Expert Doctor

Fat Grafting

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Robert True, MD

Colleyville, TX

Fat Grafting

When people consider the effects of aging on the human body, they often think about gray hair and sore joints.  Not many people stop to consider the impact of aging on the fullness of the face and other areas of the body.  If a person finds they are lacking volume and fullness in certain parts of their body, they might be a good candidate for a fat grafting procedure.



Fat grafting is necessary for some people because they are lacking fullness in certain areas of their body. The fullness has disappeared for one reason or another. Certainly age can decrease the fullness in the face and in the buttocks area. In other words, as a person gets older, there are certain areas on the face that will lose its volume. If you look at the face of a young person they have nice well-formed cheeks without any kind of sunken look. The buttocks are another area where some people do not have enough fat there because of genetics. When people lose fat in the buttocks area, that area needs some pumping. Same thing with the breasts because there is fat that is present in the breasts and some women just do not have enough fat in that area.

A doctor will perform some liposuction on other areas of the body to harvest the fat. Once it processes, the fat is then reinjected into those areas of the body that have lost volume. It can be an outpatient procedure or it can be a procedure that is performed while the patient is awake.



The best results from fat grafting come when treating smaller areas, like the face, so not as much fat has to be used. The thing about the fat is when it is inserted into the subcutaneous tissue there has to be good ingrowth of the natural vessels. The microcirculation has to grow into the fat to feed the fat. Otherwise, the fat will just go away. If it does not get nourishment, it just dies off. There will be anywhere between 30%-50% reduction in the amount of fat that survives simply because the microcirculation did not get there. However, there are systems and techniques to try to increase the development of the microcirculation to grow into the fat.

One of these techniques is called PRP (platelet rich plasma). It is when some blood is harvested from a person and the doctor then spins it down in a special way to get the platelet rich plasma portion from the blood. That portion of the blood is the part that has growth factors. When a person has a cut, the cut will heal together. There is this little sticky glue that comes out of the cut called the platelet rich plasma that has the growth factor. The growth factors stimulate growth of the microcirculation into the cut. It also stimulates the fibroblast and the tissue cells to grow into the cut so it will heal after a few weeks.

The initial process is stimulated by the growth factors that come from the platelets. Doctors get those platelets, concentrate them and then reinject them into the areas where the fat grafting occurs. Doctors mix the fat with the PRP and inject them into the areas that are being augmented. The PRP increases the chances of the survival of the fat which stimulates the micro circulations. And when that happens, there is a better survival rate and a nice area of fat development.



If a person has a lot of volume loss in the face, it is recommended that they do fat transfer. In addition to that, they might want to add some other procedures along with it like a CO2 laser, which can smooth the skin, decrease fine wrinkles and fade age-spots and pigmentations. When a person loses fat a lot of times it can be secondary to the aging process. They get a sunken look right below the eyeballs, in the cheek area, and different areas on the face. These areas need a reinjection of the fats. If they have a lot of volume loss, patients can pay for different fillers to plump up the areas but they only last about a year. A doctor can do a lot more volume in fat. Facial fillers might cost about $675 but it takes 5 or 6 CC’s in the face to get good results, which runs up the cost. A patient can put 30 or more CC’s of fat into their face and get a nice result that lasts about a year or two. The key fact of this procedure is that it is the patient’s fat and volume being put in the tissues. Too much filler can give a dull look to the face simply because it is not the patient’s tissue. Putting fat in there, along with the microcirculation that goes into the fat, gives a nice fullness and natural color.



If a woman wants a mild breast size increase, a fat grafting procedure to the breast is a great idea. There can only be so much fat put into the breast and have it take. A doctor can put around 400 CC’s in the breast but only about half that much might survive simply because there is not that much sub-Q tissue that will grow into the new fat cells. Women who want a lot of volume might be better off doing an augmentation. Women who do not want the augmentation find fat transfer to be an ideal solution.



A lot of people do not have as nice of a volume or the right curvature in their buttocks as they would like so they are good candidates for buttock augmentation. This procedure is designed to make the whole back and buttock area conform to the best curvature for a woman.

In other words, there has to be a decrease of volume in the lower back and the waist needs to curve in. When the fat is harvested for the buttock transfer, patients are encouraged to have liposuction done in the muffin top and waist area.  The fat grafting method gives a fuller look as well as contouring the body.

It should be noted that some women do not have enough fat to put in the buttocks or the breast. These women may want to do buttock or breast implants.  Instead of fat, the implants can improve the form and volume of these areas.



