Northern Virginia- Fairfax and Manassas
By: George Bitar, M.D. and Larry Lickstein, M.D.
Board Certified Plastic Surgeons
It is important to clarify that fat grafting has been named fat transfer, fat transplant, fat injections, lipo-transfer, lipo-structure, etc. It is essentially the same procedure. The concept is simple: take fat from areas in the body where it is abundant, and place it in areas where it is needed. The area where it is most commonly injected is the face, since as we get older; we tend to lose the fat in our face. It is also done to hands, thighs, buttocks, and most recently, breast. All procedures performed on the breast potentially will affect the results of a screening mammogram. These breast procedures either partially mask breast tissue or cause scaring that requires further interpretation. The American Society of Plastic Surgeons Fat Graft Task Force has published a position statement on this technique which can be referenced at:
Per the Task Force, “Concern regarding interference of autologous fat graft with breast cancer detection is not validated by the limited number of studies available on the topic.” Further, “The safety, efficacy, outcome of any given case is dependent on the technique used.”
We believe that fat grafting is a very important tool is cosmetic rejuvenation, especially for the face. Fat is abundant, is easily molded, has a natural feel and look, can be permanent, and does not cause any allergic reactions. Infection rate is also negligible. The downside to fat grafting is that it is not completely predictable. While most of the fat injected will be permanent, it is difficult to predict the exact amount. Everybody’s fat behaves differently, and a compounding variable is the location in which the fat is injected. Recently, fat grafting has been shown to have the added benefits of stem cells, found in the injected fat, which not only provide volume, but also create skin improvement, wrinkle improvement, and other positive changes that are not explainable by volume alone.
Fat grafting can be used to create a nicely rejuvenated face, in someone with loss of fat over the years from his/her face, or someone who has had a facelift and wants more plumpness in their face. Fat can also be used to correct body contour deformities from liposuction that has yielded unsatisfactory results to car accidents, or to aging hands to make them look more youthful.
Fat grafting to the body has been most popular in gluteal (buttock) augmentation. This procedure is commonly known as the Brazilian Butt Lift. This is a safe and effective way to improve the aesthetic contour of the buttock region. Fat transfer to the breast has also increased in popularity. Combined with external tissue expansion using the Brava Bra, natural augmentation of the breast can be achieved without an implant. Fat transfer to the breast is also very effective in camouflaging wrinkling after breast reconstruction or augmentation. Contour irregularities after breast biopsies or lumpectomy are also correctable using this technique.
Preparing for Surgery
An initial consultation is set-up where we discuss the fat grafting procedure, and whether you are a good candidate for the surgery. Your medical history is reviewed, and you will be asked to see your medical doctor for a physical check-up and a few labs to make sure you can undergo the surgery safely. You are given the opportunity to be seen by your own doctor to give the green light for surgery. You are asked to stop smoking, if you are a smoker, two weeks before and two weeks after surgery, for the surgery to be performed safely, and for you to have optimal results. You are given the opportunity to talk to patients who have had the same surgery you are considering. We will see you shortly after the surgery (in a day or two usually). You are seen regularly after your surgery. You are always welcome to come back for follow-up, even years after your surgery, free of charge.
The Fat Grafting Procedure
For the right patient, fat grafting can be an extremely gratifying operation. The advantages are natural looking results, long-term enhancement, quick recovery period, and no scarring. This procedure takes about one hour, depending on where and how much fat grafting is going to occur.
The procedure is relatively simple and straightforward. A patient, who is deemed a good candidate for this procedure, is given antibiotics, and anesthetized in the operating room. The body is injected with tumescent solution to the abdominal area, where the fat is usually removed via a special technique, to keep as much of the fat cells alive as possible. After the fat is harvested, it is processed and then injected with a needle to the areas where it is needed, most commonly including the cheeks, smile lines, lips and the pre-jowl area.
How We Minimize Complications of Fat Grafting:
At the Bitar Cosmetic Surgery Institute, we take pride in making sure we provide for our patients the best surgical experience possible , anticipating problems or set-backs, and addressing them before they happen. This is a process that includes the pre-operative preparation, the actual surgery, and the after care.
General complications can occur with any surgery. Cosmetic surgery is usually a safe surgery performed on healthy patients and, as all surgeries go, is with low risk. What we do to even lower the risk of complications is to operate at a first class hospital with board certified anesthesiologists and nurses. To avoid post-operative complications, we advocate early mobilization –patients seen in our office one or two days after surgery- and active participation in their own post-operative care. When we create a partnership, the results invariably improve.
Before surgery, our patients are tested to make sure they do not have any common bleeding disorders by their own physicians, and by lab tests. Bleeding with any form of fat grafting is rare.
The most important step in avoiding infections/wounds, in our opinion, is to perform the surgery at a first-rate surgical facility with board certified anesthesiologists and nurses. Patients are given the appropriate intravenous antibiotics coverage throughout the surgery. During the surgery, the skin surface of the patient is cleaned properly. After the procedure, our patients are prescribed a one-week course of antibiotics to minimize infection. As a result of these extra precautions, our rate of infection after liposuction is extremely rare. Since with liposuction there is no skin removal or tissue manipulation, other than suctioning fat out of the body, open wounds are extremely rare.
We exercise caution around the nerves in the body and avoid aggressive fat grafting, thus, minimizing nerve injury. Temporary loss of sensation from a “stunned” nerve or a bruised nerve may occur in the time period after surgery, but sensation in the vast majority of cases returns within a few weeks.
Fat Grafting May be Temporary
One of the least pleasant aspects of fat grafting is that is could be temporary. Extra caution is utilized in the operating room to make sure the fat is handled properly and injected properly.
Our office will provide you with a detailed post-operative instruction sheet that will be individualized to your needs. We usually see patients the day after surgery in one of our offices to make sure that everything is O.K., and that you are healing as planned. Multiple visits in the year after the procedure will ensure the best outcome possible.
For more information about this procedure call our office and speak to our friendly staff member at 703-206-0506.
Information on this web site is for information only. Do not use the information to diagnose or treat your plastic surgery or cosmetic surgery problems. Please contact your plastic surgeon with all questions and concerns.