Facial Fat Graft Feels Hard Post-procedure

FAT GRAFTING aka LIPOINJECTION aka AUTOLOGOUS FAT INJECTION
The massage should be guided by your surgeon as opionions vary.
You did not specify the timing of your procedure as this can be important in the evolution of the post operative findings.
Firmness as Dr. Law documented can vary as a result of :

area injected i.e. cheek bone/ tear trough fat will feel firmer than cheek hollows
volume injected
amount of associated bleeding bruising
degree of "fat take" survival

Firmness is common with any procedure for the first 4 days. As the blood supply reaches or doesn't reach the fat cells some will die "fat necrosis" and trigger a process of inflammation and fibrosis (scarring) which will typically develop over a 3 week period. By 6 weeks, this process is generally completed and the areas continue to soften.
Therefore the 3 week period is a good time to assess the results of the lipoinjection procedure. While it may remain slightly overcorrected at this point, a soft area indicates good fat survival whereas a firm area indicates poor fat survival. This may be the result of a variety of factors and not always directly attributable to the technique. For example, a history of smoking contributes to poor fat survival as does previous scarring or surgery in the area. Aspirin or NSAID use may cause greater amounts of bleeding which can also be pericieved as hard
If other procedure have been simultaneously performed in the same area, this can also contribute to sensations of irregularity and firmness.
Rarely the fat may die and form a cyst or an abscess which needs to be drained or aspirated.
I hope this helps.

No, this is very normal. I tend to think when the areas are hard, the fat tends to last longer. Maybe the fat was a better quality to begin with.

  An important missing information with your question is the time since your procedure.  But certainly, massaging the area might be very beneficial and I don not see a downside to it.

After autologous fat graft  to the face is not unusual to experience some harness of the area. This can be secondarily to scar tissue. However,  you should be evaluated by your surgeon because fat necrosis initially will present as a hard area

With regards to FAT TRANSFER to face these are important points to consider;


Some degree of hard or lumpy region within the area of transplanted fat can happen after procedure.

It is important to be evaluated by your surgeon. He should guide you as to the degree, intensity  and frequency of massaging.

Unless there is granuloma or infection the hardness should  resolve shortly.


Hope this helped.

Dr. Sajjadian

Some degree of hardness or firmness is very common after fat transfer.  This is due to the expansion of the tissue as a result of fat injections.  Also, post-operative sweeling contributes to this firmness.  Most of this firmess should subside in upcoming weeks. By 6 weeks, the tissues should be much softer.  Massaging obviously help. 

 

Some degree of short-term firmness and swelling is common after fat grafting and by itself should not be cause for alarm.  Obviously you speak with your doctor for reassurance.

Early after surgery, almost every graft becomes firm to some extent. This is due to the healing around the graft and the metabolism away of, or encapsulation of, dead tissue.
With fat injection, many of the cells die before they are even injected. I believe this is inherent in the fat injection process where living cells are harvested under a vacuum and then injected. Our histoloogy studies have also confirmed this.
So in the first several months after surgery, this is normal.
If at six months or more after surgery, hard palpable lumps are present, it is possible that cells from the fat injection have died and have been walled off (encapsulated). If they are bothersome, they can be removed surgically. Otherwise, they are often left alone.

Kung,
It is unclear from your question how long ago you had your fat grafting. If you are recently post-op, then what you are describing is normal since it is likely due to swelling and possibly deep bruising/hematomas. However, if you have long term lumps then you may have fat necrosis or excess fat injected. If you are concerned you should go back to your surgeon and they should be able to help you.
David Shafer, MD
New York City.

Hi Kung Fu Geisha,
One of the great and amazing features of fat transfer when performed properly is that the fat takes on the characteristics of the tissue that it is implanted over. That is when over the soft tissue of the cheek, it feels soft; when over the bones of the cheek it feels hard like bone.
It is not normal to feel distinct hard lumps or masses after fat transfer. You should return to your surgeon for evaluation. Good luck and be well.
Dr. P