Is fat necrosis guaranteed with facial fat transfer?

Question

I understand that the transferred fat that does not survive is absorbed by the body, and that fat necrosis can occur when the fat cells die, forming a lump. So what would cause the dead fat cells to form a lump (necrosis) instead of being absorbed and going away? And how do you know the difference between a fat necrosis lump and a regular living fat lump?

Jason Emer, MD · Answer

fat grafting should have a smooth result despite if it survives or not.  consider adding PRP, Sculptra, a cell or Renuva to continue the viability.  Best, Dr. Emer.

Daniel Barrett, MD · Answer

Dear janay_smith,
in most cases 30-50% of fat is lost after some time. Fat viability depends a lot of surgeon technique. The fat has to be placed back into the buttocks as soon as possible so that it has a greater chance of survival. It has to be placed carefully so that not too much fat is placed in only one area.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Patrick Flaharty, MD FAACS · Answer

Fat transfer is very technique dependent. With good technique lumps are rare. Most lumps are caused by putting too much fat in one area (bad technique) and are avoidable by placing very small grafts distributed over a larger area. Good technique requires time, patience and experience. When fat cells die, which does happen to a percentage of the fat cells which are implanted, they are generally absorbed by the body and do not cause lumps or bumps. If you are considering fat grafting I recommend you consult with a surgeon with extensive experience in facial fat grafting as experience makes all the different with this procedure.

Mats Hagstrom, MD (license on probation) · Answer

The lack of host tissue in combination with grafting too much fat in a single area is probably the primary reason people develop palpable lumps from fat transfer rather than having the fat absorbed.
This happens in thin areas like around the eyes for example.
The lack of host tissue limits the potential survivability of grafted fat and is unforgiving for the residual scar tissue and necrotic fat.
When good technique is used in patients who are good candidates this undesirable outcome is minimized. Grafting conservatively may mean that someone may need to undergo a few sessions of fat transfer to finally get the ideal outcome.
I suggest having a few in person consultations. 
Best, 
Mats Hagstrom,MD

Robert T. Buchanan, MD (retired) · Answer

The main reason that there are so many problems after fat grafting is that many of the people doing the grafting do not understand what they are doing and do fat grafting like they were doing an off the shelf filler. With the latter, it doesn't matter if you place a large amount in one place. It doesn't need any blood supply to work and, in fact, the more you hide it from the blood supply, the longer it lasts. Fat, however, requires a blood supply in close apposition to stay alive and then grow. If you put too much in that is away from the circulation, it dies. This is even so for using a large bore canula. The fat in the center of the line of injected fat is too far away from the blood supply and it dies. An expert will understand all this and generally gets around 80% take and rarely any lumps.

Is fat necrosis guaranteed with facial fat transfer?

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