Autologous Fat Transfer (AFT) involves the removal of fatty tissue from one area of the body and using it as a “filler” material in another location. Fat transfer was initially utilized to correct or treat areas of small volume loss that characterize the face as we age--deep nasolabial folds (“laugh-lines”), cheeks, or eyelids. This procedure can very efficiently fill these defects and smooth out associated creases. More recently AFT has been increasingly performed in larger volumes, in to improve the appearance of buttocks, to augment breasts and for breast reconstruction. Fat is typically harvested from the abdomen or inner thigh (the “donor site”), but may also be taken from the front or outer thigh, the lower back, or the hips. Unlike conventional fillers that disappear over time, fat grafting has the potential to be a permanent filler material.
There are many reasons that people might choose to undergo fat grafting. Although it seems counterintuitive, the fat in our faces and hands is what gives us a youthful appearance. As we age, we lose this fat and are left with hollow areas, fine lines, creases, and sharper angles. Therefore, one of the most common reasons for patients to undergo fat grafting is to fill these creases and soften gaunt angles. AFT is a relatively safe and simple procedure and can be performed in any patient who is a candidate for volume restoration with traditional fillers (e.g. hyaluronic acid, etc), or in appropriately selected patients considering breast or buttock augmentation (in lieu of placement of and implant) or breast reconstruction. Larger-volumes transfers are typically performed for the aesthetic enhancement of the breasts or the buttocks, but may also be used for reconstructive purposes, such as after a mastectomy or to correct contour deformity after an excessive amount of liposuction. Lastly, the fat for transfer must come from somewhere, so it is important that you have an appropriate donor site from which your surgeons can harvest adequate tissue.
The level of anesthesia required depends upon the location and volume of AFT performed. Small transfers can generally be done with local anesthesia perhaps in combination with some sedation. Larger volume transfers will usually require more significant sedation or general anesthesia.
Small “access” incisions usually about 2-3 mm will be made in the neighborhood of the donor site. Your surgeon will do his or her best to hide these incisions in natural creases, stretch-marks, previous scars, or hair-bearing areas. Similarly, small incisions must be made near the recipient site. These will be hidden as much as possible too.
To make the fatty tissue easier to retrieve, the surgeon will treat the donor site with fluid that provides anesthesia and decreases bleeding (“tumescent solution”). Using a special needle, the fat globules will be gently vacuumed into a syringe. Next, the “lipoaspirate” or suctioned fat is processed to separate the healthy fat cells from the oil, blood, and anesthetic fluid (the “rest”). The fat cells are then ready for injection into their new home!
The newly harvested fat will be injected into the donor site. This is done very carefully, a little bit at a time, to ensure that the results are just right. If too little is injected, the results will be unimpressive, too much will be too obvious. If the fat is too clumpy, the final result will be uneven. It is also important that the fat end up in the right layer, such as within the existing fatty layer or overlying the bone. For these reasons, it is essential to choose a surgeon with substantial experience in fat transfer techniques and who will be most able to avoid the common pitfalls.
You should expect the area where the fat was placed to be very swollen for 2-4 weeks after fat grafting. Some patients even note swelling for up to 16 weeks after these procedures. This is normal and will improve over time. Common tricks including ice and elevation will help to minimize the swelling.
Fat grafting is a clean procedure done under sterile conditions and the risk of infection is very low. While some patients note bruising at the donor or recipient site, the incisions used for fat grafting are very small and the incidence of significant bleeding is exceedingly low.
The common risk is a dissatisfying aesthetic outcome. This may be due to too much or too little fat injected, the fat being too lumpy, or the procedure not meeting your expectations in some other way. If this were to occur, your surgeon would work with you to revise your results to whatever extent is feasible.
Fat grafting is a relatively non-invasive means of achieving potentially permanent contour changes of the face and/or body, using your body’s own tissue thus obviating the need for use of prosthetic material. Small-volume transfers may be used to achieve a more youthful appearing face, neck or hands. Larger volumes can be used to augment the breast or buttocks, or to aid in reconstruction. While fat transfer represents a relatively safe cosmetic technique, it is essential to select an experienced surgeon to ensure that you reach the aesthetic outcome you desire.
Structural fat grafting: more than a permanent filler. Coleman SR. Plast Reconstr Surg. 2006 Sep;118(3 Suppl):108S-120S.
Thorne, Charles, et al. Grabb and Smith’s Plastic Surgery, 6th edition. Philadelphia: Lippincott Williams & Wilkins, 2007.