Fat transfer is designed to restore lost volume and reverse the signs of aging. The added bonus of a fat graft is that as you're enhancing the look of one part of your body, you're also removing unwanted fat from another!
In this guide we cover everything you should know about this common plastic surgery procedure before scheduling your first consultation.
Table of Contents
- What Is Fat Transfer?
- Fat Transfer Treatment Areas
- Fat Grafting vs Other Volume Enhancement Injectable Treatments
- Treatments That Can Be Combined With A Fat Graft
- Ideal Candidates
- Non-Ideal Candidates
- 10 Fat Graft Preparation Tips
- What to Expect During Recovery
- 10 Fat Graft Recovery Tips
- Weekly Timeline of Results
- Limiting Fat Re-Absorption
- Side Effects & Risks
- Pricing — How Much Does a Fat Transfer Cost?
- Fat Graft FAQs
What Is Fat Transfer?
One of the most common effects aging has on the human body is a gradual loss of tissue volume in a number of very specific areas. Whether it's in the face, breasts, buttocks, or even the hands and feet, this can leave you looking older than you feel.
A fat graft is a cosmetic procedure during which fat is taken from a donor site and reinjected elsewhere in the body, adding volume to that area. This is also commonly known as autologous fat transfer (autologous means that the donor and recipient are the same). When the fat injection is small, it’s known as microlipoinjection or micro-fat grafting.
When performed alone, a small fat graft is usually done with a simple local anesthesia, and can usually be performed as an outpatient procedure. Some doctors may offer an oral sedative for more uneasy patients, although this is not required in most cases. General anesthesia may be required if a large amount of fat is transferred. The specific type and amount of anesthesia required depends on the amount of liposuction and fat transfer each patient's unique situation calls for.
A standard fat graft is made up of three steps: fat removal, fat isolation and purification, and fat re-injection.
- Step 1 – Fat Removal
All fat graft procedures begin with liposuction to take out some extra, unwanted fat from a specific donor site that has been identified ahead of time. This can be performed on the abdomen, butt, hips, “love handles,” or thighs. Areas in which the fat is too fibrous (like the male chest) are generally avoided. Very low-intensity liposuction is used in order to collect as many undamaged fat cells as possible. A small-gauge hypodermic needle or a special cannula (a thin medical tube used in liposuctions) is also used to limit damage to the fat cells, which is key to longer lasting results. The type of liposuction that is performed is often the tumescent technique. Any type of liposuction that minimizes damage to the fat cells is ideal. Laser assisted liposuction, such as SmartLipo, should not be used as it destroys fat cells with heat.
- Step 2 – Isolating and Purifying the Fat Cells
Once enough fat has been collected from the donor site, an extremely high-speed centrifuge is used to spin the fat. This whirling action separates the fat cells from the liquids that are also removed during liposuction. Any damaged cells are removed so that only whole, undamaged, and cleansed fat cells are left to be used for the actual graft.
- Step 3 – Re-Injecting the Fat
The final step in any fat graft is the re-injection of the purified fat cells into the target site. By this time, the doctor will have already decided on the site for each fat injection, using his or her skill and experience to correct imperfections and create a new shape or contour. Different needles will be used to inject the fat cells at various depths to achieve the desired results.
It's important to remember that in many cases, some of the fat that is re-injected into your body may be re-absorbed over time, causing volume loss. In fact, some amount of fat absorption should be expected, although it’s difficult to predict exactly how much. For this reason, many doctors will add more volume than you might think you need to make up for that loss. Touch-up treatments may also be required to achieve the best results.
It can be pretty easy to start thinking about fat grafts as the “safer” procedure for adding volume, thanks to the fact that it doesn't involve any foreign materials in your body. However, it's important to remember that fat grafting is still a fairly new procedure, and very few clinical studies have been done on it yet.
Those studies that have been performed involved fewer than 100 participants, and on average, followed up with their participants less than 4 years later. This means that true long-term effects aren't fully understood yet.
Fat Transfer Treatment Areas
Volume loss is a perfectly natural and normal part of the aging process. There are a number of procedures that can address this reality, but fat grafting offers several advantages over implants and synthetic fillers.
First and foremost, fat grafts use only your own, natural fat. The filler material doesn't come from an animal, a donor, or even a synthetic product. It's just you. That means that there is absolutely zero risk of allergic reactions or of your body rejecting the transfer.
