Fat composition or BMI - which is the best indicator of whether there's enough fat to harvest?

Question

I've seen websites where surgeons refer to BMI as an indicator of whether there's enough fat to harvest. I have a BMI of 20.5 (height: 5 feet 6 inches, weight 127) but have rolls of belly fat. No loose skin, never been pregnant. Is a caliper test a better indicator of whether I have enough fat to harvest?

Connie Hiers, MD, FACS · Answer

An examination is the best test since many consider skin rolls actual fat instead of just skin. You need an examination to be sure.

Darryl J. Blinski, MD · Answer

You left out "experience" of the surgeon. At a BMI under 21! You have VERY VERY limited donor fat to use in fat transfer. Since you did not post photos very hard to advise if you are even a candidate for the SKINNY BBL.....

Mats Hagstrom, MD (license on probation) · Answer

I’m a board-certified plastic surgeon who’s been practicing for well over 20 years. about mid career I began specializing my practice exclusively and only liposuction and fat transfer procedures. I began doing fat transfer procedures as a resident in the 1990s. I’ve done over 8000 liposuction and fat transfer procedures.
Delivering consistent quality liposuction and fat transfer results is far more difficult than most people believe in this definitely includes plastic surgeons. most plastic surgeons are not as good at these procedures as they think.
There are a few situations that now challenge me or where I feel there may be uncertainty in the outcome. Year after year my results became more and more predictable and I became better and better at determining and knowing exactly what each person‘s results would look like based on their individual candidacy for the procedure.
Both technically doing liposuction well and the ability to accurately assess patients has taken decades to get good at. Still to this date the one thing that has more variation than anything else is the amount of fat that can be removed from thin people. for years I wanted to design an ultrasound device we could use to measure Liposuction results by actually getting objective criteria of exactly how much fat had been removed and use this to help maximize ideal income and use it as a both physician and patient educational device.
While it was a good idea it never materialized.
Calipers is probably more accurate and my preferred way of assessing patients is simply by examining them. Personally I don’t like assessing Fattic this by folding and pinching the fat because you get two layers of skin and two layers of fat in doing so. Instead I put the skin under gentle tension and with the tip of my finger very gently push against the skin until I feel the muscle wall underneath. it’s simply how I personally assess and teach my patients to assess the thickness of their subcutaneous fat. The thickness of fat is only one variable. The second variable that determines the third dimension is the area treated. Generally speaking for Loby of my patients or patient who may not have enough fat for a fat transfer the best option is not gain weight but rather to include more areas with Liposuction until you have enough fat to do the procedure.
Before you even go there I have to emphasize The importance and how few surgeons can do this procedure well. you need to find someone who is on top of their game for both Liposuction and fed transfer and you need to absolutely confirm this.
Once you find the right provider you can then work with them in regards to your candidacy for the procedure.
Defined the best providers patients will need to have a multitude of consultations. It’s not possible to find the providers from home using your computer.
It requires having multiple in person consultations.
It’s time consuming and requires a substantial effort.
The price people pay for not properly vetting their plastic surgeon has too many times lead to being disfigured for a lifetime from the date of the procedure forward so I encourage everyone to put in the effort and thoroughly vet as many surgeons as it takes to find the right one.
During in person consultations ask each provider to open up their portfolio of before and after pictures and show their entire portfolio.
Simply being shown a handful of sample pictures which most likely represent the best results of their career is completely insufficient to get a clear understanding of what average results look like in the hands of each providers. When it comes to fat transfer there’s an entire whole Nother dimension that needs to be taken into consideration and that is timing of after pictures. fat transfer results especially of the breast can look incredibly impressive early after the procedure but these swollen results before the fat has resorbed Do not at all represent our final results look like. We need to confirm specifically how far out after pictures are taken. If you see anyone showing you pictures with postoperative results with patients in the operating room in the recovery area or with surgical markings or any form of bruising or evidence of just having had surgery and then simply eliminate that provider as a potential provider for you immediately.
Showing these type of pictures is a complete bait and switch. It’s on ethical anything appropriate unless the surgeon is simply using the pictures to explain how much the area treated with a fat transfer shrinks over time. After pictures should be taken a minimum of 3 to 6 months after surgery.
Ask providers to show as many pictures as possible a patients with similar body characteristics to you. You should also ask the providers to show it examples of excellent outcomes, average outcomes and some of the worst outcomes.
