Society’s relationship with fat is a curious thing, isn’t it? In certain places we cannot stand to have an extra inch of it, and in others, we grieve once it’s gone. Take our cheeks for instance: Google “How to make my face look thinner” and you’ll find more than 4 million entries with all kinds of slimming advice. But, once we hit a certain age and start to lose volume in our cheeks and midface, suddenly our fat becomes a hot commodity.
The same can be said for our bodies. While we may not want extra body fat around our waistlines, to reshape the breasts and butt, a little bit of fat can go a long way. This is where autologous fat transfers come in. Here, we explore how long this all-natural filler really lasts in all the places we actually want it to.
Fat Transfer Basics
A fat transfer involves taking fatty tissue from one part of the body and redistributing it to another. Think of a fat transfer as the Robin Hood procedure of the cosmetic world, stealing from fatty-rich areas of our bodies to give to the poor. “Simply put,” explains Miami plastic surgeon Sean Simon, MD, “fat is removed via liposuction from areas where it is unwanted, and then ‘harvested’ to be used to sculpt areas that may be deficient in volume.”
These are the areas most commonly injected with fat for youthful rejuvenation or to add volume. New York plastic surgeon William Lao, MD notes that in terms of what will absorb best, “facial fat grafts tend to have a higher take rate than transfers done on the body.”
Fat is considered an organic filler. “We can add fat in hollow areas like the temporal area, the cheeks, nasolabial folds, marionette lines, and sometimes the jawline,” says Houston plastic surgeon Henry A. Mentz, MD.
“Breast augmentation can be performed with natural fat transfer for a subtle increase in cup size,” notes Houston plastic surgeon Kriti Mohan, MD. “It can also be particularly helpful to correct mild breast asymmetry.”
Fat is effective for natural-looking hand rejuvenation, “especially in older patients when the fat has atrophied, leaving a skinny, veiny appearance with prominent tendons,” says Dr. Simon. Fat injected into the backs of the hands results in reduced skin laxity and barely visible superficial veins.
A Brazilian Butt Lift is a fat transfer to the butt. “It adds more fullness and you can also contour the outer hip, produce an hourglass shape and reduce the appearance of a hip dip,” explains Dr. Mohan. Although a popular surgery, Eugene, OR plastic surgeon Mark Jewell, MD says it’s also one that carries certain risks, including a high mortality rate from fat embolism.
These can include, “the abdomen or thighs to correct contour defects caused by previous surgeries, like liposuction, cancer removal or trauma,” says San Diego plastic surgeon Joseph L. Grzeskiewicz, MD.
“There are parts of the body that hold fat better,” says Dr. Mentz. “Basically I think the higher the circulation and movement, like around the mouth and lips, those are areas that the graft is less likely to take and more volume is necessary. Generally it’s about a 50 percent take rate, however around the mouth it’s probably more like 30 percent,” says the surgeon.
The amount of fat that stays in the body is highly dependent on patient anatomy, as well as the surgeon’s specific technique and experience. According to La Jolla, CA plastic surgeon, Robert Singer, MD, who has been performing and lecturing about fat transfers in the face since the ‘80s, “Generally, 30 to 50 percent of the injected will fat remain. Some patients will benefit from a second session.”
“Many patients who I have done fat grafting on for the face come back many years after with minimal fat loss,” explains Dr. Lao.
After about six months, the fat cells that remain should stay long-term. Dr. Grzeskiewicz notes that we should think of fat transfer as more of a regenerative process than a simple injection. “Don’t think about how long fat stays in the body in terms of a duration or how much stays in terms of a percentage or volume, because it does not appear to work that way,” he explains. “In addition to ‘adipocytes,’ or mature fat cells, fat also contains other important elements like stem cells, precursor or progenitor cells that eventually grow to become fully formed fat cells, fibroblasts, microscopic blood vessels and cells clinging to the walls of those, and the fibers themselves—all of which appear to play their own roles in this regenerative process.”
Findings reported in a recent study in Plastic and Reconstructive Surgery Global Open state that with fat transfer, the presence of new blood supply, cell growth, fiber content, and other things associated with fat is seen in the skin at around six months, and these changes appear to be longstanding. This means the injected fat continues to create new tissue growth after it has been injected, which appears to be living, normally functioning regenerated tissue.
“Although a fat transfer goes through a reabsorption process, the percentage of reabsorption can vary from patient to patient, procedure to procedure, and the location of the grafting,” adds Dr. Lao. “However, typically the remaining portion of fat transfer can last forever.”
New innovations give patients more options for how to transfer fat into a whole new spot.
Faking a Six-Pack
In procedures like high- definition liposuction, fat can be manipulated to create the appearance of muscle definition. “It is possible to use fat to perform 3-D etching on the abdomen and other areas in order to create a more toned and sculpted look,” explains Dr. Mohan.
Although not yet FDA- approved, some doctors incorporate platelet-rich plasma (PRP) into their fat transfers to help boost cell regeneration. “In addition to using power-assisted lipo to harvest fat, the fat can then be mixed with PRP, which allows for a better environment for survival of the transplanted fat cells,” says Dr. Simon.
Some devices and techniques allow doctors to break down fat into smaller portions to create “nanofat” injections. “We can then inject using a 30-gauge needle, which is the same size needle we use to inject Botox,” says Dr. Grzeskiewicz. According to Dr. Mentz, fat can help fix bra-strap indentations for patients with larger breasts: “I will often add fat to the grooved areas to give the shoulders a more slender and feminine appearance. This helps has helped my patients feel more confident in their clothing.”