Secondly, once the targeted area is fully healed, it reveals amazingly smooth, natural and long-lasting looking results.
Fat grafting is such a versatile procedure that they can be used on nearly any part of the body where you want to add volume, the most popular being the breasts, butt, cheeks, lips, hips, and hands.
If you're looking into breast augmentation, but only want to increase your bust by about one cup size, a fat graft might be right for you. In such cases fat transfer breast augmentation can provide more natural looking results than implants.
Though less popular than traditional breast augmentation due to its limited ability to increase cup size, it's that same limitation that makes this treatment ideal for breast asymmetry problems. It often doesn't take too much added volume to correct a “lopsided” look. Strategically placed, fat transfer can also give your breasts more fullness in areas that you think need it, like the upper portion or on the inner parts to enhance cleavage.
For this type of procedure, fat can be taken from your waist and those dreaded “love handles,” thighs, buttocks, arms, or even from your back. You will need to have enough “pinchable” fat in one or more of these locations. If you don't, you may need to consider traditional breast augmentation with breast implants.
When performed on the buttocks, this procedure is more popularly called a Brazilian butt lift. A Brazilian butt lift enlarges and lifts the butt, providing a more youthful and perkier profile.
Just like any other fat graft, unwanted fat is removed from the areas around your posterior, like the abdomen, inner thighs, and love handles, and is re-injected into the buttocks. Fat transfer from stomach to buttocks is common. Usually, a lot of fat is required to achieve the desired results, which means in many instances more than one donor site is used.
One of the places where age related volume loss is most obvious is in the face. As you age, you start to lose the fat that gives your face its plump, youthful look. Volume loss can be especially noticeable around the eyes, cheeks, and jawline. A fat transfer can be used to fill out the cheeks, temples, lips, and any other area of the face where it's needed.
If your face doesn't betray you with signs of aging, your hands will. As you age, the skin on the back of the hands starts to thin out, exposing the bones, veins, and tendons beneath. Wrinkles also become more pronounced and severe.
Fat can be taken from other parts of the body where it isn't needed or wanted, like the abdomen, and used to give your hands a more youthful volume and appearance. This same procedure can also be done for the feet to help with similar age-related volume loss.
Fat Grafting vs Other Volume Enhancement Injectable Treatments
As you look into your options, you'll probably come across some information regarding injectable fillers. This will undoubtedly lead you to wonder which treatment is better suited to your unique goals. Both of these treatments are safe and effective for restoring age-related volume loss. That being said, there are some important distinctions between the two, and it's in your best interest to understand those differences before deciding on a treatment.
The first, and arguably the most important difference, is that while a fat graft uses natural fatty tissue from your own body, volume enhancement injectables such as Juvederm, Restylane, and Radiesse are made up of substances that have been manufactured. There are a great many of these products available, some of which are specifically designed for wrinkles, and others that are best for volume loss.
Surgical vs Non-surgical
Another important distinction between these two treatments is that a fat graft is more invasive than injectable fillers. With any fat graft, a small incision is required to allow for fat to be removed and collected. This incision is so small it may only need one stitch to close.
There's a short recovery time associated with fat grafting procedurse due to swelling, and you'll need to be willing to accept the low levels of risk that are involved with any kind of minor surgery. Fat grafts also usually require mild anesthesia, which can be a concern for some people.
On the other hand, injectable fillers are minimally invasive and therefore have a significantly reduced recovery period. Of course, the extent and longevity of the results may be more limited as well.
Speaking of recovery time, that's the next big difference between these two treatments. Fillers have virtually no downtime. This is because they're simply injected, and begin to work practically right away. Often, the only noticeable side effects of injectable fillers are some mild bruising and swelling at the injection site. This usually takes a few days to subside.
Fat grafts, on the other hand, require a bit more of a commitment to the recovery phase. Most patients should expect to be up and about quickly, and back to their normal activities within a week or two following a fat transfer. Of course, the more fat that is removed and transferred, the longer the recovery may be.
Longevity of Results
Despite a longer recovery period, the slightly more invasive fat graft procedure does have one major advantage over injectables: longevity. Treatments of this nature can be expensive, so how long your results last can be extremely important. Most injectable fillers are, by their very nature, temporary. Depending on the formula, they can typically last for about 6 to 18 months, with repeat injections necessary.
