I Am 7 Weeks After my Full Face Fatgrafting and the Fat is Almost All Gone is This Normal?

It's common to feel as though the grafted fat is disappearing as the post-treatment facial swelling goes down. In my experience, it takes many months for the final fact grafting result to become evident. Studies show that the fat grafts continue to 'blossom" up to 18 months or so after surgery.

It is not uncommon for patient to feel that the injected fat is all gone after the initial swelling goes down.  I would suggest being patient and then evaluating the outcome, preferably comparing pre-op and post-op photos at 3-6 month.

There is no substitute for reviewing photos.  Unless your surgeon really did not put much volume in, there is no reason to believe that the fat is gone.  Generally 60-70% of the grafted fat survives.  However, what is true is that the swelling associated with the fat grafting disappears around this time frame creating the impression that the fat volume has disappeared.  It is for this reason that I am not a big fat transfer fan.  It is a set up to want more grafted fat.  By carefully reviewing the before and after photos and knowing where the fat was actually placed, it should be possible for your surgeon to demonstrate the volume from the grafted fat.

Unfortunately, fat grafting can be unpredictable as to its "take" or viability.  At this point, I don't think that you have had much take and the procedure will need to be repeated or you will need to consider another alternative like injectable fillers.

It's a little unusual for the fat to be completely gone in 7 weeks. Probably the swelling, which can be significant, is gone and it looks less volumized by comparison. However, fat grafting is very technique oriented. When done by someone experienced, the survival can be up to 70-80%. Fat must be harvested very tediously, prepared carefully and by specifically nd then inbjected by the smallest of amounts (like micro-droplets). Fat grafts must be small enough to aquire a blood supply fo rit to survive, and the smaller grafts have a much better chance.  Then the post operative swelling can be extreme for several weeks.

I have seen patients that have had fat grafts and virtually none survived and others who had faces much too full. One thing to keep in mind is that if the grafts are taken from the abdomen and the patient gains weight, the face can get very fat. Removing excess fat can be challenging.

E. Ronald Finger, MD

Savannah Plastic Surgeon

For fat grafting to truly represent 'grafting', the grafted tissue must gain a blood supply in its new location which provides a source of oxygen and nutrients and allows the tissue to persist indefinitely. If the grafted fat does not acquire a blood supply in the first few weeks after surgery, the body will gradually break it down and dissolve it, and no long-term benefit will be achieved in terms of soft tissue augmentation. Successful fat grafting surgery therefore requires a great deal of focus and attention to detail, to ensure that the fat which is harvested is viable tissue (i.e. not damaged by the harvesting process), and that the fat is delivered in such a way that the potential for ingrowth of blood vessels is maximal. If this process of blood vessel ingrowth (neovascularization) does not occur, then the injected tissue cannot truly be considered a 'graft' and is instead just another 'soft tissue filler' of limited duration.

 

The take of fat after injection into the face is both unpredictable and variable. I have seen results that range from complete loss of the fat to fat injection sites that actually have overgrown and need to be reduced later. My observation is what you see in most cases by three months is the amount of fat that has taken and survived. If your perception that by nearly two months after surgery all the fat is gone, then that is likely true. Is this a normal result?...yes it can be. Is is what everyone wanted?...no. 

Fat grafting like any other procedure will depend on the surgeon's skill and patient's tissue. We do not have access to your before picture,amount of fat grafting and your after picture. It would be impossible to make comments about the results. You need to discuss your concerns with your surgeon.

Although fat grafting is thought of as an ideal filler, as it is a patient`s own tissue, it can be somewhat unpredictable.  Viability of the fat cells is dependent on the tissue becoming revascularized and is probably  best done by multiple injections of small amounts of fat.  The procedure is very technique-dependent and is an area of significant interest and research in plastic surgery, presently. 

Fat graft to the face is very technique sensitive and experience matters.One should expect at least 60-80% of the fat to stay long long term. Review this with your surgeon and compare to the preoperative pictures.

Or consult another Board Certified Plastic Surgeon (American Board Of Plastic Surgery).