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Fat transfer from one area of the body to another is a form of tissue grafting. Tissue grafting has been used for a very long time by surgeons, first and foremost in skin grafts to treat burn victims, and has excellent results for cosmetic goals as well.

Does fat transfer last?

Plastic surgery is a field of innovation, and years ago, plastic surgeons began experimenting with transferring the fat that was obtained during liposuction procedures. 

Gradually, the process of fat transfer has much improved. There’s no question that fat transfer works. The only question is, how much difference will you see? When used for reconstructive purposes (i.e., during cancer reconstruction) by plastic surgeons, there are reimbursement codes that exist, and you know that Medicare and the insurance companies don’t like paying for things that don’t work!

Factors that Affect Fat Grafting Success

In the section below, the factors that make fat transfer succesful will be explained. There is no question that some of the fat is lost after the transfer. These strategies are employed to maximize the portion that survives permanently.

How the Fat is Harvested  

Studies have shown that the success of fat transfer depends on factors during the removal of the fat, such as the aspiration pressure used and the cannula sized used. The donor site (where the fat comes from), itself is not as important. Separation from excess fluid ensures that the surgeon is injecting a higher proportion of fat, and we prefer at our center two rounds of gentle gravity separtion. 

How the Fat is Injected

Slow, slow, slow is the answer to a high success rate of fat survival. Slow injection while withdrawing the canulae leads to small droplets of fat cells surrounded by cells in the recipient area with whom the new cells will “share” resources such as oxygen and nutrition until they grow their own more secure attachments. Fast injection leads to larger droplets, and those droplets will be too large to be supported by surrounding tissue. Fat injection therefore requires slow injection techniques, and is time-consuming.

The Recipient Area

The recipient area is very important in determining the success rate of fat transfer. Again, fat grafting is a three-dimentional deposition of fat cells into the donor area, and therefore (somewhat unfairly), the smaller you initially are, the smaller the amount that can be fit in one session. Example: someone with about 200 cc of native breast volume or 500 cc of native buttock volume will not fit as much tissue as someone with larger breasts or buttocks. But do not despair—there's a way around that limitation.

The Healing Process

Do not sit too much on your buttocks for one week after surgery. A good recovery from surgery will assure a greater proportion of fat survivial. Conversely, an infection in the recipient area, while uncommon, may decrease fat survival.

Strategies to augment eventual size of recipient area

The main strategy that Dr. Khalifeh uses to achieve the patient’s desired size is staged grafting. Because there are limits to how much fat will survive in one injection and pushing fat beyond that limit is counterproductive, we divide the fat injections into two sessions.

Example

A female patient comes to us with the aesthetic goal of larger breasts. She also desires a slimmer abdomen and wasteline. Our solution would involve two sessions:

  • First session: A lipo abdomen, fat transfer to the breast is performed. We then wait 2-3 months.
  • Second session: After 2-3 months, a liposuction of the flanks and fat transfer to the breast is performed. This way, no fat is wasted and much larger sizes can be achieved rather than if we try liposuction abdomen flanks in one day with fat transfer to breast in one day.

To answer a very commonly-asked question, there is no reliable method to store the fat for reuse later. The best place to store it is to leave it right in your body. Because we perform most of our procedures with awake liposuction techniques, serial scheduling of smaller procedures with short recovery periods is very feasible. And the total cost is comparable to a longer procedure under anesthesia.

The BRAVA System, and Why We Don't Use It

For the breasts, there is a wearable device that has been designed to stretch the native breast tissue. This is achieved via negative pressure, i.e., suction. This is called the BRAVA system. The strategy of the BRAVA is to “expand” the breast, therefore fitting more fat for fat transfer. While we have looked into the BRAVA system, we have decided against it because:

  • Most of our patients prefer not to wear the cumbersome device for a prolonged period.
  • The BRAVA system adds about $2,000 - $3,000 to the cost of the procedure without superiority to our staged approach.
  • Dr. Khalifeh would rather do a staged awake procedure to achieve the larger sizes desired by our patients rather than have them wear the BRAVA in order to fit more fat in one larger single session.
  • With any medical device employing negative suction, including BRAVA, there are risks of irritating the skin, which can lead to marks.

In theory, the BRAVA system is not a bad idea (as long as the patient understands the risks and benefits). However, because we perform most of our procedures in awake sessions, we are able to obtain large volumes of transferred fat via staged procedures, without the added inconvenience of wearing an inconvenient BRAVA device.

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