Fat transfer, or fat grafting, involves moving fat from one part of the body to another. Fat is removed with liposuction and then injected into another part of the body. This adds volume and in many cases also improves the appearance of the overlying skin due to growth factors in the fat cells. Fat can be transferred in small quantities to the lips, cheeks, or areas of depression from scarring. It can also be transferred in larger quantities to increase the size of the breasts or buttocks.
How does it work?
When fat is removed from the body and re-implanted, it must grow new blood vessels in order to survive and become permanent. This takes a few weeks, and during that time, fat cells survive by oxygen and nutrients diffusing into the cell. This is why it’s important to be cautious about how fat is transferred and how the area is managed after the procedure. Transferring too much fat altogether or more than 1-2mL into the same exact spot might lead to death of the fat. Excess pressure on the area for more than 20 minutes after surgery can also lead to loss of fat. Usually, volume is just slowly lost. But sometimes, the fat can turn into oily cysts or hard lumps of scar tissue.
How does the fat behave over time?
By 6 months after the procedure, the fat that is present should permanently remain if there is no change in health or infection in the area. As a patient gains and loses weight, the new fat in the area will behave like the fat from the area where it was taken. So if you take fat from a “trouble spot” it will be less likely to be affected by weight loss, but it might be more affected than the surrounding area with weight gain. This is a careful consideration when deciding which areas to take and transfer fat.
Where can I transfer fat?
Fat can be transferred anywhere on the body. The most common areas our practice treats are the lips, breasts, and buttocks.
What are the risks?
There are multiple types of risks possible, and it depends on the amount and location of fat transfer. With small areas of fat transfer like the lips, the biggest risks are bruising, asymmetry, loss of fat, cyst or lump formation, and contour irregularities from liposuction in the “donor” area. Downtime can be less than a week depending on a person’s pain tolerance and activity level.
With larger amounts of fat transfer, the risk of fluid pockets (seromas) in the area of liposuction, loss of fat, cyst or lump formation, and risks of anesthesia apply. The downtime is extended to weeks instead of days, and compression garments and lymphatic massage treatments become essential to healthy recovery and good results.
Targeting Specific Areas
Some patients prefer the more permanent effects of fat transfer compared to filler. Obviously there is appeal to lasting results and benefits to the quality of the skin where the fat is injected. But fat can be permanent and can change with weight gain or loss, so it should be done carefully to avoid problems in the future. The most common type of fat we use in the face is referred to as Nanofat. This is fat that has been passed through multiple filters to break up the cells and release the growth factors. This stimulates the area to thicken collagen and smooth the overlying skin. Rather than add volume, it helps improve skin texture and plumpness.
Many patients like the idea of fat transfer to increase the size of the breasts, but usually a cup size is the maximum amount of increase in one surgery. I more commonly use fat in strategic areas (cleavage, areas of rippling, contour depressions) to enhance natural breasts or augmented breasts.
When fat is injected into the breasts, any fat that doesn’t survive can turn into a cyst or lump. Although there is no current evidence to show that this increases the risk of breast cancer, the presence of a new cyst, lump, scar tissue or calcification may require more imaging or even biopsy to rule out breast cancer.
Known as the “Brazilian Butt Lift”, transferring fat to the buttocks is is the most common type of fat transfer done in our practice. It is more likely to add size and shape to the buttocks than to effectively “lift” them, especially over time and with weight gain or loss. The results depend on how much excess skin there is to fill out, how strong the connective tissue is, how much fat is available for transfer, and the patient’s pre operative shape. Suctioning of fat around the buttocks can also help improve the shape dramatically, even if fat is not injected. These areas include the love handles, upper back, inner and outer thighs, and waistline.
The most common complication of fat transfer is loss of volume over time, but there can be some serious risks. If too much fat is injected or if it is placed incorrectly, this procedure could cause fat to be injected into the blood vessels, which can be fatal. If proper guidelines are followed regarding the amount and location of injected fat, the risks are minimal. This is why it is important to ensure that your surgeon or surgery center follows current guidelines from the ASPS (American Society of Plastic Surgery) and the AAAASF (American Association for Accreditation of Ambulatory Surgery Facilities).