a process associated with every fat transfer (grafting); a certain amount of fat grafts will not receive sufficient blood supply and will undergo necrosis (die). It happens in multiple areas after massive fat grafting, but most of these lumps are so small that they are not noticeable unless they are close to the skin. Larger areas may also form and present as a solid mass, as in your case, unfortunately. This is not very frequent, but it happens to most experienced surgeons; it is not the surgeon's mistake or botched result, it is the unpredictable result of fat transfer. In your best interest would be to wait at least one year for mass to decrease in size and consider revision with the removal of mass and careful, possibly staged fat grafting. Hope this helps.

Semih Yildiz, MD, FEPOBRAS · Answer

A solid-feeling area 7 months after fat transfer can be fat necrosis, but it can also be firm scar tissue, an oil cyst, a fluid collection, or another post-surgical change. Please contact your operating surgeon and arrange an in-person evaluation, because a physical exam is needed to judge this accurately. Ultrasound or MRI may be useful to see whether the area is solid, cystic, or related to deeper tissue.

Fat necrosis can happen after fat grafting when some transferred fat does not develop enough blood supply. It may be more likely in areas with larger volume transfer, uneven healing, pressure, trauma, or local swelling. Some small areas soften over time, while larger or painful areas may persist.

Treatment depends on the exam and imaging. Options may include observation, guided drainage if there is a cystic or fluid component, medication or injections in selected cases, or surgical removal if it is large, painful, growing, or causing contour problems. Your concern about asymmetry is valid, because removing a firm area can leave a depression; sometimes contour correction or staged fat grafting is considered later.

Seek same-day care or urgent contact with your surgeon if the area is rapidly enlarging, increasingly painful, red, warm, draining, or associated with fever.

John L. Burns Jr., MD · Answer

Some of the fat may have coalesced forming a pocket of fat that has not adequately intercalated into the fat of the butt.  This could be removed and replaced with fresh fat.

Daniel Barrett, MD · Answer

Dear Eclectic203330,
I understand your concern. However, without a proper assessment, it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Bryan Curtis, MD · Answer

Fat transfer to the buttocks, commonly known as the Brazilian Butt Lift (BBL), is a popular cosmetic procedure designed to enhance the size and shape of the buttocks using the patient's own fat. While the procedure has gained popularity, there are concerns and considerations, including the possibility of condensed fat development. Here are some key points to consider:Concerns:1. Fat Resorption: One of the challenges with fat transfer is the potential for some of the transferred fat to be reabsorbed by the body. Not all the fat cells survive, and the degree of resorption can vary from person to person.2. Condensed Fat Development: In some cases, fat cells in the buttocks may cluster or condense, leading to irregularities in the contour and potentially affecting the aesthetic outcome.3. Symmetry Issues: Achieving perfect symmetry can be challenging, and factors such as uneven fat absorption or distribution may contribute to asymmetry.4. Weight Fluctuations: Significant weight fluctuations after a BBL can impact the results. Losing or gaining weight may affect the distribution of transferred fat and overall buttock shape.Possible Solutions and Considerations:1. Expertise of the Surgeon: Choosing a board-certified plastic surgeon with experience in fat transfer procedures is crucial. A skilled surgeon can minimize the risk of complications and ensure a more favorable outcome.2. Proper Technique: The technique used during the fat transfer process is crucial. The surgeon's approach to harvesting, processing, and injecting the fat plays a significant role in the success of the procedure.3. Postoperative Care: Following postoperative instructions is essential for optimal results. This may include wearing compression garments, avoiding prolonged sitting, and adhering to activity restrictions during the initial recovery period.4. Realistic Expectations: Patients should have realistic expectations about the outcome of the procedure. It's important to understand that not all transferred fat cells will survive, and multiple sessions may be required to achieve the desired results.5. Maintaining a Stable Weight: To preserve the results of a BBL, it's advisable to maintain a stable and healthy weight. Significant weight fluctuations can impact the distribution of transferred fat.6. Follow-up Consultations: Regular follow-up appointments with your surgeon allow for the monitoring of your recovery and addressing any concerns or issues that may arise.Before undergoing a fat transfer to the buttocks, it's crucial to thoroughly discuss your concerns with a skilled plastic surgeon. They can assess your individual case, provide recommendations, and help you understand the potential risks and benefits of the procedure.

Mats Hagstrom, MD (license on probation) · Answer

To make a quality assessment regarding the outcome of a plastic surgery procedure we generally need to see a complete set of proper before and after pictures. If you don’t have before and after pictures to mask your surgeon to forward the pictures they took diet. I also suggest you follow up with your plastic surgeon regarding your concerns in regards to the outcome. 
Firm lumpiness after fat transfer is usually a clear indication that you have symptomatic, fat necrosis. This is usually a direct reflection of how the procedure was performed.Delivering consistent quality, liposuction and fat transfer results is more difficult than most people realize. The number of plastic surgeons who’ve mastered this procedure are in a small minority.
It may be possible to improve your outcome with revision surgery. To make an assessment we need to see before and after pictures. Removing necrotic fat from fat transfer procedures can be involved in complicated. Sometimes it requires a direct open excision.
For some individuals, it may be better to leave the necrotic fat in place and except it as part of the outcome.Generally, speaking revision work is more difficult and more complicated than primary procedures for both Liposuction and fat transfer. The importance of provider selection cannot be over emphasized.
The following are some general guidelines for finding the best provider for your needs.
To find the best provider, I suggest patient schedule multiple in person consultations with experienced plastic surgeons in their community. During each consultation, ask each provider to open up their portfolio and show you their entire collection of before and after pictures of previous patients who have similar body or facial characteristics to your own. An experienced plastic surgeon should have no difficulty showing you the before and after pictures of at least 50 previous patients. An experienced provider should in fact have hundreds or preferably thousands of before and after pictures to choose from for commonly performed procedures. 
Being shown a handful of preselected images, representing the best results of a provider’s career is insufficient to get a clear understanding of what average results will look like in the hands of each provider.
There is no correct number of consultations needed to find the best provider. The more consultations you scheduled the more likely you are to find the best provider for your needs. 
Take careful notes during each consultation, especially regarding the quantity and quality of before and after pictures. It’s not a bad idea to bring pictures of your own body/face to use as reference when reviewing before and after pictures. 
The biggest mistake patients make is scheduling only one consultation without properly vetting or comparing providers before scheduling surgery.
Best,
Mats Hagstrom, MD

Concerns & considerations: fat transfer to buttocks - condensed fat development & solutions?

Answers (6)

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