Why didn't the fat stay from my two facial fat transfers?

Question

I got a facial fat transfer, and almost immediately I liked the results before much swelling started. The swelling subsided and time passed, and I felt like all of the fat had resorbed and I was back at square one. I had the procedure preformed a 2nd time. Again, at first it looks nice and full and youthful, but given some time all or most of the fat resorbs. why is this? is it my particular fat cells? is it my doctor's technique? what could possible be done with better results next time?

Sultan Hassan, MD, FRCS(Plast) · Answer

thank you for your question with regards to fat survivability following a facial fat transfer. Fat survival depends on many patient related factors as well as surgical factors. it is best to have a full consultation with an accredited plastic surgeon. Fat survival rates vary from 30 - 85% at 3 months postoperative. i always advise my patients that fat transfer is best considered to be a staged operation, where to achieve the best results, more than 1 operation is likely.

Jason Emer, MD · Answer

Fat transfer results are very technique dependent, however they are unpredictable.  I would suggest going to an expert for harvesting and transfer and consider having PRP added to the fat before reinjection.  In my hands this has been shown to increase the survivability of the fat, along with water-assisted removal/harvesting.  I suggest making an appointment with an expert.  Best, Dr. Emer.

Michael Law, MD · Answer

Always be careful as you select a surgeon as fat grafting, specifically fat grafting of the eye area requires specialized instrumentation, surgical expertise, experience and patience on the part of a surgeon. One way to get a sense of a surgepon's ability to provide permamnet results is to look at their before and after photos. Fat grafting has become very poular and physicians wihtout appropriate training and instrumentation are providing less than ideal result.  View dozens of before and after photgraphs of fat grafting that are appealing to you before considering a fat grafting surgery. The survival of grafted fat is variable from procedure to procedure.  As it is essentially impossible to quantify the survival of grafted fat as a percentage of the total amount of fat that was transferred, I instead tend to look at it in terms of what percentage of the overall improvement (that is seen early postoperatively) is still persistent at four months postop.  If it's still there at four months, then it has a blood supply and will persist long-term. In my experience, most patients show a 50-80% persistence of the early improvement at four months.  If less than 50% of the improvement has persisted, most patients need and want a secondary fat grafting procedure.  We perform such fat grafting 'touchup' procedures at a significantly reduced cost compared to the initial procedure, and patients are advised of the potential expense before they have their initial surgery.  Another way to look at this issue is to ask 'what percentage of patients require a secondary fat grafting procedure in order to get the result they are looking for?'.  Because my approach to fat grafting is conservative, I have a fairly high number of patients who return for a second procedure.  I would much prefer to have a patient like what they get and return for more, than to have a patient who is unhappy because they feel that their fatgrafting was overdone.   If you look at reviews posted by fat grafting patients who have had a very negative experience with the procedure, you find an abundance of patients that feel that an excessive amount of fat was placed in their face.  They're not just unhappy - they feel disfigured.  So a conservative approach is absolutely critical to success with facial rejuvenation by means of structural fat grafting.  To be worth a patient's time and money, fatgrafting needs to look natural, and not like a trip to the operating room.

Patrick L. Basile, MD · Answer

Thank you for the question. Fat resorption after transfer is very common, but the percentage varies person to person. Some patients lose a little and others more. I tell my patients that the average loss is about 20-30% but this can vary widely. Technique is important, but really it is only a component of success. The fact that you had two transfers that were both fully absorbed leads me to believe that this may not be the best procedure for you. You could try another provider, but the chance of success is probably lower than someone who has not had an issue already.

Frederic H. Corbin, MD (license restricted) · Answer

Thank you for your question and all surgical results are dependent on four things;  1) appropriate planning, 2) appropriate execution, 3) the patient following instructions and 4) Mother Nature being kind.  If the first three were executed appropriately then mother nature just wasn't kind.Dr. Corbin

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