James J. Romano, MD
1) In what areas can be fat be grafted in the body?
a: Any area where fat exists in the subcutaneous space.
2) Where is the fat removed from?
a: Areas where you have an excess of fat. This is an area where fat has NOT been suctioned before, so there is no scar tissue to affect harvesting. It should also be an area where there is not a lot of fibrous tissue, like the male chest. It should also be an area where a reasonable amount of fat can be removed, unlike the knees or arms.
3) What are the best sources for fat?
a: Areas where you have good quantity of fat, soft fat, no scars, and where you want to see a cosmetic result, like a “flatter” abdomen.
4) Do all areas that I want grafted respond to fat grafting equally well?
a: No. The lips and laugh lines respond the least well. It takes sometimes three grafting sessions for lips to enlarge. All other areas of the face and body do reasonably well, and the fat survives and gives a very nice result in one session.
5) Do you freeze fat and re-use it later?
a: No. I don’t believe the fat cells are as healthy. There is a much greater risk of infection.
6) How many sessions of fat grafting are needed?
a: As many as it needs to obtain the results desired. In the lips and laugh lines it often may take three sessions, but one may work. All other areas are usually successful in one session.
7) What is the science and theory behind fat grafting?
a: Fat cells are very delicate and fragile and only loosely connected to their blood supply. The cells are harvested very gently with a syringe and needle, then prepared, then injected into the treatment site in many small crisscrossed tunnels (microfat grafting). The fat cells survive and keep their volume if and when the new blood supply grows into them.
8) What factors determine the feasibility of fat grafting?
a: The anatomy and contour of the area to be treated, how much fat is available as a source for transplantation, how much fat is available to graft once it is harvested and prepared, and how much fat actually survives once it is transplanted.
9) How much fat is usually available for fat grafting?
a: This depends on your body. If you have a lot of fat, it is easy and usually taken from the hips and/or abdomen. If you do not have much fat, you will need harvesting from many areas and it is helpful to gain weight.
10) Are all areas on the body equally good sources for fat?
a: No. Soft and non-fibrotic fat is best, usually from the central abdomen. Areas of previous liposuction with scarring are not good.
11) How do you harvest the fat?
a: With small cannulas so that only small fat parcels will be harvested. This will allow the best opportunity for new blood supply to grow in. It is harvested under very light suction so that the fat cells will not be destroyed. It is harvested using a minimal of anesthetic solutions so these will not violate fat cell vitality.
12) How is the fat prepared?
a: The fat is carefully and gently washed with a special solution and then mixed with some antibiotics. The healthy fat cells are then separated from the dead cells and the fluid. They are loaded into syringes and made ready for injection.
13) How is the fat injected?
a: Fat is injected and transplanted using the micro-grafting technique. This means using very small cannulas. This is so very thin tunnels will be created with fat filling these tunnels. The fat tunnels are at different levels, and cross through the area to be augmented. Together, these will allow the best opportunity to have the new blood supply grow in.
14) How much of the fat that is liposuctioned will survive?
a: Only about 25 to 30 percent of the fat will survive
15) Is fat grafting permanent?
a: Yes, usually about 80 percent of the fat survives.
16) How many procedures are needed to achieve the desired results?
a: Most patients reach the goals with just one procedure, but a second may be required.
17) How long does the procedure take?
a: It depends on the areas to harvest and to graft. If it is a small area like the lips, it can be as little as one hour. If it is a larger area like the buttocks with liposuction, the procedure usually takes four to five hours.
18) What is the recovery time?
a: It depends on the areas and the size to be treated and where the fat is harvested. In lip grafting you feel fine right away; you just look very swollen for days to weeks. For buttock grafting, after about two days most patients feel good enough to walk around and slowly get back to their normal activities. There is not much unusual swelling. Patients are not allowed to sit on their buttocks for the first week to two weeks.
19) With exercise, will the fat grafted become muscle?
20) What weight should patients be for fat grafting?
a: There is no minimum weight. Patients just need to have enough reserve fat to harvest and graft.
21) How much fat will be needed for fat grafting?
a: We only take out as much as we anticipate needing for the fat grafting. Over-treating or injecting extra fat is not good, as this creates a mass of fat that is too big for the blood supply and doesn’t live. If you have enough fat, and you want a large volume of fat transplanted, it is better to do it in stages.
22) What is the cost of the procedure?
a: Pricing depends on the patient’s anatomy and the donor sites or areas to be liposuctioned.