Fat grafts, on the other hand, can last for years. This is thanks again to the fact that the process uses your own tissues, which are reconnected to your blood supply during recovery, and function exactly as they did before being moved to a new location on your body.
Because fat grafts are much more in-depth than injectable fillers, naturally they're also more expensive. That said, it's important to remember that the results of a fat graft are much more long lasting, with the body usually only absorbing a limited amount of the transferred fatty tissue. Often, only one treatment is required to achieve amazing results.
Fillers have a much lower up-front cost, but because most are only temporary, and are eventually completely absorbed by your body, they need to be repeated fairly often. This drives the price up over time.
We all know that the most important aspect of any treatment is its results. And in fact, both of these treatment options provide excellent results when performed by an experienced medical practitioner. Fat grafts have the advantage of offering a more global improvement, while volume enhancing injectable fillers are much better suited for smaller, precise improvements.
Treatments That Can Be Combined With A Fat Graft
Fat grafts are a very popular treatment, and can easily be combined with a vast array of other cosmetic treatments to achieve a more complete result. The treatments it can be combined with include, but aren't limited to:
- Injectable Fillers
Not only do these two treatments help with similar issues, they can be combined for a comprehensive result. Fat grafts do an excellent job restoring volume and lift to the face, with injectable fillers bringing improvements to fine lines and more precise areas. You may also choose to use temporary injectable fillers in areas that you want to show the gradual effects of aging. Doing so may give you a more natural appearance. For example, when you’re younger, plump lips may work with your youthful facial fullness. But as you get older, your lips may look overinflated and become unnatural looking. In this case, temporary results would be preferable so you may want to treat your lips with injectable fillers instead of fat transfer.
- Other Facial Procedures
It's very common to combine facial fat grafts with a variety of other facial surgeries for a completely new look. Rhinoplasty (nose job), blepharoplasty (eyelid surgery), or a facelift at the same time as a fat graft can help you achieve outstanding results.
- Other Body Procedures
A fat graft doesn't just add volume to your face or other areas where it's needed, it also removes unwanted excess fat from areas where it isn't wanted. For this reason, many people choose to combine their fat graft with other body improvement procedures, like a tummy tuck, or liposuction of the abdomen and waist. These combinations result in a more curvaceous and appealing body contour.
- Breast Augmentation
While a fat graft can be used for mild breast augmentation by itself, it's also fairly common for women undergoing breast augmentation with implants to combine the procedure with a fat graft. While this combination won't help either the implants or the graft to last any longer, it does give implants a softer, more natural look. Over time, it's not uncommon for breast implants to slowly become more visible, and a fat graft can help to smooth them out and maintain your contours. It can also help fill in any areas that the implants can’t reach.
- Buttock Augmentation
Similarly to breast enhancement, a fat graft can be used to augment the buttocks on its own as well (Brazilian butt lift), but is also often combined with augmentation using implants. The problems with buttock implants on their own is that they can't correct asymmetry problems, can't give you that coveted hourglass shape, and, even if placed inside the actual muscles, the edges of the implants are often visible, especially in particularly thin patients. For these reasons, a fat graft is often combined with the procedure to correct each of these limitations.
Fat grafts can often soften or even eliminate aspects of aging “wear and tear” that appear on your face and body. Smile lines, frown lines, marionette lines (those unsightly lines that run from the corners of your mouth, straight down to either side of your chin), wrinkles, furrows, sunken eyes and cheekbones -- these are all concerns that can be addressed.
Lips, hips, and buttocks that have lost volume over time can also be treated with a fat graft, as can scars or other depressions in the skin, like acne pock marks. Anyone suffering from one or more of these conditions might be a good candidate for this procedure.
Generally speaking, the ideal candidate for a fat graft is an adult who wants to enhance one part of their body by adding volume, while also removing unwanted excess fat from another part of their body.
As with any medical procedure, candidates should be in good overall health, and have realistic expectations for the outcome of the treatment. Other criteria include the following:
- You need to have enough excess fat that can be removed with liposuction, cleansed, and re-injected. If you don't have enough fat to treat the targeted area, you won't be a good candidate.
- You'll need to be realistic about the possible outcomes, and fully understand that you might need to undergo multiple procedures to achieve your ultimate goals.
