How is fat grafting performed, and what is the recovery and down time like?

Thank you for your question. What I can describe is what I do in my surgical practice but I cannot speak for the other surgeons who may have differing practices and hence the downtime and results may also be different. In my practice of facial fat grafting, I prefer to use much less fat to get similar if not better results as I do not believe in overfilling a face. The entire procedure is usually performed under deep sedation so that I can minimize the amount of anesthetic injections, which can cause unnecessary facial swelling and bruising. My patients are put on a special post-operative regime to reduce swelling and promote recovery.

Even with these precautions there is still significant swelling and downtime of about 1 week or more. Younger patients who tend to require less fat grafts or patients who have smaller grafted areas tend to recover faster. Nonetheless, the swelling in the first week is significant and you will not be able to meet people professionally or socially. Most of the swelling would have resolved after the first week. It would be ideal to straddle your recovery between two weekends to give a maximum of 9 days before returning to work. Most bruises will also have settled by then. However, you will probably still find your face slightly swollen and the best results are only seen at the 3rd week.

This is a brief rundown of how the fat grafting is done:

Pre-operative assessment. An in-person consultation and clinical examination with an experienced doctor is important to establish your treatment goals and expectations. A 3D assessment with a simulator will be useful to give you an ideal of how you can look like after surgery.

Fat graft harvest. The fat graft can be harvested from several possible donor sites such as; the tummy, inner thighs, arms. The fat is harvested using specialised Tulip cannulas that ensure that the parcels of fat that are harvested are small and ideal for fat grafting. Special cannulas are also used so as to increase the survival rate for the fat

Processing of microfat for structural fat grafting. The fat grafts for the face are processed differently from fat grafts to other parts of the body such as breast or buttocks. I routinely process them using the Coleman technique so as to ensure the highest graft take whilst minimising the incidence of lumps. The fat is centrifuged. Afterwhich, the excess blood is drained and the oil is wicked away. The purified fat graft is then transferred into 1cc syringes in preparation for fat grafting to the face. Nanofat, if required for facial rejuvenation can also be prepared by using specialized Tulip filters.

Fat injection. The prepared fat is carefully injected into the targeted areas. Common areas for structural fat grafting in the face include:

1. Forehead

2. Temples

3. Tear trough

4. Sunken upper eyelid

5. Midcheek

6. Nasolabial folds

7. Marionette lines

8. Chin

9. Earlobes

What to expect? In comparison to other procedures, the pain from fat grafting and from the donor sites are minimal and should be manageable with painkillers. Most of the pain would resolve in a day or two. Immediately after surgery, there will be swelling and bruises to the injected areas as well as the donor sites for fat harvest. The swelling should subside in a week or two and the bruises may take a week to disappear.

I hope this answers your questions. Have a great week ahead!

Dr. Terence Goh

Thank you for your Direct to Doctor query. Fat grafting is a multistep procedure:

Fat harvest - usually through liposuction

Purification or concentration - excess fluid, blood and inflammatory cells are removed. Some doctors do stem cell concentration in this stage (the efficacy and validity of this procedure needs to be discussed)

Injection - into the area of interest

For fat grafting in clinic, the rules in Singapore allow for only 100cc of fat to be harvested and only in clinics accredited to do liposuction. After purification and concentration, usually not more than two thirds of the fat will be left to use for grafting. Hence, in the clinic setting, fat grafting is mainly used for face or minor corrections to body contour or for minor reconstructive surgery purposes. This is usually done under local anaesthesia.

For larger volume fat grafting, the procedure has to be performed in a MOH certified day surgery center. The steps are the same but it allows for larger volume of liposuction and therefore greater volumes of fat for grafting. E.g. to breast or buttock. These procedures are usually performed under general.

The downtime is related to the amount of fat harvested. I usually advise 1 week for clinic procedures and 2 weeks for more major work in day surgery. Different plastic surgeons will have different practices for reducing downtime, so best to check with the specific surgeon. It also depends on how big an effort you are willing to make to achieve a faster recovery. In my practice, I have different recovery regimes for my patients depending on how often my patients are willing to come to the clinic after their fat grafting.

Best wishes

Liposuction is performed to areas of unwanted fats such as ones’ hips, abdomen, thighs (inner and outer), and arms. The unwanted fat is collected and will go through a centrifugation process to separate and remove unwanted components such as blood, water or oil. The remaining fat is then collected and injected to areas such as smile lines, cheeks, lips, dorsum of the hands, breasts and butt. This process is known as fat grafting.

It depends on which area we are grafting the fat and one example commonly requested is the buttocks. The fat needs to establish a new connection with the blood vessels for oxygen and nutrition in order to survive. It is crucial to inject the fat cells in small amounts like thin spaghetti because if you inject too much in bullous or lump, the inner part of the fat inside the bullous will not get enough nutrition, then the fat cells will die and will be reabsorbed before they can be connected with the blood vessel.

I usually inject around 200cc to 400 cc of fat into each buttock at the subcutaneous layer and not into the muscle to avoid the risk of fat embolism. The final results will usually show after 3 to 4 months’ time.

If the main goal is augmenting a breast or buttock with fat grafting and if the patient has enough fat around the body, we may need more than 1 stage of lipo and fat grafting because there is limit of how much fat we can graft per area and I cannot store your fat in the refrigerator but in your own body. Once we harvest the desired amount of fat to graft, we will stop the liposuction to keep some fat in the patient ’s body for the next session.

For this procedure, I like to perform it in the operating theatre in the hospital where the environment is well equipped and safe. The procedure time will vary from 1 hr to 4 hrs depending on how large a liposuction we need to do and how many areas of fat grafting we need to perform. The patient is advised to stay at least a minimal of 1 night in the hospital.

There will be some slight bruising around the liposuction area and the grafted areas for about 1 week and one can resume back to normal exercise after 2 weeks when he or she feels well. In some cases where liposuction is done in a few areas, I will advise the patient to wear a surgical support garment for around 2 weeks or more.