Facial Fat Graft Feels Hard Post-procedure

I had an analogous fat transfer to the upper cheeks and orbital region. The fat feels hard like a rock underneath the skin. Is this normal? Should I massage it? I can also feel uneven areas on the outmost region of the cheeks. Does hardness indicate that the fat cells died in the process? What should I expect from here?

Doctor Answers 22

Firmness After Fat Grafting

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Firmness in grafted fat tissue can occur on occasion postoperatively, but fat that feels “hard as a rock” is distinctly unusual. In most cases, facial areas that have received autologous fat grafts should feel soft and supple, although there may be some mild to moderate ‘firmness’ for the first week or two as the relatively modest postoperative edema (swelling) subsides. Also, the feeling of firmness may vary with the amount of fat grafted into a given area. 2-3cc of fat in the anterior cheek should feel fairly soft in most patients, while 4-5cc will feel noticeably firmer. Again, firmness should subside gradually over the first two to three weeks after surgery.

Hardness in grafted fat tissue suggests a problem with surgical planning, a problem with surgical technique, or a possible postoperative complication. I have met with a number of patients who have undergone staged fat grafting procedures in other practices using previously harvested, frozen autologous fat. Many of these patients have experienced, among other things, hardness in the grafted areas postoperatively as well as no significant long-term persistence of grafted fat. It is widely accepted in the plastic surgery community that only autologous fat that has been freshly harvested should be used for grafting.

Hardness can also result from over-grafting and/or an inappropriate grafting technique. While in some cases it is desirable to add a large amount of fat in a certain area, adding too much fat may prevent new blood vessels from growing into the recipient site. An over-grafted area feels very firm immediately postop, and often turns hard as the grafted fat fails to develop a new blood supply. Failure to evenly disperse grafted fat throughout the recipient site will also impair the establishment of a new circulation. ‘Fat necrosis’ is the medical term for the phenomenon of fatty tissue turning very hard due to an insufficient blood supply. In some cases fat necrosis will soften over time (usually months), but it may also may remain hard indefinitely.

Hardness could also result from a persistent, organized hematoma in a grafted site. The only way to diagnose the cause of hardness, and to make treatment recommendations, is by physical examination. Heat and anti-inflammatory medications may be helpful in some cases; massage can be used in some instances but should be carefully directed by the physician.

Severe hardness following fat grafting certainly deserves a careful evaluation by your doctor, and some appropriate treatment recommendations based on that evaluation. Firm areas usually soften with time; the fate of hard areas really depends on the diagnosis. Whether or not fat will persist when the hardness resolves will take several months to determine.

Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Depends on the timing

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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 :

  1. area injected i.e. cheek bone/ tear trough fat will feel firmer than cheek hollows
  2. volume injected
  3. amount of associated bleeding bruising
  4. 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.

Palpable fat grafts after surgery

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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.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 188 reviews

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Hardness/ Firmness after Fat Transfer to Face is not common

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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

Hard/lumpy areas after facial fat transfer

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It is entirely normal - and expected - to feel firm/hard/lumpy areas for the first few months after fat transfer to the face. These islands of swollen tissue will soften with time.

Visible lumps, on the other hand, are more tricky. Your surgeon's judgment will help decide how they should be managed: massage, steroid injection, or other treatments.

Facial fat transfer, artfully done, is a problem that creates happy patients and good results. Try to weather the uncertainty of the first several weeks, and you'll likely be fine.

Good luck,

Mike Nayak

Fat graft take

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Fat grafting is a nice way to provide autologous tissue augmentation. Hardness can mean alot of diffirent things at different times. If it si early post-op, it may mean nothing. If it is longer than say the first few weeks, it may represent scar tissue or grafts that have not taken well and are undergoing fat necrosis and resorption.

Fat grafted takes on the qualities of nearest tissue

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Fat grafting is an excellent way to bring youth to your face. Losing volume plays a huge part in the aging process. Hence, replacing this fat to the face can reverse a lot of the aging that has occurred within the face.

One rule in fat grafting is that fat will take on the characteristics of the tissue that it is placed near or on. Hence the fat that is placed on your cheek bone will feel like bone, etc. During the post procedure phase, however, the fat will feel hard due to the inflammation that it is undergoing. Fat is one of the most inflammatory substances in the body and hence it will lead to a lot of inflammation.

The key during the healing phase is to be patient. It will eventually soften and feel more like your own tissue.

Consulting a Board Certified Facial Plastic Surgeon would be something that I recommend. We specialize in the face and are highly qualified to help you with this.

Philip Young, MD
Bellevue Facial Plastic Surgeon

Facial Fat Graft Feels Hard Post-procedure

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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

Results after fat grafting to face

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Fat grafting to face is a very effective and powerful procedure. This is performed through very small needles and by adding a drop of fat at a time. When we transplanted fat from one area of the body to the other we can expect approximately 20% of this fat melt away. It sounds as if you are in the middle of the healing process. You should expect the fat to become progressively more soft until you reach your final result at about 6 to 8 months. At that time, if you continue to have areas of firmness or areas that are uneven, return to your plastic surgeon for evaluation. They may recommend additional fat grafting to help even out the areas or the injection of medication that will help smooth the areas out.

Is "the orbital region" the eyelids?

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If you are referring to fat injections in the lower eyelid, you might be experiencing a fairly regularly reported problem in that area. The skin there is usually pretty thin, and resorption of the fat is common. Although you might see a good result initially, uneven withering of the fat can lead to an unfavorable appearance and areas of firmness later - even months and years later. These changes can be especially noticeable as your weight fluctuates.

I'd recommend that you follow the advice of your surgeon.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.