- If you're undergoing a fat graft for breast augmentation, it's important to keep in mind that this procedure can only give your bust line a modest increase of about one cup size. Don’t expect a dramatic increase.
- Women whose breast shape needs a little help during a breast implant procedure can use a fat graft.
- Similarly, breast irregularities or ripples left over after undergoing a breast augmentation with implants can be corrected with a fat graft to hide these contour issues and achieve the optimal shape.
The fat grafting procedure is available to a wide range of potential patients. That being said, there are a number of factors that might make you a poor candidate for the procedure.
- Very thin patients aren't ideal for this procedure, as a certain amount of “pinchable” fat is needed for the transfer itself.
- Similarly, patients who have recently lost a significant amount of fat in a short period of time, as is the case with bariatric patients, tend to be left with a lot of very loose skin. They won't be suitable for this procedure. Keep in mind that further removal of fat in areas like the mid-section can contribute to even looser, saggier skin.
- Patient who are unable to maintain a stable weight for a few months.
- As with most medical or cosmetic procedures, smokers make poor candidate for fat grafts. Smoking can have a strong negative impact during recovery because nicotine constricts the blood vessels, preventing the newly transferred fat from connecting to your body's blood supply. This leads to a high percentage of the transferred fat cells dying off both during and after surgery, causing poor results and an increase in complications.
There are a number of medical contradictions that might also make you a poor candidate for a fat graft. These include the following:
- Severe cardiovascular or renal disease
- Severe blood clotting disorders
- Active hepatitis or chronic liver failure
- Active cancer
- Morbid obesity
- Major immunosuppression
- History of malignant hyperthermia
- Any history of poor wound healing
What to Expect During Recovery
Even though the fat graft procedure is fairly simple, it is considered a surgery, and there's a bit of a recovery process. As soon as your treatment is completed, you'll notice some mild to moderate pain and discomfort. This is usually easily controlled with oral pain medication. More severe pain is possible, but rare; if you experience severe pain don't hesitate to call your doctor's office immediately. This pain and discomfort will gradually fade over the first 48 hours or so after the procedure. If your pain increases instead, call your doctor right away.
At the time of your procedure, your doctor might put you in an abdominal binder if your mid-section is a donor site. This is a special compression garment that will help prevent blood and other fluids from collecting beneath the skin and improve contour irregularities. You'll be asked to keep it on at all times, except while bathing, for a few weeks. It's important you follow all your doctor's instructions regarding the compression garment to the letter. Not following these instructions can lead to a poor outcome or complications.
You might also notice a little drainage from the incisions at the donor site for the first 2 or 3 days after the procedure. This is fairly normal and nothing to be concerned with. However, if the drainage becomes more pus-like and is accompanied by a bad odor, see your doctor as soon as possible — those are possible signs of infection.
There will likely be some bruising and swelling around the injection site. This usually reaches its height 2 or 3 days after the procedure, then slowly begins to fade. In fact, bruising and swelling usually start to subside very quickly after about 72 hours or so.
In many cases, you'll be able to go back to most of your usual activities practically right away. The real question will be whether or not you want to. Due to the swelling, many people choose to take a few days to a week off from work. In most cases, the vast majority of swelling has gone by that time, and any lingering bruising can be camouflaged with makeup.
You'll likely be asked to book a follow up appointment sometime around 8 weeks into your recovery. By this time all the swelling should be completely gone, and your early results can be evaluated by your doctor. It's at this point during your recovery that your doctor can assess if you'll need more treatments to reach your goal. Additional treatments will most likely have to wait at least 3 months to make sure the original graft has had enough time to connect itself to your blood supply through new blood vessels.
Weekly Timeline of Results
Recovery and results following a fat graft procedure can vary quite a lot from patient to patient. In fact, while some patients might be able to see their result almost right away regardless of where on their face or body they were treated, others might need to wait several weeks for the swelling to completely fade. It all depends on your body and recovery rate.
In general, most people are able to see their final results slowly revealed over the course of 3 to 4 weeks, or possibly longer when higher volumes of fat are transferred. The main issue that delays the visibility of your results is swelling.
- Week 1
Swelling and bruising can often be rather significant during the first week. Your results might be hard to see, or even completely hidden.
