Highlighting the fat graft

OP. DR. YUNUS DOĞAN

All about fat grafts/injections

Many of us have minor flaws that only we fixate on. We might hate our dimples or notice that one breast is smaller than the other. The difference in size may be insignificant to others but to us, who stare at it in the mirror every day, the asymmetry can be crippling. Maybe one eyelid droops a little lower than the other or those old acne scars are the one sign of our youth that haven’t vanished as quickly as our hairlines and efficient metabolism.

Is plastic surgery an option for such “small” grievances? We know we can grow a big, beautiful butt with a Brazilian butt lift (BBL) and have the breasts of our dreams with breast augmentation (breast lifts, breast implants, breast reductions.) But what about filling out overlooked-but-still-visible areas? Consider a fat graft.

This article is the twelfth in a series highlighting some of the most popular plastic surgery procedures. In the Highlighting series, we tell you ALL the alternative names of the surgery so you learn the medical terminology as well as develop a little street cred with slang terms. We share a little history of the procedure and describe the general process. We mention possible complications and give you an idea of the typical recovery time.

Also known as/similar or related names are:

Adipose fat, adipose tissue, autologous fat transfer, autologous fat transplantation, fat graft, fat injection, fat transfer, free at transfer, lipofilling, lipoma, liposculpture, microlipoinjection, volume transfer.

First recorded

Which came first, the cosmetic or reconstructive fat graft? Did fat grafts originate as an answer to narcissism or necessity? An abstract from the National Library of Medicine doesn’t immediately answer this question, proposing that the earliest fat grafts were used to “correct contour deformities mainly on the face and breast.” Deformities can hinder movement and bodily function or they can merely inhibit your social life. So which was it? Let us set the scene.

The year was 1893. German plastic surgeon Gustav Neuber extracted fat from the arm to inject into the orbital (eye) area to correct scars left behind from osteomyelitis (bone infection.) Narcissism for the win!

Two years after Dr. Neuber’s pioneering surgery, fellow German plastic surgeon Viktor Czerny moved a benign lipoma from a patient’s buttocks to her breast to avoid asymmetry after a partial mastectomy. Talk about distributing your assets! We first mentioned Dr. Czerny’s back door-to-top-shelf contribution to breast enhancement when we highlighted your headlights.

Abdominal fat was reassigned to the face in 1909 to correct deficits in the malar (upper cheekbone) and chin areas. Unfortunately, one of the complications of early fat grafts was reabsorption, where the transplanted fat naturally dissolves and disappears into the body.

According to the Journal of Craniofacial Surgery, German surgeon Eugene Hollander proposed mixing patient fat with harder fat collected from rams. To be injected smoothly into transplantation sites, this mixture needed to be heated to become fluid. Early documentation reported patients having a “painful rash” lasting 2-3 days but then achieving satisfactory results.

It took almost 100 years for modern fat grafting to truly develop - in the late 1980s - thanks to the rising popularity of liposuction. We no longer needed animal donors! During this time, fat grafts were used to correct a variety of asymmetries, including posttraumatic deficits.

General process

The American Society of Plastic Surgeons gives you the skinny on fat injections and it can be summed up in three steps: extraction, processing and reinjection. Fat is harvested from where it’s most plentiful (and where you and your surgeon have agreed upon) via liposuction. Then it’s processed with decanting and centrifuge to eliminate any dead cells, debris or excess fluid to ensure your graft will consist of the healthiest and most viable material. Finally, it’s reinjected in small droplets throughout the receiving site’s subcutaneous tissue. Spreading it out subcutaneously gives each droplet the best chance of survival with sufficient blood supply.

Your level of consciousness depends on how much fat is being extracted. Local anesthesia (aka you’re awake and aware of what’s going on) is usually adequate for volumes under 500cc. If you’re moving more than 500cc, you will receive IV or general anesthesia and fall fast asleep, waking up to a new and improved version of yourself.

What could go wrong?

Complications that may occur include:

• Fat embolism - fat can accidentally be injected into a vein and travel to your lung.
• Seroma - fluid build-up under your skin.
• Reabsorption or death of fat cells - even after appropriate cleaning, some fat cells may not survive.

What could go right?

Manifest balance in your life and think about:

• Symmetry in the affected body part(s.)
• A natural solution to filling in and hiding scars.
• Reassigning fat from a problem area as a solution for a different problem.

Recovery time Unless you’re combining fat grafts with more complicated procedures, you will go home the same day as your fat injections. Your surgeon will give you specific aftercare instructions, but you will most likely be told to rest the newly transplanted area during the first week. You may also experience swelling and bruising in both the donor and recipient areas.

For optimal recovery, make healthier choices regarding everything you’re putting in your body. As with larger, more complex procedures, your body needs the right fuel to heal. Junk food and nicotine are not in your best interests and may end up negatively affecting your healing and outcome.

The last stitch

Fat graft plastic surgery is a relatively easy way to correct a number of cosmetic deficiencies and irregularities. It may also open the door to less aesthetic and more reconstructive solutions in the future, as doctors develop techniques involving stem cells. Stay tuned for more information about reconstructive fat grafting. In the meantime, research fat grafts as a way to repurpose any excess fat you might be carting around.

There’s an old saying to discourage people from indulging in junk food: “a minute on the lips, a lifetime on the hips.” Thanks to fat grafts, you can put it back in your lips!