Fat grafting CAN be permanent. It is important that a plastic surgeon not over-correct. Achieving survival of grafted fat requires appropriate instrumentation, meticulous surgical technique, and a willingness on the part of the surgeon to put a significant amount of time and effort into mastering the procedure. The fat must be harvested in a manner which ensures fat viability, and it must be grafted in a manner that permits revascularization (i.e. blood supply) of the grafted tissue.Areas that already have some soft tissue fullness, such as the cheeks, are relatively easy to expand with grafted fat, as a robust ‘scaffolding’ exists to hold the grafted fat. Thinner areas are more challenging: the temples, the lower lid / cheek junction, the nasal dorsum; these areas frequently require more than one fat grafting procedure to achieve the desired degree of volume enhancement. One can only add but so much fat in a single treatment when the ‘scaffolding’ is limited.There really are no ‘shortcuts’ that a surgeon can take when performing fat grafting surgery. Every step in the process must be performed with great attention to detail. Make sure that the surgeon you choose provides some description of their fat grafting technique, provides some indication of their level of experience with fat grafting, and demonstrates to you a high level of success in terms of fat survival and natural-appearing results as represented by ‘before and after’ photography.Look at photographic examples of the doctor’s work and decide if the aesthetic ideal is consistent with your own.A link to my fat grafting gallery is below.Make sure that the ‘before’ and the ‘after’ images have the same perspective, the same lighting, and the same amount of make-up applied. ‘Before’ photos taken in the early morning (and without any makeup applied) placed next to ‘after’ photos taken later in the day and in full makeup are meaningless for the evaluation of a surgical result. fat grafting is a procedure in which small amounts (less than 0.1 cc at a time) of fat are carefully introduced in a series of discrete layers to gradually 'build' new soft tissue structure. As there is space between each micrograft, new blood vessels are able to grow into the grafted fat, allowing it to persist indefinitely. If this process of blood vessel ingrowth (neovascularization) does not occur, then the transferred fat cannot truly be considered a 'graft' and is instead just another temporary 'soft tissue filler' that is broken down and reabsorbed over several weeks. Fat grafting requires specialized training and specialized surgical instruments, as well as patience and meticulous attention to detail on the part of the surgeon. When performed properly, permanent and natural-appearing aesthetic enhancements can be achieved. However, some fat will be reabsorbed. Therefore, I do let my patients know that it is possible that they may want a "touch up" fat grafting procedure at some point in the future. The price for possible follow up treatments are carefully outlined prior to the initial surgical procedure.Some plastic surgeons elect to over-fill faces with fat, knowing that some fat will be reabsorbed. The problem is we can't predict exactly how much fat will be reabsorbed and sometimes patients can have a very unnatural looking result This result could be a prolonged healing period where a patient feels uncomfortable being seen in public for months. Worse, this result can be permanent. It is very important to view many many before and after photos of fat grafting. View photos of patients weeks after surgery, and patients years after surgery.
