Lumps after 2nd round of fat transfer to my calves? (Photos)

Question

I had my second round of fat transfer to my calves. First injection was unsuccessful as almost all of it was disappeared. After almost 2 years, it is the 10th day of the second round. But especially on my right leg, there are big lumps looking so ugly. It is also so hard it doesn't feel like a living tissue. I am also concerned about where they are as they are not on the inner side of my leg. The doctor opened up a new entry point and seems to me the fat is in the wrong places.

Ajaya Kashyap, MD · Answer

Thank-you for your question! The lumps you feel now could be because of some blood in the tissues or swelling in addition to devitalised fat. It is still early in the postoperative period . Your surgeon could suggest some measures like massages/ injections or ultrasound treatments that could help.  For now, please  discuss your concerns with your surgeon and follow his instructions. All the best

Daniel Barrett, MD · Answer

Dear Angel1ss,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Mats Hagstrom, MD (license on probation) · Answer

In order for fat grafting or fat transfer to be successful don’t have to be an abundance of host tissue. Grafting also has to be done in a technically correct manner and in volumes that represent what the host tissue can tolerate.
If there is no host tissue or if host tissue is insufficient and fat grafting will never work. 
Grafting ankles can be done in one of two ways. Drafting can be done using the subcutaneous fat layer as host tissue or the soleus and gastrocnemius muscles it’s nice to be done grafting into both muscle and subcutaneous fat.
Generally speaking The amount of fat that can be grafted should never be more than the amount of host tissue that’s currently present. In other words any attempt at doing more than doubling the volume will lead to significant increase in fat necrosis and loss of the graft.
For example if someone’s subcutaneous fat layer is 1/4 inch thick and you could attempt to graft about a quarter inch a fat through that tissue doubling it in its thickness during the procedure. The fat still has to be stratified and spread out as evenly possible for it to be successful but no more than a quarter inch of fat should be grafted during any one grafting session.
The best way I can describe this is using the analogy of a chessboard.
If the white squares represent grafted fat than the black squares represent host tissue. you know that for the procedure to work every white square has to be surrounded by black squares or the fat will die.
If too much fat is injected in one area or if there simply more grafted fat then there is host tissue increased fat necroses is expected.
Muscle is highly vascular and serves as excellent host tissue for fat grafting. Ratio with grafting into muscle is that muscles also have larger arteries and veins that supply them muscles are quite vascular tissues. In the path plastic surgeons used to routinely graft fat into the gluteus muscle as part of a procedure called the Brazilian butt lift or BBL for short. that substantial number of patients had serious complications with fat entering veins and at least in that anatomic area the great majority of plastic surgeons no longer graft in the gluteus muscle.For gluteal augmentation the majority of plastic surgeons in the United States no longer graft into the glute muscle. this is to minimize the chance of developing fat embolism‘s which are a very serious complication that can be fatal.
The amount of subcutaneous fat varies from person to person and varies between the buttocks and the leg. over grafting leads to graft failure and this is very predictable.
I’m curious how someone who learned firsthand the limitations of fat grafting would sign up to have the procedure done twice?
Of course times where building up volume is very important and because of the inherent limitations as series of operations which typically are done about six months apart. for example a woman with a cup breasts who want to have sea cup breasts cannot obtain that with a single round of fat transfer but could if she does it two or three times at six month intervals.
Early after fat grafting the grafted fat needs to establish a new blood supply. This process is one of three steps in the survival of tissue graft.
The steps are imbibition, inoscultstion and neovascularization. 
At 10 days you are in the neovascularization phase raft survival. that that’s successfully develops an ingred of capillaries will live and survive in its new location and the fact that fails to develop a successful in the growth of capillaries is dead or will soon die and become fat necrosis.
There’s nothing patients can do other than avoid pressure and immobilization. substantially more fat is Grafton then there is host tissue to support it the body ends up with an excessive inflammatory response to manage clearing out larger amounts of necrotic tissue.
Larger amounts of dead fat also breakdown and can liquefy into oil cyst. this whole process takes time and at this point there’s nothing you can do other than follow your doctor‘s instructions and give it time.
By six weeks you’ll have a good idea of what the results will look like though if there is a high percentage of fat necrosis it may take longer than that for the body to absorb the necrotic tissue.
It is much much too soon to judge results. I’m assuming you had a discussion with your surgeon during a consultation of exactly what areas will be grafted and if the fat would be grafted into subcutaneous fat, muscle or both etc.
By six weeks you should have a pretty good idea of what the results will look like.
If it procedure doesn’t work the first time then doing the same thing twice typically leads to the same type of results. Unless somethings done differently patients should not expect anything different than what happened the first time.
Best,
Mats Hagstrom MD

Lumps after 2nd round of fat transfer to my calves? (Photos)

Answers (3)

Recommended reading

Everything you need to know about Liposuction Revision

Our mission is to create a world where every investment in modern beauty is Worth It.

Lumps after 2nd round of fat transfer to my calves? (Photos)

Answers (3)

Browse related questions

Recommended reading

Everything you need to know about Liposuction Revision

Our mission is to create a world where every investment in modern beauty is Worth It.