Fat Grafting Result: Is this Final or Not?

Question

I had facial fat grafting 3 months ago (30cc of purified fat transferred to temples and cheeks). My doctor said it was a substantial amount as I asked for more, but just to confirm: 1) Is 30cc a "standard" amount to transfer to face or on the high side? I'm trying to gauge whether I should repeat the procedure. 2) At 3 months will I lose even more fat, or are these results permanent? I'm worried I'll lose more. Thanks.

Timothy R. Miller, MD · Answer

No.The final result is seldom seen after three months.  Recent studies (and clinical experience) have demonstrated that the volume of transferred fat continues to stabilize and improve even after a year from the procedure.  The initial volume loss you see (e.g., the first few months) is largely from swelling and the resolution of the swelling is sometimes mistaken by patients for the loss of fat cells.The amount of fat that can be safely transferred and survive (and without contour problems) is limited per treatment and varies per patient and by technique.  The amount of 30 cc may be an appropriate amount for some patients and not enough for others.  Additionally, adding more fat is an option one year from the initial procedure (earlier in some cases). The attached link provides more information.I hope this helps.

Christian A. Prada, MD, FACS · Answer

In general about 40% of the fat injected survives long term. Some will quote more, but in general after years of doing this I find this to be pretty accurate. I also find that at 3-4 months most of what you see is what will be there long term. I do quote a 50% chance of a secondary procedure to add more fat. Think of the procedure like sculpting a clay model. You don't just slap a large chunk in any one area, but rather add a little here and there to get a natural, smooth and symmetric result. In many cases you add more as you see how it looks.

Jin-Sung Kim, MD · Answer

Hello, Thank you for your inquiry. Normally, when I operate a fat grafting surgery, I highly recommend patients second retouch-up due to the rate for survival of fat. Eventhough the amount of fat is seemed to be enough at the first time of injection, there would be probable to be remained around only 20-30% as time goes by. That is the reason that most of patients want to have second retouch-up. I recommend you that checking a balanced fat and comparing photos between before and after. Thank YouDr.Kim Jin-Sung

Michael Law, MD · Answer

Sometimes people do require follow up fat grafting touch up procedures. At three months, you should have a fairly good idea about how much fat will remain, but too soon to have more fat added.  Your plastic surgeon should have many photos to share which, in addition to before images, should include three months after fat grafting, six months after fat grafting and a year or more after fat grafting.Plastic surgeons who perform a lot of fat grafting will include a quote for fat grafting follow up procedures, if needed, so that patients are prepared for what they might expect in the future. I perform fat grafting almost every day I operate. It is impossible to determine exactly how much fat will survive. It is critical NOT to over-correct.

Anna I. Wooten, MD, FACS · Answer

The amount of fat needed in the temples and for cheek plumping varies patient to patient.  This is guided by how much deflation has occurred.  Usually 70% survives long term, meaning after 3-4 months.  When you decide to do this, one must recognize that usually a second treatment will be needed.  This is something that needs to be tweaked in more than one injection to achieve the desired result.  The surgeon will use more of a feathering technique, rather than just pushing the fat into the area in a hurried fashion.  It is often best to see how it looks after the absorption is completed in that 3-4 month period and then add more fat if needed.  I hope this has helped you.  Best of luck.

Steven Wallach, MD · Answer

30 cc's is a lot of rose patients and minimal for others.  It really depends upon your goals, and the amount of deflation you have.   Best to ask your surgeon.

Alyson Wells, MD, FACS · Answer

The amount of fat grafting needed in any particular patient to plump up the hollow areas at the temples and give fullness to the cheeks can vary.  The amount that eventually survives and becomes permanent can also vary from person to person and can be somewhat unpredictable.  Without seeing pre-operative photographs, it is difficult to speak in any terms other than general ones.  30 cc of fat transferred into just these areas is a robust amount--I have transferred more and less.  With proper harvesting, processing, and injecting technique, I would estimate that 70% or more of the fat persists long-term.  I also believe that application of ice to the areas post-operatively will decrease the amount of fat that persist.  At 3 months, I would not expect further loss of fat.  Some patients do need a second treatment.  Speak with your plastic surgeon about the possibility of a second procedure and the optimal timing.  Best wishes!

R. Stephen Mulholland, MD (retired) · Answer

Dear Anonymous59,

Transplantation of micro fat grafting of the face is an
excellent clinical option for those suffering from volume loss and/or
asymmetry.  Fat grafting to the temple
supraorbital buttress and for orbital buttress, mid face, cheekbones, jaw line,
even lips and nose can be excellent options. 
Depending on the number of treated areas will determine the amount of
fat injected.  I’ve been doing fat
grafting of the face for almost 20 years and the average amount of fat injected
is usually in the order of 20-40 CCs. 
Depending on the technique deployed between 30% and 70% of the fat
grafts will pick up a blood supply and survive. 
I always recommend to patients that a second fat grafting enhancement
session is often needed at one year to create optimal volumes and shapes.

It is too early to tell how much “take” you’ll have from a
fat grafting session until approximately 3 months.  It has been my experience that at 3 months
the amount of fat that is present has survived to contribute to shape and
volume will persist.

It is important to remember that the normal aging process is
catabolic, there is a natural breakdown process for facial fat and this
continues well into the 60s and 70s and will contribute to progressive loss of
the fat used in more youthful years.

I hope this information has been of some assistance and best
of luck.

For more information, please review the link below.

R. Stephen Mulholland, M.D.

Certified Plastic Surgeon

Yorkville, Toronto

Windell C. Davis-Boutte, MD (license suspended) · Answer

Well, without an idea of how much volume loss you have undergone in the temple and cheek areas, it is difficult to answer your question. I use anywhere from 30cc to 70cc, depending on the patient, and the desired result. I do find that, about 75-80% of fat transferred survives in the facial areas.  Usually by 3 to 4 months, the patient will see end results. At this point, we sit together to discuss additional options if more volume is desired.  It is best not to be overzealous.Much Success!Windell Davis Boutte, MD

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