Fat transfer is a minimally-invasive surgical procedure during which a person’s own fat is harvested though needles, or cannulas, then purified outside the body and re-injected into areas that need more volume. In essence, fat is taken from wherever it is unwanted and transferred to wherever it is wanted.

(2) Are these types of procedures popular?

Very. Just in the last ten years, many advances have been made in the harvesting, purification and injection techniques. Many plastic surgical training programs have begun to incorporate fat transfer into their curricula, and it is routinely discussed at national and international plastic surgical meetings

(3) What are the different kinds of fat transfer procedures? How are they performed?

Fat transfer procedures may be categorized as cosmetic procedures and reconstructive procedures. Cosmetic purposes primarily include facial rejuvenation (cheek augmentation, lip augmentation, lower eyelid treatment, nasal contouring, wrinkle/crease filling, acne scar treatment) and buttock augmentation; reconstructive purposes include filling of post-cancer defects, treatment of radiation damage and scar revision to name a few. They are all performed using sterile technique in an operating room, and they all include various methods for (1) fat harvesting that is similar to liposuction, (2) fat purification using centrifuges, strainers and/or wicks, and (3) fat injection using syringes and specialized needles or cannulas. The fat must then be painstakingly placed in tiny particles throughout the surrounding tissues in a latticework, or honeycomb pattern, so that they take on blood supply and become part of the body once again.

(4) What types of fat transfer procedures to you perform in your practice?

Facial rejuvenation, buttock augmentation, filling of breast cancer defects and scar revision.

(5) What are the pros and cons of these different fat transfer surgeries?

Pros: Permanent, natural, safe, minimally-invasive, affordable. Cons: Variable results depending upon surgeon and patient.

(6) What are the side effects of fat transfer surgeries?

One side effect is favorable: stem cell activity. Fat is rich in stem cells, and current research is attempting to understand how fat transfer procedures may maximize their utility.  Many patients describe improvements in skin tone, clarity, texture and pore density above areas of fat transfer, which may possibly be due to stem cell differentiation into skin cells. Negative side effects can include oil cysts, fat necrosis or granulomas.

(7) What should a patient consider before considering this type of plastic surgery? How are these considerations different from other plastic surgery procedures?

First, the results may be unpredictable. They are highly dependent upon the surgical technique and the surgeon’s experience, but also the patient’s own fat and blood supply. Second, the results change significantly over time. Most studies show that 50-70% of injected fat cells survive, which means that up to half of the immediate result may be lost. This leads most surgeons to “over-correct” during the procedure, knowing that the final outcome will be less. Finally, it is a permanent solution, unlike fillers such as Restylane or Juvederm that fade away after a year. Some patients use temporary fillers to test their appearance before committing to fat transfer.

(8) What do you see as the future of fat transfer plastic surgery? Where is it headed?

One of the most exciting and controversial applications for fat transfer is in cosmetic breast augmentation. Many women (and surgeons) are thrilled by the idea of taking fat from the belly, or the hips and using it to enlarge the breasts. These techniques are being developed and refined, but many questions about long-term safety and the effect on breast cancer screening will need to be answered before this becomes mainstream. Also, more breakthroughs in the delivery of stem cells through fat transfer will likely be seen soon.

(9) Please add any additional information that you feel the readers would like to know that is not covered here.

Fat transfer may be done under local or general anesthesia, depending upon the extent of the procedure and the areas of treatment. Minor facial rejuvenation typically costs around $2000, major facial rejuvenation costs around $5000, and buttock augmentation costs around $10,000.

Quotes may attributed to Dr. Jeffrey Donaldson,

In the past decade, a new generation of plastic surgeons has turned upside down the traditional thinking about aging, beauty and the aesthetic ideal. It used to be assumed that aging effects were due to gravity and stretching, and that tissues sagged and fell over time. While this may be true to a certain extent, there is another fundamental process at work: loss of volume.

Technological breakthroughs in 3-D imaging, CAT scanning and MRI’s clearly demonstrate a decrease in the amount of bone, size of fat pads, quantity of muscle fiber and thickness of skin over time. In contrast, high-definition photographs show that skin landmarks such as moles and freckles do not descend appreciably as a person ages. These studies suggest that the wrinkling and hollowness that characterize old age are similar to a grape becoming a raisin, or a helium balloon that has deflated — it is due to volume loss from deeper within the body, and not just sagging of the skin itself. 

This new understanding has major implications for the treatment and prevention of aging. The face lift provides an excellent example. The old mantra was to lift, tighten, stretch and smooth the skin, but now we know that the skin is merely redraping over less underlying tissue. If only the skin is tightened, the effect may appear as if a patient is standing in a wind tunnel — the skin is swept back smooth and tight, but overlying a hollowed and sunken framework. The more pure anatomic approach is to rejuvenate the face by restoring inner volume where it has faded. This may include the addition of fat grafts,duplication of underlying fascia and muscular tissue, placement of implants, and/or injection of hyaluronic acid filler such as Restylane and Juvederm in combination with a face lift. When the deeper tissues are filled, then the skin is pushed out and wrinkles smooth more naturally. 

Dr. Jeffrey Donaldson is a champion of this new volumetric philosophy. He uses fat transfer, fillers and advanced multi-plane surgical techniques to restore volume and create youthful, soft, natural effects in the face and body for patients in Columbus, Ohio. Cosmetic surgery has rapidly evolved with these recent discoveries, and Donaldson Plastic Surgery offers you the most up-to-date results.

Several weeks ago, the company Allergan launched a new and improved version of Juvederm that contains lidocaine — a numbing medication similar to novocaine. Their studies have shown that 9 out of 10 patients are more comfortable with the lidocaine than without, and so far Dr. Donaldson’s patients agree. Procedures that might have otherwise required a nerve block (direct numbing of a facial nerve) can now be done safely and comfortably with the new filler alone.

In the last several days a competitor, Medicis, announced the availability of their latest products: Restylane-L and Perlane-L. These next-generation fillers also contain lidocaine for a more pleasant cosmetic experience. Dr. Donaldson is one of the first plastic surgeons in the country to have them available for his patients.

Whether you have had Juvederm or Restylane in the past or are curious to try one of them for the first time, you will most likely benefit from the addition of lidocaine to the filling material. Columbus, Ohio plastic surgeon Dr. Donaldson believes that increased comfort is a major advantage, and Juvederm XC, Restylane-L and Perlane-L are important breakthroughs in cosmetic medicine.