Frequently asked questions about structural fat grafting (fat injection)

How is structural fat grafting (fat injection) done ?
Is everyone suitable for treatment by fat grafting (injection) ?
Before treatment - how do I prefer for fat injection surgery ?
In hospital - what happens when I come in for fat grafting (injection) surgery?
After treatment - What should I expect once I get home after fat grafting?

Is fat grafting safe? What are the risks?
How do I arrange a consultation about fat grafting with Mr Hamilton in London, UK?

How is structural fat grafting done?

Fat is removed by very gentle liposuction in areas of the body with fat deposits such as the tummy, hip, outer thigh or around the knees. The fat is then purified and very carefully re-injected into the affected areas, carefully re-building the desired three-dimensional structure.

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Is structral fat graft or fat injection suitable for everyone?

No. Correction by fat grafting alone is usually best reserved for those with early aging changes, requiring a moderate change in contour and skin tone or those with post-traumatic or post-liposuction defects.

Those with more extensive changes or desiring a more dramatic correction are usually best treated with other surgical techniques. However, in many of these cases, fat grafting can be used very effectively in addition to give a better overall result.

Fat grafting to the lips for increased fullness can be used in many cases and has a similar (though longer lasting) effect to that seen with non-permanent fillers.

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How do I prepare for fat injection surgery?

Where possible, it is important to avoid aspirin or non-steroidal anti-inflammatory drugs such as ibuprofen (Brufen) and diclofenac (Voltarol) for two weeks pre-operatively. These drugs reduce the ability of the blood to clot and can make bleeding more of a problem during and after surgery.

Smoking can increase the likelihood of wound problems and abstaining from smoking for at least 2 weeks preoperatively and postoperatively is a sensible precaution.

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In hospital - What happens when I come in for fat grafting / fat injection?

You will be admitted to the hospital on the day of surgery and be seen in the ward by Mr Hamilton and the anaesthetist. The areas intended for correction will be re-discussed and some pen marks placed on your skin to guide the surgery.

What type of anaesthetic will be used for the fat grafting procedure?

Structural fat grafting is usually carried out under general anaesthetic as this allows the fat to be harvested and injected painlessly. Occasionally small areas can be treated using local anaesthetic.

What does the fat injection or grafting operation involve?

In theatre, Mr Hamilton will aspirate the required amount of fat from the area discussed before surgery – usually the tummy or hips. The fat is then purified using special equipment to give the best quality fat for re-injection. The fat is then injected at the site for correction, carefully layering and shaping it for the desired effect.

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After treatment - what should I expect after fat grafting treatment?

Will there be scars after fat grafting?

Usually, the fat is removed through very small scars hidden in skin creases or near the belly button. These are usually almost imperceptible after they have healed. Similarly, tiny stab incisions are made for injection on the face and are usually virtually invisible after they have settled.

What happens after fat injection (fat grafting) treatment?

Typically, after a gentle night in hospital, you will be able to go home the following morning. It is best to take things easy, avoiding bending down too much and exercising for several days. There is usually some bruising and swelling which settles considerably over the first week after treatment.

Depending on the exact procedure, you will be seen back at the consultation room 7 to 10 days after surgery when the sutures will be removed and general advice on recovery and scar management to speed up your progress will be given.

Typically, another review appointment will be made thereafter to see the final result.

Does the fat disappear with time after fat grafting?

Some of the fatty tissue does not “take” and will slowly melt away. In most cases, the large majority of the fat will stay permanently, though, of course, changes to fat deposition will continue naturally over the years.

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Safety and potential risks

Fortunately, the risk of significant, long lasting complications in structural fat grafting is very small indeed. There are some problems which can develop though these tend to be temporary and short term.

• Bleeding under the skin (haematoma) – due to different local anaesthetic solutions and careful anaesthetic technique, this problem is seen less frequently in modern facial rejuvenation. It is seen more commonly in patients taking blood-thinning medication such as aspirin and other non-steroidal painkillers such as ibuprofen (Brufen) or diclofenac (Voltarol). These medications are therefore best avoided pre and postoperatively. In structural fat grafting, when haematomas do occur, they are usually small and settle quickly.

• Numbness and nerve damage – some numbness of the skin overlying the treated area is common after structural fat grafting is normal but very quickly returns to normal. A feeling of “pins and needles” is normal as this sensation recovers. The motor nerves which move the face are very seldom at risk. Cases of damage to these nerves have been described in the medical literature though it is exceedingly rare. In the vast majority of these, recovery was complete over a period of 2 to 3 months following surgery.

• Infection – infection with fat grafting is very rare indeed. However, as with all surgical procedures, infection occasionally occurs and antibiotics are sometimes needed.

• Scars - the scars resulting from fat grafting are usually very small and well hidden In a small proportion of patients the scars can thicken somewhat usually in the first couple of months (hypertrophic scars) and may need some additional treatment to encourage them to settle.

• Excessive resorption (disappearance) of the grafted fat – in rare cases, most of the grafted fat may disappear at an early stage. This is probably more common in smokers but can affect any individual and consideration of re-grafting may be necessary.

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Summary

For the appropriate patient, structural fat grafting can give very pleasing, long-term results. Mr Hamilton will be happy to discuss your suitability for these procedures at you consultation and to give an honest and friendly opinion on the results which might be achieved.

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