Facial fat transfer consistency - why do some results look amazing and others are deforming?

Question

Why do some fat transfers look amazing and others are deforming? Is it all practitioner dependent? Patient retention? Luck?

Tim Neavin, MD · Answer

Fat transfer is an art.  Unnatural results often occur when fat is not injected into adjacent areas to "blend".  Most of the time when I perform fat transfer, I inject the entire face -- from chin to forehead.  You simply want to put the fat back to where it once was.  Fat is lost globally in the face, not just in discrete areas.

Mats Hagstrom, MD (license on probation) · Answer

There are two variables that determine liposuction and fat transfer results.
The first is patient candidacy and the second is the skill of the surgeon.
All other variables are fairly minor in comparison to those two single variables when it comes to delivering consistent quality results with both Liposuction and fat transfer.
Some individuals are inherently good candidates for Liposuction, some are good candidates for fat transfer and some may be good candidates for both, some for one and some for neither.An individual who is an excellent candidate for both Liposuction and fat transfer has the potential for having stunning results if the procedure is done by a sufficiently skilled and experience provider.
They also have the potential for having disfigurement if done by a provider who lacks sufficient skill and experience.
An individual who is not a good candidate for either Liposuction or fat transfer is never going to have a great result even in the hands of the best provider.
Understanding and determining candidacy is the scale and itself and a fairly complex topic..
For Liposuction it can be summarized by the three words “young, tight and pudgy”. Those are the characteristics that usually allow us to get great Liposuction results. The opposite is also true. For example older individuals will have skin laxity due to weight loss typically do not get good liposuction results.
For fat transfer technique is paramount but so is his candidacy. Candidacy for Fat transfer is fairly complex but one of the fundamental underlying principles is an understanding that in order for grafting of any kind of tissue to survive there must be sufficient post tissue to support the graft.
Grafted fed needs to be surrounded by live vascular tissue in order for it to survive. excessive grafting put in grafted fat next to grafted fat causes the grafted particles to undergo necrosis with increased graft failure.
Delivering consistent quality results with both of these procedures is more difficult than most people believe and this includes plastic surgeons.
Most plastic surgeons think they’re better at Liposuction and then they actually are.
The number of plastic surgeons who have truly mastered both liposuction and fat transfer is relatively few.
Both Liposuction and fat transfer should be considered permanent and irreversible procedures.
Both can leave people disfigured.
For this reason patients should be far more selective than they ever thought necessary in order to find the best providers.
To do this I recommend having multiple in person consultations with local board-certified plastic surgeons. Bring pictures of your own body the same way plastic surgeons take before and after pictures.
During each consultation ask each provider to open up their portfolio and show you their entire collection of before and after pictures for the procedure or areas you’re interested in having treated. ask providers to only show you before and after pictures of the previous patients will have similar body characteristics to your own. Bring printed copies of pictures of your own body to use for reference.
There’s no point in seeing a handful of preselected images representing the best results of a providers career done an individuals were perfect candidate if it doesn’t match your candidacy. There’s no point in seeing a handful of preselected images representing the best results of a providers career done an individuals were perfect candidate if it doesn’t match your candidacy.
The goal is to see what average results look like and get some kind of confirmation of how many of these procedures each provider has actually performed.
Ask providers to show you examples of excellent outcomes, average outcomes and outcomes that did not turn out as well as they had hoped.
Ask specifically what the revision rate and revision policy is.
Discuss all complications the surgeon has had with these procedures, how many and how they were managed.
For reference and experience surgeon should have no difficulty showing you at least 50 set a before and after pictures of commonly performed procedures. Experienced surgeons will in fact have hundreds or even thousands of before and after pictures of commonly performed procedures.
I suggest patients start by having at least five in person consultations and consider rescheduling more until they feel very comfortable they found the best provider.
Finally I recommend reading all reviews on various physician review websites paying close attention to providers justified negative reviews.
Confirm that many of the reviews were written regarding the procedure you’re interested in and pay careful attention to justify the negative reviews.
The absence of justified negative reviews is more important and more telling than having an abundance of positive reviews.
When in doubt slow down and schedule more consultations.
I do not believe you can properly vet plastic surgeons by having virtual consultations or using a computer or cell phone.
Finding the right provider is a monumental task that takes serious time and commitment.
Most patience do not put anything near the proper amount of effort in the process of properly vetting plastic surgeons or differentiating between scale and experience among different providers.
Most patience do not put anything near the proper amount of effort in the process of properly vetting plastic surgeons or differentiating between scale and experience among different providers.
To me personally I find it mind-boggling how many people have surgery having had only a single consultation.
On a final note fat transfer is somewhat unique in that results change drastically over time.
To understand what the actual results look like requires having absolute confirmation of the time frame one after pictures were taken in relationship to the date of surgery.
Early postoperative fat transfer pictures of remarkable but early results do not resemble final results by any stretch of the imagination.
Temptation lurks in the background and unfortunately some cannot resist posting early fat transfer pictures as “The result”. Personally I find that to be deceiving and bordering on an ethical but different providers have different standards. early results are after all at least true for that time. long-term results are generally very different than the early result when it comes to far transfer.
Best,
Mats Hagstrom MD

Richard P. Rand, MD, FACS (retired) · Answer

There are many factors that determine the results of facial fat transfer. Some are: the patient's own anatomy and skin texture, the patient's cooperation with post-procedure protocols, the technique used by the surgeon (both harvesting/processing and injecting), the surgeon's "eye" for what looks good, and the amount of fat that survises or "takes." And there are more than that as well. So, if you are concerned, better to start with dissolvabel fillers like HA products because if they don't please you, at least they will dissolve or can be dissolved.

Facial fat transfer consistency - why do some results look amazing and others are deforming?

Answers (3)

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