Overfilling with Fat Injections

Do most doctors put in more fat than needed when doing fat injections? It seems like since a lot of the fat might not survive, you'd have to put in too much hoping it would go down eventually. I'm just wondering if this is a standard practice because it's the only thing that would explain some of the super overfilled faces I've seen on sites like this.

Doctor Answers 8

Fat Grafting - Too much of a good thing The photos will tell the story

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Fat grafting has certainly changed in the last decade or more. Twelve years ago, very few plastic surgeons were performing fat grafting. Often, the result of this style of plastic surgery was hollowed cheeks and upper eyelids. A look I still see surprisingly often today. However, patients wanted something more. The demand for surgery that didn't leave them looking hollowed an unnatural seemed to make fat grafting the new "darling" of plastic surgery. Problem is, fat grafting is a technique that requires specilized training, instrumentation, and meticulouis atention to detail on the part of a surgeon in order to perform fat grafting in a way that it is lasting, soft and natural looking. Some plastic surgeons are exceleent with fat grafting, they love the procedure and their results are conservative and very natural looking. Others are very heavy handed with fat grafting and do their patients more harm than good by over-filling their faces. 

As with any cosmetic surgical procedure, there can certainly be 'too much of a good thing'. Over-grafting of fatty tissue will distort facial features and produce unnatural proportions that look like surgery rather than appearing to turn back the clock. An important part of my preoperative evaluation is reviewing photographs with patients from their twenties and thirties (and from their forties for patients in their sixties and seventies). Such photographs are invaluable in confirming the manner in which a face has aged, and in planning a surgery that is designed to help a patient look more like their youthful self.

To get a sense of the aesthetic vision and results your surgeon achieves, view heir before and after gallery. Their should be a minimum of a dozen different patients each from three perspectives, fornt, side and oblique. They should be cropped similarly with similar lighting. The results will generally be somewhat consistent. Some results are quite filled-looking. This is overfilled in my opinion. Others look very natuiral and not like they have had plastic surgery at all. 

Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 121 reviews

We overcorrect fat injections by about 15%.

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This is an art more than a science, and individual technique matters a lot.  But in general, with excellent technique, 85% of fat injections may survive.  So one should not overcorrect by more than 15%.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Fat grafting (lipoinjection)

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Yes, there is an inherent unpredictable aspect ot fat grafting that is related to difficult with predicting fat survival with transfer. If I can provide a sample analogy. IF you want to start a plant from seeds, they typically ask you to place 2-3 seeds in a hole, because not all the seeds will germinate. The same goes for fat cells,

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

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Overfilling with fat injections

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I don't do much fat injecting anymore but those who do typically overfill knowing that a certain amount of the fat will be resorbed. The problem is that you don't know how much will survive or not and there are reports of the rare patient in whom all the fat "took" after being overfilled. Personally I find the temporary injectable fillers to be much more predictable because you don't need to guess and overfill and you don't need a surgical procedure to harvest he fat.

Fat transfer overfilling may require removal of excess

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With the new techniques in liposuction for fat transfer, the preperation of the fat and centrifuging fat, the risks of large amount of fat not taking is very small. Most of the fat will stay.

Overdoing the fat transfer: if all the fat takes then you need to remove the excess.

Doing the best technique and giving the fat chance for a good take is a much better approach.

Samir Shureih, MD
Baltimore Plastic Surgeon

Fat Grafting Results

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In short, yes. Surgeons do tend to place more fat than is needed in the area. This is because as the others explained to you, not all the fat takes and there is often a need to perform 1-2 more injections to get complete correction of the area of interest. This is because the fat take is unpredictable and we dont know how much of it will survive, but we do know not all of it will, no matter how much of an expert one things he or she is. So there is a tendency to overfill with the fat knowing that you will have resorbtion over time.

Generally whatever result you have at about 4-6 months is what you are going to have.

Farbod Esmailian, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 88 reviews


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obviously, every doctor is different but if the fat does not resorb then you have a problem. i personally get consistently excellent fat take. i also see that the real problem is that most doctors do not understand the long-term nature of fat transfer, i.e., after 3 months the fat cells shrink and after 6 months they start to grow and blend up until 2 years later. those who are putting fat in early again for a touch up at 3 months can have overfilled faces by 2 years. i only do fat transfer once in 95% of people and occasionally do a touch up only about 2 to 3 times a year, which i do not charge for. here are some links and videos to help you understand my philosophy.


sam lam

Sam Lam, MD, FACS
Dallas Facial Plastic Surgeon

Many plastic surgeons prefer fillers instead of fat

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I like Dr. Placik's analogy. It is quite true. Despite our best technique at fat harvesting and grafting fat, we are in effect planting a lot of space occupying duds who will not provide long term fullness.

Fat cells can be killed by the vacuum of suctioning when we get the fat. They can be destroyed when the fat is washed and processed to separate good fat from obviously dead fat. It can be destroyed by the pressure of the syringe implanting the fat in its new location and finally, if blood vessels are slow to feed the new grafted fat, some of it will die. For THESE reasons, many surgeons graft more fat than is needed (IE more seeds than will germinate) AND plan on several grafting procedures to reach the cosmetic goal.

For this reason, a lot of Plastic surgeons shy away from using fat for some areas where lumpy bumpy dead fat nodules are either visible and palpable, instead we resort to better 100% reliable fillers EVEN THOUGH they are temporary (10-12 months). These areas are the lower lid / cheek junction along the tear trough and the lips.

Peter A. Aldea, MD
Memphis Plastic 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.