Fat grafting, also known as autologous fat transfer, fat injections, or lipofilling, is a cosmetic procedure developed to smooth out irregularities and augment areas on the body that have become grooved or sunken. The first attempts at fat grafting occurred over a hundred years ago when German surgeons in the last decade of the 1800s began experimenting with injecting fat as a way to correct damage caused by scars. Unfortunately, while there were early successes, the results were inconsistent.
It wasn’t until modern liposuction was developed in the late 1900s that the techniques for removing and purifying the fat became more predictable. Since the process was refined, it has become a standard tool in the plastic surgeon’s toolbelt, particularly to correct depressions in the skin or to contour irregularities caused by surgery or trauma. Fat grafting has also become established as a relatively safe way to rejuvenate the face, hands, and feet.
Utilizing the patient’s own fat as a filler has several advantages over other types of filler, but it has its disadvantages as well. Though occasionally prone to reabsorption, fat transfer procedures have been shown to last longer as a facial filler than the leading FDA-approved synthetic fillers in most cases. While most dermal fillers have a shelf life of two years or less, fat transfer can sometimes develop enough of a blood supply to become permanent. There is little to no chance of an allergic reaction. The process is, however, a more costly, labor-intensive treatment with a longer recovery time.
Fat grafting, no matter where it is being implanted, is a three-step process. First, the fat to be transplanted is removed via manual liposuction. Neither laser nor ultrasonic liposuction can be used for extraction as these methods destroy the fat cells. Transferrable fat can technically come from any part of the body, but the most common donor areas include the following:
- Love handles
Next, the fat is treated with either a sterile saline solution or processed with decanting and centrifugation to remove dead cells, excess fluid, and debris before reinserting the material. Finally, the fat is then introduced to the new area and injected as tiny droplets throughout the subcutaneous tissue in the new area. Using small droplets helps to ensure a good blood supply to each droplet of fat, giving each cell its best chance at surviving.
Common areas to augment
There are several specific areas that frequent candidates for fat grafting. Along with scarred or depressed areas caused by injury or surgery, some of the more common areas augmented by autologous fat transfer include:
- Face –This method adds volume to the cheeks, improves the skin’s texture by reducing wrinkles and grooves, and helps to repair old scars.
- Hands and Feet – adding tissue under the skin of the hands and feet smooths them out, giving them a more vital and youthful appearance.
- Hips – Some people use injected fat to increase the size of their hips and remove any indentations that might interfere with a smooth profile.
- Buttocks – While fat grafting is fairly safe in most cases, the procedure to enhance the buttocks, known as a Brazilian Butt Lift, carries greater risk. According to the American Society of Plastic Surgeons, complications from this specific procedure make it the most deadly cosmetic procedure, with a mortality rate of 1 in 3000 patients, caused by fat embolisms in the veins of the gluteal muscle.
- Breasts – Although fat transfers have been used to repair and augment small areas of the breast in the past, recent strides have allowed some plastic surgeons to completely reconstruct the breast.
Risks and Recovery
With the exception of the Brazilian Butt Lift, fat grafting is typically a fairly safe procedure. There is little to no chance of rejection or allergic reaction, though reabsorption may be slightly more likely when using your own fat. However, no surgical procedure is without risk, and fat injections are no exception.
For one thing, they are less precise than other dermal fillers, leading to more irregularities and asymmetry than other methods. Healing takes a little longer than when using dermal fillers, as well. Bruising, swelling, and even some minor scarring are all considered normal for a few weeks after a fat transfer has taken place, rather than the week or so it takes to recover from other fillers.
More serious side effects can involve the blockage of a blood vessel, pooling of blood, and fat necrosis. Depending on where the blood flow is blocked, the embolism can lead to tissue damage. If blood is blocked from a vital organ, it can even lead to death. Fat necrosis develops when an area of fat isn’t provided with enough blood. The tissue then dies, causing the area to turn black. This can cause either dimpling or hard, round lumps to develop under the skin and may lead to infection.
If you are considering getting cosmetic surgery, you may want to set up some time to talk to a plastic surgeon about whether fat grafting is a good alternative for your particular situation.