Fat Grafting (Body)
Overview | FAQ | Photo Gallery
Patient Specific Questions
- Can I get my breast augmentation performed with fat transfer only?
- Which areas of the face and what volume of fat can be transferred?
- Why is 30% of the fat transferred volume lost at one year follow up?
- How does fat grafting help the divots (cellulite) I got following liposuction?
- Is fat grafting painful?
In order to be a good candidate for breast augmentation surgery, you must have enough fat depots on your body to allow for harvesting of fat in order to inject into the breast. Unfortunately, most small breasted patients are also quite thin and don’t posses enough fat to allow for a substantial volume of fat to be transferred. Remember, that overfilling by approximately 300 cc is required to compensate for the 30% of volume lost at one year following surgery. Thus, if you were considering 400 cc breast implants, you would want to be injected with approximately 700 cc of fat per breast. This requires liposuctioning approximately 1500 to 2000 cc of fat from your body as this will yield approximately 700cc’s of fat following processing. If you are fortunate to have a large deposit of fat and small breasts, then you are a good candidate. In contrast, patients who have failed breast augmentation with breast implants are ideal candidates, as they have no other option for breast augmentation. In addition, they usually have stretched out their breast skin envelope prior to having the implants removed for infection, capsular contracture, etc. and so will have increased room to accommodate the fat injections. For patients who have a tight skin envelope, two separate sessions may be required to attain the desired breast volume.
Several areas can now be successfully filled by fat grafting including the cheeks, jaw line, laugh lines extending from the corner of the lip (those extending up are called nasolabial folds; those extending downward are called marionette lines), in the hollow of the lower eyelids, temple region, under the eyebrows, under the upper eyelid (if fat was over-resection following upper eyelid surgery), and the lips. Volumes of injection include:
|Facial Region (each side)||Volume of injection (cc’s)|
|Upper lips||1 to 2|
|Lower lips||1 to 2|
|Nasolabial fold||2 to 3|
|Marrionette folds||1 to 2|
|Cheeks||2 to 6|
|Lower Eyelid hollow||2 to 4|
|Upper Eyelid hollow||1 to 2|
|Eyebrows||1 to 3|
|Temples||2 to 4|
|Jawline||2 to 5|
Fat grafting requires avulsion of fat cells from their residence where they maintain a vascular supply to a new environment where they possess no direct vascular supply. As a result fat cells are required to keep alive by obtaining their nutrients by virtue of diffusion until a direct vascular supply sprouts into them. During this delay prior to vascular supply reintroduction it is believed that approximately 30% of cells do not make it and are eventually reabsorbed by the body over a one-year period. In order to optimize fat cell viability, fat cells are transferred in 0.1 to 0.2 ml micropackets so that their surface area to volume ratios are maximized. This allows more of the cells to live by diffusion until the vascular supply is re-established.
Cellulite or dimpling is a complication of liposuction and is most commonly observed following more recent liposuction techniques involving mesotherapy (injection of fat dissolving material) and/or SMART liposuction (laser liposuction). Due to uneven liposuction techniques and/or liposuction in areas that are considered contraindications patients may observe divots and cellulite formation. Areas that are considered liposuction contraindications include the back of the thigh, the area located between the flanks and the hips, the ankles, the calves, and the middle of the medial thigh. These areas have strong fibrous attachments from the skin to the underlying muscles and thus removal of fat from these areas only promotes tethering of the skin down to the pulley effect of these attachments tightening down. To correct these deformities, the patient’s divots will have to be grafted with fat to resist the cable effect of the fibrous attachments. In addition, patients may benefit from addition of fat to areas that have been over aggressively liposuctioned resulting in correction of contour deformities, i.e. divots.
Fat grafting requires modified liposuctioning of fat cells followed by processing of the fat cells, and finally re-injection of fat cells into void/deficient contour areas. Both harvesting of fat and injection of fat utilize micro-cannulas, which are smaller version of cannulas used in liposuction. As a result postoperative pain associated with fat grafting is similar to liposuction procedures. Patients should expect to be sore for approximately one week. Patients often describe a dull muscle like soreness that you might experience after weightlifting.