A person who smokes can pretty much forget about doing fat transfer. Smoking decreases the oxygenation to the tissues and they will not heal well. A person should stop smoking two to three months before having a fat transfer to give the tissue enough time to start rejuvenating itself and to get rid of the bad hemoglobin. When a person smokes their body produces an excessive amount of something called carboxyhemoglobin. Carboxyhemoglobin uses up the good hemoglobin and does not allow the maximum amount of oxygenation of the hemoglobin to occur.

If a person has bad diabetes, the procedure will not work well on them either. Diabetes is a microvascular disease. The microvascular system of a diabetic just does not work very well and if fat is put into the areas of a diabetic person it probably will not survive post injection.



A healthy body is very important for fat grafting. A person needs to have good tissues since they are relying on the microvasculature to go into the fat and feed it. If a patient has good health, good tissue, good nutrition, and good circulation then there is a higher chance that the fat will survive.



The number one misconception about fat grafting is when the fat is put in an area all of it is accepted. The reality is when fat is put into an area the patient sees maybe 50% of what they are going to see when the final results are visible. In a lot of people, within two to four weeks they will see a nice volume but it does not stay forever. Naturally we still age as well hence our biology.



For the facial area, the fat grafting procedure works very well. It lasts about a year or two but the patient will still age. People need to have realistic expectations because it will not last forever. Even a face lift does not last forever. Most plastic surgeons say a facelift will last anywhere between five to ten years. There is a difference in ideas now about face lifting. It is not just lifting and tugging and pulling on the skin. It is also enhancement of the volume. Most plastic surgeons now combine a face lifting surgery with some sort of volume enhancing procedure on the face using the fat to make it look better.

Some people call that fat balancing on the face. The surgeon is balancing the fat in the face and making it look young again. There is the idea that the person is going to get a lot of fat transferred there and they are going to have a lot of volume. Unfortunately, it just does not work out that way.



Some people think that fat grafting is a totally benign procedure. That is not true because there is the possibility of infections. The fat can bring in bacteria and cause a little infection. Also, there can also be fat necrosis which is essentially little cystic areas of fat inside the tissue that causes a little lumpiness. It is not that common but it can occur and people need to realize the procedure is not totally benign. Most of the time everything goes well without infections, increase in bleeding, or other complications.



The downtime for fat grafting is variable. For the face, there is maybe three to seven days of downtime due to swelling. If bruising is present, it is usually present for two to three weeks and can be covered up with makeup after about a week. Even if a person does the CO2 laser using the fractional method makeup can be put on the face within about a week.

On the breast and buttocks, there is not a lot of restrictions after the procedure. They need to take it easy for a day or two but then they can go back to normal activities. The only thing with the buttocks is that a person has to be careful sitting down. Any kind of pressing on the fat will compress it and the fat is just not going to survive. To prevent this problem, the patient has to sit down a certain way. They cannot sit on the back part of the buttocks because that is where the fat was placed. After two weeks results are more set and they can resume normal sitting posture.   



When liposuction is done via the tumescent method, people can usually go back to normal activities the next day. During this method, the procedure may be performed while the person is awake. Afterwards they are a bit sore, have to wear a garment, and drain a little bit, but they can resume most activities quite rapidly. 

The main limitation is the fact that the patient has to have enough donor fat for the procedure. It is very difficult to get enough fat to harvest for reimplanting from women who are very thin and skinny. The face does not require a lot of fat. The face might use 20 or 30 CC’s of fat that will be harvested from some place on the body. In some thin women, it is still a challenge to do that so those women have implants in the face or fillers as their only options.



Most people see great results within one or two weeks.  A lot of fluid has gone away, the swelling is gone and they see a nice enhancement of their tissues. While some patients do see a pretty good amount of improvement after two weeks, it does take others a little bit longer for the fluid to go away. It is a little longer before they know how much volume is going to stay but, generally speaking, it is somewhere between two to four weeks.

Over the next three to six months, they might see a reduction in the enhancement because they start losing volume as the aging process continues.



Fat grafting is a good option for patients who want to add some volume to various parts of their body without the use of an implant. Whether or not a person is a viable candidate for a fat grafting procedure depends on their overall health as well as their available amount of donor fat. Potential patients should consult with an experienced doctor before making a final decision to undergo a medical procedure.


Written by Cosmetic Editorial Team- MA

Based on an exclusive interview with Dr. Robert True in Colleyville, TX