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Fat Grafting: A Discussion with Board Certified Plastic Surgeon Brian S. Glatt, MD, FACS

Dr. Brian Glatt

Brian S. Glatt, MD, FACS, a Board Certified Plastic Surgeon at Premier Plastic Surgery Center of New Jersey in Morristown,  answers frequently asked questions about fat grafting.

 

Fat grafting or transfer involves harvesting or “taking” fat from one area of the body where there is some excess (using liposuction techniques) and grafting or injecting it into other areas of the body or face to produce enhanced volume.  After taking the fat, it first needs to be prepared and “purified” to get rid of any excess liquid, numbing medicine, or blood, which leaves behind only the pure fat cells.  This maneuver maximizes the results of the grafting.  The purified fat is then injected into target areas using specialized blunt ended cannulas, which are hollow tubes with specialized openings at the end.

Fat grafting has become an extremely popular procedure since almost everyone has some excess fat somewhere on their body that they do not mind giving up and placing into areas where they could use some more bulk or fill.  As techniques and methods of fat grafting have improved over the years, the success rate of the procedure has grown significantly and the results have become more predictable and reliable.  Also, these procedures commonly do not require a trip to the operating room as Dr Glatt can easily perform them in an office setting under local anesthesia or with a minimal amount of sedation for comfort. 

Fat can be grafted or transferred from almost any part of the body to be placed almost anywhere else.  The most common areas (or “donor sites”) where fat is taken from with liposuction are the outer thighs, abdomen, and flanks.  By far the most popular location fat is grafted into are areas of the face, such as the cheeks, nasolabial folds, deeper lines and wrinkles, the hollows beneath the eyes, the brow to provide additional fullness, the temple areas for hollowness in this region, and the lips.  In addition, Dr. Glatt frequently performs fat grafting as a routine part of other surgical procedures, such as placing it in the upper cheek to augment a standard facelift or in the tear trough area as part of a surgical lower eyelid rejuvenation.  The Brazilian butt lift is actually a variation of a large fat grafting procedure where a high volume of fat is grafted back into the buttocks for large volume augmentation and shaping. 

Fat is being used by some practitioners in the female breast for augmentation.  Fat grafting to the breast is still considered quite controversial.  This is because if the fat transfer is not completely successful, the grafted tissue can form scar lesions or nodules, which could potentially confuse future mammograms.  For this reason, Dr. Glatt does not perform fat grafting in place of standard breast augmentation procedures.  Dr. Glatt does, however, utilize fat grafting in secondary revisions to enhance contour following breast reconstruction procedures, and published an article on these techniques in 2009.

Advantages of this procedure is that fat is a natural substance, being your own tissue, and there is usually plenty of it for use.  The grafted areas will gain and lose weight with you as you move through life.

Disadvantages are that you may need multiple sessions to achieve your desired result or you may have loss of grafts if fat does not “survive”.  The procedure is somewhat more invasive than having an off the shelf injectable filler such as Juvederm.  You may also require IV sedation anesthesia for larger or more extensive fat grafting procedures.

There are no actual side effects of fat grafting surgery, however patients do need to be made aware of some risks and recovery issues.  For instance, there is usually a great deal of bruising afterwards (at least 1-2 weeks) in the area where fat is placed.  There is also a good deal of swelling, and the area will look overdone at first, until the swelling and bruising resolve.  Some of the grafts may not “take” or be successful and this could lead to the results “melting away” and cause contour irregularities or asymmetries.  This is unusual, but is a possibility.  The opposite could occur also, where too much fat may be placed into an area and stay, which could cause different types of small irregularities or asymmetries that may need to be corrected.  

Patients should have an idea of how much fullness they are looking for and what areas they wish to be treated.  In addition, you must allow for adequate recovery time after this procedure.  Each patient must be prepared for the possibility that you may need multiple sessions to achieve desired results, but this should be discussed with you beforehand at your initial consultation.

Success rates are improving as we learn more about how to best perform all aspects of the procedure:  how best to harvest the fat and from which areas does fat work the best; how do we maximize the survival of the fat with purifying techniques and which ones are most effective; which cannulas work the best and which specific techniques and volumes have the highest success in different areas of the body.  All of these questions need to be definitively studied and figured out!   Right now, there is significant variation among different practitioners for each and every little step of the procedure and therefore tone may see mixed results depending on the experience of the particular practitioner.  It is important to go to a Board Certified Plastic Surgeon who performs these procedures regularly and is comfortable discussing all aspects of the technique.

To schedule an appointment with Dr. Glatt to discuss fat grafting, call Premier Plastic Surgery Center of New Jersey’s Morristown office.