Will fat transfer see an increase in volume after 3 months?

Question

I would like to hear opinions on the timeline of a facial fat transfer. I have heard that the initial volume achieved by the graft will go down after 3 months (due to decreased swelling + transferred fat dying). Some doctors say that the volume will reach its lowest point at 3 months, but then may see an increase in volume again due to vascularization after 6 months. In your experience, does this "second" volume increase happen?

Jonathan Kulbersh, MD · Answer

Thank you for your question. The current scientific estimate is that approximately 25-50% of the transferred fat will survive. To counteract this absorption, it is common practice to inject more fat cells than necessary. This may initially produce a swollen appearance that will gradually decrease in fullness over the next few weeks or months. Typically, there is no increase in volume after this time.

I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon. They will be able to answer any questions you have and determine the best approach to help you achieve your aesthetic goals.

I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon. They will be able to answer any questions you have and determine the best approach to help you achieve your aesthetic goals.

John Reilly, MD, FACS · Answer

Hello, I believe It would be unusual to see an increase in volume after three months. No reasonable physiologic or anatomic explanation exists.

Mats Hagstrom, MD (license on probation) · Answer

The second volume you are referring to does not happen. Grafted tissue will either reestablish a blood supply or not and this happens within the first week. Tissue cannot maintain viability without having a continuous source of oxygen and nutrients through the blood supply for more than a few days. The decrease in volume as seen after a fat transfer, represents the reduction in tissue size from swelling and the absorption of necrotic tissue. By six weeks patient can begin to see what the results will look like in by three months results are final or very close to final. The amount of time it takes to see your final results. Depends on what type of procedure and the volumes of fat injected.
There is no long-term increase in volume unless the patient gains weight.
Facial fat transfer is not an easy procedure to master. The procedure has inherent unpredictability lacks precision, and can be unforgiving if the results don’t turn out well. Grafting fat is dependent on sufficient volumes of host tissue to support the graph the tissue. The thickness of host tissue varies dramatically throughout the face, especially around the orbits where host tissue is at a premium and often very thin. Knowing how much fat can be grafted in a single session and taking the available post tissue into consideration to get consistent quality results requires years of experience with a total commitment to mastering the procedure. The number of providers who can get consistent quality results with very few patients needing revision surgery is small. 
For these reasons, I recommend most patients stick with fillers, because fillers are inherently superior to fat grafting for facial volume augmentation.
Patience for fat transfer should have a clear understanding of the inherent nature of the procedure, including the high degree of variation in outcomes especially when done by average or inexperienced providers.
Once fat is grafted weather in survives becomes palpable or visible fat necrosis it is difficult to remove.
Best,
Mats Hagstrom, MD

Will fat transfer see an increase in volume after 3 months?

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