- Week 2
At this point in your recovery, the bruising should be mostly gone, but often some swelling still remains. You'll be able to wear makeup to hide any lingering signs of the procedure, but your results might not be fully apparent yet. There's usually a lot of improvement between the 7th and 10th days, but many people still aren't ready to be seen in public yet.
- Weeks 3 – 4
By the third week most people feel like they're starting to look more like themselves, and the final results begin to be revealed. Once the swelling completely recedes, you'll be able to fully appreciate the changes made to your face, body, or hands. Keep in mind, sometimes swelling can persist for as long as 5+ weeks.
- 6 Months
Several months after your procedure, the newly grafted fat will have reached its full volume, and you can enjoy your final results.
In the end, you can expect a softer, fuller appearance in the areas where the fat was transferred, leaving you looking refreshed and rejuvenated. Many people will also notice an improvement to their skin texture. A fat transfer before and after can be quite impressive. Results can be quite long-lived, usually lasting years.
Limiting Fat Re-Absorption
One of the main concerns patients have for their results is the problem of fat re-absorption. Due to natural processes inside your body, much of the fat that is re-injected can be absorbed by your body, robbing the treated area of volume.
The survival of the fat, and how long results last, depend on a number of factors, including your surgeon’s skill, the process through which the fat was removed, purified, and re-injected, and your own behaviors during your recovery. Depending on these elements, anywhere between 20% and 90% of the transferred fat can be absorbed, though the average is usually somewhere between 25% to 40% when advanced techniques are applied. Experienced surgeons are aware of this loss, and plan for it during the procedure.
There are a few things you can do during your recovery to make sure your fat re-absorption rate is low:
- Wear the proper clothing
In addition to the compression garments your doctor gives you, you'll also need to wear loose fitting clothing during your recovery. Squeezing freshly transferred fat into tight clothing is one of the fastest ways to kill it.
- Be mindful of how you sleep
For the same reasons you shouldn't squeeze your new fat graft into tight clothing, you shouldn't sleep with your weight on the graft for at least 2 months. For facial fat transfers, sleep on your back, keeping your face out of the pillow. Breast augmentation patients should sleep on their back as well. Buttock augmentation patients, on the other hand, should sleep facing down to keep weight off their backside.
- No smoking
Your transferred fat needs to make a connection with your body's blood supply in order to take hold in its new location, and flourish. Smoking prevents that from happening. Cigarettes affect the flow of oxygen and nutrients through the blood stream, effectively crippling your body's ability to heal. For newly transferred fat, this means certain death.
- Feed the fat
During your recovery phase, your body will need extra calories to continue to provide your transferred fat with blood. Eating nutrient-rich foods with healthy fats will help your body form a lasting connection with the graft, and ensures most of it isn't re-absorbed.
There isn't really a way to accurately predict how long the results of a fat graft will last, but under the right circumstances they can last for a very long time, with some surgeons claiming permanent results.
Side Effects & Risks
As with every medical and cosmetic procedure, fat grafts include a certain risk of side effects and complications. Far and away the most common side effects reported by patients are swelling and bruising, but other complications can be seen at both the donor and injection sites.
Some of these other complications and risks include:
- Seroma or hematoma, which are blood or fluid accumulations under the skin
- Reaction to the anesthesia
- Damage to the underlying structures
- Skin or fat necrosis
- Loss of sensation
- Permanent skin discoloration
- Fat embolism
- Blood clots
- Poor or unexpected results
Pricing — How Much Does a Fat Transfer Cost?
There are a lot of factors that go into calculating the cost of a fat graft treatment. One of the most important of these factors is the reason for the graft. For example, if you're applying the fat graft to a lip enhancement, the price will be very different from that of a procedure to augment your breasts or butt. The size or extent of the treatment area also plays an important role in determining cost.
The anesthesia used, where the procedure is performed (i.e. as an outpatient or in-hospital procedure), your doctor's skill and experience, and even your geographic location can all play a role in what you actually pay for the treatment.
In general, you can count on fat grafts costing more than other injectable fillers like collagen, Sculptra, or Restylane, but even that can be difficult to predict. They are, however, consistently more expensive than liposuction alone. This is simply because liposuction is only the first part of a 3-part process.
The fat transfer to face cost can reach anywhere between $350 for a smaller procedure, to $5,000 for more extensive treatments. On average, facial treatments can cost about $450 to $750, and between $900 and $1200 for the lips.