Ask how many people have had revisions and I asked to see pictures of the patients who got revisions.
If anybody had two rounds of fat transfer asked to see those pictures.
Bring pictures of your own torso and your own breasts with you so you can compare side-by-side and find other patients who look just like you do. Try and remember what you look like without a picture of yourself at hand isn’t as good.
I would say an experienced provider should have no difficulty showing you at least 50 sets of before and after pictures of procedures like breast fat transfer. Highly experienced surgeons will have hundreds or even thousands of procedures that they perform frequently. well the fat transfer results may be your primary purpose for having the procedure to Liposuction whether it’s important to you or not is equally as important to review and assess the surgeon for. When things go wrong with breast fed transfer it is often the harvesting of fat or liposuction that goes wrong leaving people with an irreversible problem.
When reviewing before and after pictures asked to see all areas treated with Liposuction. While reviewing those pictures asked the surgeons to point out what areas were treated and what areas were not treated and look carefully at transition zones between treated and untreated areas for liposuction.
Look at all areas treated with Liposuction very carefully to make sure there are no skin contour irregularities on any area in any picture.
If surgeons are reluctant to open up their portfolio and simply keep referring to their pre-made sales reference pictures and tell them that you’re making your decision based on the surgeon that has the most experience and that needs to be proven by showing you the most number of pictures. Let them know how many doctors you’re consulting with and that one of the major determining factors is there collection of before and after pictures. 
On the wrong surgeons aren’t going to do this for you. You will have to push them and ask. In my opinion it’s totally appropriate and patience should be advocates for themselves and demand to see as many pictures as possible. Those who don’t I’m not properly vetting their provider which must be done to minimize the chance of a negative outcome.
Like I said earlier delivering consistent quality liposuction and fat transfer results is far more difficult than most people believe. Most plastic surgeons are not particularly good at either one of them.
You’ll find that the more experience the surgeon has the more confident they will be in specifically assessing how much fat can be removed from each area. For most women the go to area is treating the torso. Some women are bottom heavy and the lower extremities may be a better area to harvest fat from. Wherever you carry your fat that’s the place to take it. One of my more recent cases was a thin woman who wanted double breast fat transfer done six months apart. The first case we did circumferencial thigh liposuction with fat transfer to the breast. Six months later I did liposuction of her entire torso and upper extremities and grafted even more fat during the second procedure. Her outcome is hands-down the best fat transfer outcome to my career. I wish I could post pictures and the response to show you what a good outcome can look like but real self sets limitations for including pictures.
I don’t know how many consultations patients need to have to find the right provider. I recommend starting with at least five but to really find the best provider you may need to have 15 or more consultations.
I recognize this is a major effort but the consequence of choosing a surgeon who is not on top of their game for this procedure is potentially leaving patients as disfigured victims.
Lastly I recommend reading all reviews on all major physician review websites paying close attention to justified negative reviews.
The absence of justified negative reviews is far more important and more telling then having an abundance of positive reviews.
We all get one or two people who aren’t happy but providers regardless of how many positive reviews they have who have any significant number of justified negative reviews needs to be avoided.
Based on your numbers you are definitely at the verge of someone who would be challenging to treat but it’s pretty rare that someone doesn’t have enough body fat that we can’t get an impressive result if they’re willing to have enough areas treated.
I view the torso as a single anatomic unit whenever doing liposuction of the torso achieve the entire torso. This means upper abdomen, lower abdomen, potentially pubic area, love handles, waist and the entire dorsal backside and under arm area all the way to the side of the breast and up through the front bra roll. 
By doing liposuction all the way to the transition line between the breast and the torso enhances the fat transfer results.
There is no formula that you can use. In the end it’s a subjective assessment based on an examination by highly experienced providers.
You need to have a bunch of consuls anyway so why not start scheduling them.
I recommend patients not travel long distances for elective surgical procedures. Depending on where someone lives traveling may be inevitable. When traveling and try to keep distances within something that’s reasonable so you can drive it for the consultation and your postop visits.
Do not focus your effort on anybody who claims that any type of equipment is superior to other forms of Liposuction. This is just confusing sales gibberish and it is irrelevant.
The only thing that matters is the skill and experience of the provider combined with the candidacy of the patient.
Find the right provider and everything falls into place.
Best,
Mats Hagstrom MD

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