Fat grafting, or fat transfer, is a procedure consisting of removing and purifying fat from one part of the body to inject in another part, often on the breasts or face. It sounds like a plastic surgery miracle! Fat graft is an evolving technique and many new applications have been discovered in the recent years as plastic surgeons realize its regenerative potential. It is currently being used in reconstructive plastic surgeries for soft tissue defects resulting from congenital conditions, tumor removal, or trauma, and is showing promising results with diabetic ulcers, scar contractures, and radiation skin damage.
In this article, we will focus purely on the aesthetic uses of fat graft. We spoke to plastic surgeon Dr. Richie Chan 陳肖龍 who answered all the questions we had on fat graft procedures.
Which parts of the body are ideal to enhance with fat graft?
For aesthetic purposes, fat graft is commonly used for breast augmentation. I believe the second most common use is in the face but personally, I think it’s most effective in the breast. You can actually inject as much fat as you want into the breast, but it will have to be staged over multiple procedures until you reach the desired size. The more contact surface area the fat cells have in the recipient site – such as the breast – the more successful it will be. Each fat cell needs blood supply. When all conditions are ideal and we use modest amounts of fat in each procedure, 70-80% of the fat cells will successfully 『take』. The remaining will be reabsorbed into the bloodstream. If you try to put too much fat in at a time, the fat that doesn’t take will die. It may be reabsorbed or it may calcify or turn into a cyst. These present as lumps and may provoke unnecessary anxiety and lead to further investigation and procedures.
Fat graft can be used on its own for breast augmentation or in combination with implants, usually silicone ones. Women who are very slim or had previous breast surgery may have very thin skin and subcutaneous layers. Implants placed in these ladies will sometimes be very easily palpable as the overlying skin pocket is thin. In these situations, we would recommend to either augment the breasts with fat graft alone or to use a combination (fat graft and implant) techniques. With the combination technique, we put a layer of fat graft around the implant to make the breast augmentation look and feel more natural.
Where does the fat come from?
Fat is usually harvested from the thighs, abdomen, the flank (muffin top!), or hips.
What other aesthetic uses does fat graft have? Can you use fat graft to even out acne scars and/or wrinkles?
Using fat graft for acne scars and wrinkles is not very common. And there are better ways to treat both so I wouldn’t recommend fat graft.
It was initially used as a filler, especially in the back of the hand. Most people pay a lot of attention in maintaining the skin on their faces but the area that really betrays you and tells your age is the back of the hand! In the hand, the results were quite interesting. The hand not only looked fuller but the fat also had a regenerative effect on the skin, making it look younger.
Are there any benefits of using fat graft over other options for breast augmentation?
For breast augmentation, I would say yes. Fat cells that successfully survive transfer are permanent whereas most people choose to have their implants removed after around 15 years for various reasons. Implants can move, rupture, or look different as your body ages but fat grafting remains relatively consistent.
Another thing to think about when considering breast augmentation is age. Women in their 50s who are considering breast implants need to consider the possible need to have them removed in 15-20 years – obviously the risks of surgery increase as we age. That’s not really an issue with fat grafted breast augmentation.
And then there’s the added benefit of having liposuction! Obviously that fat has to come from somewhere so you get an 『asset redistribution』!
How long do fat grafting results last?
Any fat that survives the transfer and is able to attach to a blood supply is permanent. It’s your tissue so as long as the cells survives the transfer, they become integrated into the recipient site. There are usually few rejection issues as the transferred tissues are yours to start with.
Can you tell us about the procedure?
To start, we harvest the fat using liposuction from the donor area, usually the abdomen, hips or thighs. We process the fat and then, using small incisions in the recipient area, we re-inject the fat. Patients are either under general anesthetic or local anesthetic with sedation.
What is the recovery period for fat grafting? Will I have swelling and scars?
Aesthetically, it takes about three months for the breasts to 『settle』 into their new size. For the first few weeks, they will look bigger for two reasons. First of all, you will have post-operative swelling for a little while. Secondly, a certain percentage of the fat cells transferred will not survive and will to be reabsorbed by the body. This process takes a few weeks.
We usually ask women to wear a pressure garment in the area where we have removed fat. On the other hand, we don’t want any pressure on the recipient area. We ask women not to wear a bra for three months after their fat graft. It’s definitely something to consider – winter is an ideal time for this procedure! We can suggest a couple of types of bras to wear for occasional events but really, it’s important to be bra-free for the majority of the recovery period to maximize fat graft survival and optimize the outcome.
Normal post-operative swelling (for both the breast and fat donor areas) and bruising will go away in 2-3 weeks. There are small puncture wounds in the breast which require 1-2 stitches. Those stitches will be removed in 10-14 days.
Where can I get fat grafting done in Hong Kong? How do I know it’s safe?
Fat grafting is a safe procedure when done properly. It is still a surgical procedure so it has certain inherent risks. Like any medical procedure, it’s vital to undergo fat grafting with a well-trained medical professional. The specialist registry for plastic surgeons in Hong Kong can be found here.
I have a couple of recommendations when looking for a fat graft provider:
- It is possible to do fat grafting under local anesthesia only but in my experience, most people do not find this comfortable. I recommend either going under sedation or general anesthesia.
- There is an additional risk with using anesthesia so don’t go to a clinic that doesn’t have an anesthetist in place. You also want to ensure the clinic you go to has proper monitoring in place while you’re under anesthesia.
- The way you remove fat is also very important. With just liposuction, the fat is discarded so it doesn’t matter what the condition of fat cells is when they’re removed. For fat-grafting, because we want to retain the integrity of the fat cells, it is important to adopt a technique that preserves the integrity of fat harvested. I personally prefer employing a high-pressure water jet under the skin to loosen fat cells before removal. I believe it is a gentler technique and the fat harvested are of better quality compared to other methods.