For breast augmentation, fat grafts can cost between $4,000 and $15,000. Lastly, the fat transfer to buttocks cost generally falls between $6,000 and $9,000, depending on the amount of work to be done. These prices may or may not include touch ups at a later date. Be sure to find out what is and isn't included in the fees well before your procedure. You won't want any unpleasant surprises.
Unfortunately, fat grafts done purely for cosmetic reasons are never covered by health insurance. However, if the procedure is medically necessary, like when done to repair scars or to treat localized fat-loss after an injury, some or all of the cost might be covered. If you think this might apply to you, ask your doctor about insurance coverage.
Because the cost of the fat graft procedure varies so wildly from patient to patient, and goal to goal, it's easy to imagine the price ballooning up to something you can't easily afford. Luckily, most dermatologists, cosmetic surgeons and other medical practitioners who offer this procedure also offer easy financing plans. Be sure to discuss all your financial options with your doctor during your initial consultation.
Fat Graft FAQs
What is fat grafting?
Fat grafting is when fat is transferred from one area to another. Autologous fat transfer is when the fat is taken from your own body and reinjected into another part of your body.
What’s it for?
Fat transfer is used to enhance volume and erase contour irregularities.
I have hollow eyes. Can fat transfer help?
Yes, the area around the eyes can benefit from fat transfer. Hollowness and dark circles can both be improved. However, there are mixed reviews on fat injections for the eye area, with complaints regarding undesirable bulging.
How much fat can be transferred?
This depends on the patient and their goals. When the face is treated, only a few cubic centimeters (cc’s) of fat are typically needed. When the buttocks or breasts are treated, a hundred or more cc’s may be necessary. The amount of fat that is taken from the donor site is usually about two times more than what would be reinjected.
Can I get it done at a doctor’s office?
For small volumes of fat transfer, typically for the face, the procedure can be performed in your doctor’s office. For fat transfer breast augmentation or a Brazilian butt lift, the procedure is performed in a surgical facility.
Will the skin at the donor site get saggy?
When a lot of fat is removed, your skin will need to tighten up to the leaner contour. Wearing your compression garment will help this process along. If only a few cc’s of fat is removed from the donor site, loose skin won’t be an issue.
Can I get it done more than once?
Yes, as long as you have sufficient fat to transfer, the treatment can be performed more than once. In fact, you may need more than one treatment to achieve your desired results. Usually, you’ll need to wait a few months before having another procedure done. This allows for enough time to recover from the first procedure and for the majority of swelling to subside.
I don’t have enough fat. What can I do?
Your doctor may recommend that you gain weight. This should be done in a controlled manner, so you don’t gain too much. After a certain period of time, your doctor will examine you to ensure you’ve gained enough.
Can someone else donate their fat to me?
Unless that person is your identical twin, you won’t be able to use fat from another person. It must be your own. This is because fat from another person would be considered a foreign object, and your body’s immune system would react by attacking it.
Fat transfer vs implants: which is better?
The answer to this question depends on the amount of fat you have available and your goals. Generally speaking, fat transfer has a shorter recovery period and you won’t need to worry about having a foreign object in your body. However, if you don’t have enough fat to transfer to your breasts or buttocks, then you may have no choice but to opt for synthetic implants to get the volume you desire. The implant is generally constructed from silicone.
Can I use fat from my breasts?
Most surgeons avoid using the breasts as a donor site because there is often an insufficient amount of fat available to fully achieve desired results. Some doctors are also concerned about the risk of spreading cancer cells from the breasts to other parts of the body.
Can fat grafting help give me better cleavage?
To a certain extent, fat grafts can help improve cleavage. The fat would be placed in the area of the cleavage and upper portion of your breasts. However, you should know that it can only do so much. So, if you have a considerable gap between your breasts, this may not be helpful.
How long does the procedure take?
Small areas, like the cheeks, may take about an hour while larger areas, like the buttocks, may take anywhere from 3 to 5 hours.
Can I save my fat for later?
While it is possible to freeze fat for later use, the process may compromise survivability so not many doctors recommend it. Therefore, if you need to have another treatment performed, chances are you’ll need to go through the whole process of removing fat again.
How long do results last?
Once the fat has “taken”, results are permanent. However, the effects of aging and weight fluctuations can negatively affect results.