Will facial fat transfer results be impacted by type of anesthesia that is used? Are there benefits to using local or general?

Question

Do the results of facial fat transfer make a difference if one undergoes general as opposed to local in your opinion? Is going under worth it for the end result?

Mark G. Albert, MD, FACS · Answer

Hello,
Thank you for your question. I perform facial fat transfer awake under local anesthesia in my office. I perform it awake in 90% of cases and patients (and I) appreciate being able to do the procedure together – I stop periodically and ask patients to look in the mirror to evaluate whether they want more fat added; we also evaluate asymmetry, etc together. I wish you all the best.
Mark G. Albert, M.D., F.A.C.S.New York, NY and Boston, MA

Tim Neavin, MD · Answer

Great question.  I covered this topic in San Diego at the MAC meeting.  Yes, lidocaine can be toxic to adipocytes.  It is always best to have facial fat transfer performed under general anesthesia where little to no lidocaine is used in the harvesting process.

Zoran Potparic, MD · Answer

Depending of the area of treatment, availability of fat grafts harvest sites, patient preferrence, this procedure can be done in local, twilight or general anesthesia. It is best to discuss this with a board certified plastic surgeon with experience in facial fat transfer. Good luck.

George Orloff, MD, FACS · Answer

Facial fat transfer is a very common procedure. You could do a small area or you can do a large area. The decision between using local anesthetic or having general anesthesia is just a matter of how much is being performed.

David M. Kowalczyk, MD, MBA, FACS · Answer

Good evening! Great questions. Sometimes, with general anesthesia, we can be a little more “free” with how we inject the fat. Under local anesthetic, the results can also be quite nice, but we sometimes worry if we’re causing discomfort or pain. As for the outcome of the fat, I think either method works well. I would say that most of my patients prefer to undergo the procedure with local anesthesia from a cost and recovery perspective. Hopefully this is helpful for you!

Mats Hagstrom, MD (license on probation) · Answer

There are advantages and disadvantages of both. The major advantage of being put to sleep is that you will be comfortable and feel no pain during the procedure.
In regards to aesthetics the surgeon doesn’t have to worry about you being in pain and can focus all the efforts on the aesthetic procedure.
If doing this procedure with you awake all areas need to be numb and this may require using more local anesthesia which can temporarily distort your facial contours from the edema caused by injection local anesthetic. Most plastic surgeons will still inject local anesthesia even if the procedure is done under general anesthesia. The reason for this is to add a small amount of a vasoconstrictive drug which can reduce bleeding and hands reduce bruising afterwards.
There is no yes or no answer to your question. It depends on a multitude of variables. First and foremost how do you feel about having a wake surgery. The second is the skill and experience of your provider.
Keeping patients awake during surgery and comfortable and not causing pain is a skill with a learning curve.
Doctors who lack skills and experience or are impatient can make local anesthesia procedures potentially painful.
I highly recommend you let your doctor help you with this decision since he or she will be doing the procedure and knows firsthand what previous patients have experienced.
What you don’t want to do is choose local anesthesia if the surgeon always uses general anesthesia.
In those cases the surgeon will be lower on the learning curve of learning how to properly anesthetize the entire face. While this isn’t rocket science and any plastic surgeon can probably get the entire face anesthetized doing so without completely distorting what the person looks like is another story. Most people make a pre-operative plan of where and how much fat to inject so they should be able to follow that plan even if the contour is distorted from local anesthesia swelling.
Personally I’m not a big fan of facial fat transfer and believe the fillers are generally a better option.
Fat tends to be unpredictable and imprecise and unforgiving if not done to the patient’s liking.
Fillers are the complete opposite. They are extremely precise very predictable and extremely forgiving if the patient doesn’t like the outcome.
Once the fat is grafted it is very difficult or almost impossible to remove previously grafted fat in the face. Before considering this procedure you need to make sure you’ve selected one of the most talented and experience providers in your community. I personally would not consider having a procedure like this until I had interviewed with a substantial number of providers and vetted each one thoroughly to find out who has the most experience and gets the best overall average results.
I recommend patients do this by having exclusively in person consultations and lots of them.
During each consultation ask each provider to open up their portfolio and show you their entire collection of before and after pictures.
For a fat transfer it is imperative to know how far out the after pictures are taken from the date of surgery. Anybody showing you pictures that are less than three months from the date of surgery or showing you pictures that don’t represent what the actual final results will look like.
Early results can look very impressive but do not represent final results.
Confirming exactly how long after surgery the provider has taken the after pictures.
Look carefully at all before and after pictures to make sure the results look good. Being shown a handful of preselected pictures most likely representing the best results of the providers career is totally insufficient to get a clear understanding of what average results look like.
For that reason you should ask providers to open their portfolio and show you all of their results or at least as many as they’re willing to show you. I asked them to specifically show you examples of excellent outcomes, average outcomes and less than outcomes. I asked to see evidence of pictures For that reason you should ask providers to open their portfolio and show you all of their results or at least as many as they’re willing to show you. I asked them to specifically show you examples of excellent outcomes, average outcomes and less than outcomes. I asked to see evidence of patients who were unhappy with the results or patients who needed revisions.
The goal is to get the most accurate representation of what you would look like that this can’t be done if you’re only showing the providers best results.
You should also ask the provider to show you as many pictures as possible of patients with very similar facial characteristics to your own.
An experienced provider who does this procedure on a regular basis should have no difficulty showing you at least 50 sets of before and after pictures. Highly experienced surgeons will have hundreds or even thousands of before and after pictures.
Make a mental note and be familiar with facial fat transfer results can and should look like based in reviewing results on other doctors websites. If it looks too good to be true it may very well represent someone who took pictures early after the procedure though there are certainly providers to get stellar results long-term with this procedure. Personally I think it’s better to graft conservatively with the intention of having a few sessions of fat grafting gradually building up the volumes to the patients liking rather than getting it all done in one session.
Fat grafting is fickle and how graft survive is highly based on the available type and thickness of host tissue. The soft tissue layers in the face vary substantially in different anatomic areas and this varies how the fat or what percentage of the fat will survive in each area. This is what makes facial fat grafting imprecise and unpredictable.
Skill and experience can overcome much of this but it is not an easy procedure to perform well on a consistent basis.
Continue having consultations until you found someone who you feel quite confident pass the scale and experience to deliver a good outcome. The number of people posting on this website asking how previously grafted facial fat can be removed it’s not inconsequential.
Best,
Mats Hagstrom MD

Will facial fat transfer results be impacted by type of anesthesia that is used? Are there benefits to using local or general?

Answers (6)

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