How Can I Increase the Take Rate for a Fat Transfer?

Question

I recently had my third "touch up" for a fat transfer procedure where fat was injected into the tear trough areas under my eyes. In the past, the result has been great for a week or two, and then it goes away. Is there anything I can do as a patient (e.g., no alcohol consumption, avoiding movement in the area) to increase the survival rate or take rate of the fat transferred?

Thomas A. Lamperti, MD · Answer

There are several factors that can affect fat graft survival:

	
		Surgical technique. There is no one agreed upon method to properly perform fat transfer. There is a general consensus that the fat must be handled very gently, using minimal suction to harvest the fat. The fat must be isolated from any blood products, numbing medicine and ruptured fat cells. Some surgeons use a centrifuge whereas others use different methods. This is where finding a plastic surgeon who can show you photos of good long term (ideally 1+ years postoperative) results is very important. The specific details of the grafting process aren't quite as important as long as it leads to good long term results.
	
		Graft Volume. I find it very important to place the fat as a fine, three-dimensional lattice in order to maximize the surface area available for the new blood vessels to reach the fat grafts. If the fat is placed in too large a volume the blood vessels won't be able to reach the "core", leading to fat cell death.
	
		Excessive motion to the recipient site. This is what limits fat grafting results to the lips. They're so mobile that it is very difficult for the new blood supply to make it to the new fat cells. The tear trough area generally does very well in this regard as it is not mobile at all. I wouldn't do excessive massage or manipulation of the area, though.
	
		Smoking cigarettes. Cigarettes constrict the blood vessels of the face, limiting the blood supply to the new fat
	
		Age. Fat grafting doesn't take as well in patients who are in their 70s and older.


	I'm not sure how long you've waited between treatments, but it is important to realize that in my hands patients will have a perceived low point in their result about 6 months after the procedure (when the swelling has all dissipated). Then from 6 months to 18 months after the procedure the grafts will "take" and continue to blossom.

Benjamin Caughlin, MD, FACS · Answer

Most of the longevity is determined by the surgeon and their experience. Those of us that do a lot of fat transfer have used trial and error to try all of the techniques out there and we have found what works best in our hands. The goals of the patient are to keep the area safe. No trauma ( for instance no contact sports). Keep your weight stable. I make sure all my patients are at their ideal weight prior to the surgery. I had a patient yesterday that is trying to lose ten pounds so she is going to return in a few months when that is done. Smoking or anything that decreases the oxygen supply to the fat is a no no. This is includes things like skidiving, ocean diving, and high mountain climbing (again those of us that have done a lot have seen everything! Hope this helps.Best of luck,DrC

Ron Shelton, MD · Answer

The viability of fat cells after fat injections depends on how gently the fat is removed, the size of the fat particles, the manner in which the fat is treated, the recipient site's vascular supply, ensuring that the fat is not placed into an empty space without much blood flow, and that you do NOT smoke.

Jaime Perez, MD · Answer

Good results after fat transfer are obtained when the fat that is transferred survives.  If the fat that is transfered dies, the fat is reabsorbed or lost.

	
	The rate of fat survival after fat grafting depends on several factors:

	
	1.   HARVEST TECHNIQUE:  How the fat is harvested from the body and how the fat is injected in the desired area is important. Gentle technique using small liposuction canulas and low negative aspiration pressure to harvest the fat is shown to improve fat survival.

	
	2.  FAT PROCESSING:  Gentle processing of the fat after it is out of the body is also very important.  If the fat is centrifuged, it should be done at low RPM for a short period of time.  For example, 3000 RPM for 3 minutes is a preferred method.  The fat may also be allowed to separate from surrounding fluids by gravity suspension.   

	
	3.  FAT INJECTION:   Best results are obtained by injecting small amounts of fat with different passages in different layers of tissues.  This assures that each particle of fat injected is in close contact to available blood supply.

	
	4.  DONOR and RECIPIENT AREA:  Some studies suggest that some areas of the body are better fat donor sites than others.  For example, the abdomen and iliac rolls are thought to be excellent sources of fat while fat recipient sites adjacent to well-vascularized muscle are thought to be the ideal recipient area. 

	Massage to areas of fat transfer and alcohol compsuption have not been associated with increased or decreased fat survival.

	 

	Jaime Perez, M.D., Fat Transfer Specialist, Tampa, Florida

	Plastic Surgery Center of Tampa

Anthony Corrado, DO · Answer

There are many ways to improve the volume retention for fat grafting procedures. I would first suggest you find a surgeon with expert experience in the field. Fat grafting volume retention is dependent on many factors. First is the harvest technique. Atraumatic harvest is key to maintaining the viability of the injected cells. This involves low pressure syringe suction harvest, utilization of state of the art cannulas for harvest and injection, and limiting the manipulation of the grafts. Another important factor is the addition of substances to the fat graft to improve volume retention. The addition of Platelet Rich Plasma (PRP), a product of our own blood, will enhance the graft survival by providing large concentration of growth factors which stimulate cells within the fat. I wish you much luck.....Dr. Corrado

How Can I Increase the Take Rate for a Fat Transfer?

Answers (9)