A Guide to Fat-Transfer Procedures: How They Work and What to Expect

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It’s ironic that procedures like buccal fat removal and chin liposuction have taken off in recent years. It’s almost as if any small offensive pockets of fat cannot be kept around. However, there comes a time when we may want that precious fat, just somewhere else. Whether to plump, enlarge, contour or rejuvenate, fat is a hot commodity and a natural filler. 

Fat transfer, also known as fat grafting, is a procedure in which fat is taken from one area of the body and transferred to another area to enhance or restore volume. “Fat is generally used as a facial filler, for augmentation of the breasts, or for gluteal or buttock augmentation,” says New York plastic surgeon Aviva Preminger, MD.  

It can also be used to enhance the hands and other areas of the body. Pittsburgh, PA plastic surgeon Simona V. Pautler, MD says, “Since it’s made from your own natural adipose tissue, it’s a really good option for reshaping and improving the face, body, breasts and butt.”

How Fat Transfers Work

Before we can add, we must first take some away. First, the fat is harvested via liposuction from a donor site on the body, such as the abdomen, hips, or thighs. “It’s the best natural filler that we have,” says Houston, TX plastic surgeon Erica Bartlett, MD. “It’s abundant, even on very thin people. I prefer to take the fat from the inner thigh because it has the most robust stem cells of all the potential donor sites.”

“Then, the extracted fat is processed and purified to remove any impurities and excess fluids,” says Houston, TX plastic surgeon Olga Bachilo, MD. The purified fat is then carefully injected into the area in need of volume using a small needle or cannula. “I’ll use smaller needles when I need to be more precise, like 1cc or 10cc syringes. On occasion I may use a pump when I need to do a larger area, like the buttocks, where a larger amount of fat is needed.”

Fat Transfer and Breasts

For breast reshaping, fat is not as predictable for holding shape as an implant, but it’s often used as an alternative or add on. “I often combine fat and implants to create the most natural-looking results. Fat can help camouflage the visibility of the implant and creates more upper pole fullness,” says Dr. Preminger. 

Fat Transfer Risks

One of the biggest aesthetic concerns with fat transfers is overcorrection or undercorrection. This means placing too much or too little fat. “I never want to overfill in the area because if I have a very high survival rate, I don’t want to make an area too bulky,” says Dr. Bachilo.

In rare cases, fat can enter the bloodstream and cause a blockage in a blood vessel called a fat embolism, which can be life-threatening. “Brazilian Butt Lifts have the highest mortality rate of any plastic surgery procedure because of the risk of injecting fat into the blood stream. What we’ve learned is if we don’t inject into the gluteal muscle, then we lessen the risk,” says Dr. Bartlett. “For surgeons practicing BBL surgery, the recommendation is to inject the subcutaneous fat above the muscle so your risk of having that embolism is very low.”

Post-Op Care

After the procedure, the patient may experience some swelling, bruising, and discomfort at both the donor and injection sites. Depending on the treatment area, compression garments may be recommended, and the patient may have to avoid strenuous physical activity for several weeks. “Recovery and downtime generally depend on the amount of liposuction performed and the amount of fat injected,” explains Dr. Preminger. “For gluteal augmentation, post-operative instructions generally include avoiding continued pressure on the area for a few weeks.”

What to Expect

The results of fat transfer procedures can be long-lasting, but some degree of fat absorption may occur over time. Patients may need additional treatments to maintain their desired results. “The fat survival rates depend on the technique used for injection but also where on the body it is being injected,” explains Dr. Bachilo. “In the more vascular areas of the face, we get a pretty high percent of survival. In some areas of the body where there is not as much blood supply, those rates may be lower.” 

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