Are you bothered by sunken cheeks or deep nasolabial folds (deep grooves from the nose to the corners of the mouth)? Do you want fuller lips? Are you a breast cancer survivor looking for reconstruction after breast surgery without increasing your recurrence risk? A cosmetic surgical procedure called lipofilling can help.
What is lipofilling?
Lipofilling, also known as fat grafting or fat transfer, is a well-established technique in which the plastic surgeon takes fat from one area of the body, such as the belly or inner thigh, and uses it to fill irregularities and grooves in another part of the body, such as the face. Lipofilling is also used for breast augmentation and breast reconstruction in patients who have undergone treatment for breast cancer. Lipofilling can correct deformities caused by breast cancer without increasing cancer recurrence rate. Fat grafting can be used to enhance the contour of the hips and buttocks with a procedure that is popularly called a Brazilian butt lift.
Lipofilling is a type of autologous fat transfer, meaning the surgeon uses the patient's own fat tissue for soft tissue augmentation. The advantage of lipofilling is that the body does not recognize autologous fat as a foreign substance. As a result, the grafted fat tissue is easily incorporated into the surrounding tissues in the treated area.
How is lipofilling done?
To perform lipofilling, fat is harvested through small incisions in the abdomen or inner thigh. The lipofilling fat is then processed in a centrifuge machine and filtered and rinsed to remove debris and impurities. The purified fat cells are then injected into areas that need correction, such as for filling deep wrinkles and folds or enhancing the contour of the breasts or butt. The plastic surgeon injects very small amounts of the fat graft into the target area where it is surrounded by healthy tissue.
How long does lipofilling last?
As noted, lipofilling can be used to correct deep wrinkles and nasolabial folds or any irregularities that need filling. It can also be used to augment volume in areas like the cheeks, chin, and breast. After the fat injection, the body absorbs some percentage of the fat cells that were transplanted (20% to 50%). This occurs over a period of several weeks to months. After this, the correction obtained with the lipofilling technique can be considered permanent. In general, the results you get 3 months after the lipofilling will be permanent.
How long does it take for the final result to be visible? When do the bruises from lipofilling disappear completely?
It is not unusual to have some mild bruising, swelling, and tenderness in both the donor area and the treated area. You can use a cold compress to minimize swelling and discomfort. On the third day or so after lipofilling, the swelling begins to subside. Bruises can take a little longer to go away, but can be covered reasonably well with makeup. In about three weeks' time, most of the bruising and swelling from lipofilling will have subsided.
The treated area can look a little exaggerated to begin with. This is because the plastic surgeon typically over-corrects, meaning they inject more fat tissue than is needed. This is to account for the 25-30% of autologous fat that usually does not survive. The final result of the fat transfer is assessed 3 months after the autologous fat grafting procedure. At this time, the surgeon will show you before and after pictures for comparison. A second lipofilling session may be necessary in some patients to make up any shortfall in desired volume.
Is lipofilling safe?
Lipofilling is a versatile technique and an effective cosmetic procedure with a good safety record. The technique utilizes a neutral biological material, i.e., autologous fat, to restore or enhance body contour. Because the autologous fat is obtained from the patient themselves, lipofilling is a safe technique with a low risk of complications.
What are the side effects of fat transfer?
As noted, you will likely have some bruising, tenderness, and swelling in the donor area and treated area for a few days after the fat grafting. More serious side effects of lipofilling include asymmetry, over-correction, irregular contour, and infection. You can reduce your risk of complications from fat grafting by choosing a plastic surgery office staffed by board certified surgeons who have extensive experience with lipofilling.
How should you prepare for lipofilling surgery?
Before scheduling your lipofilling procedure, your surgeon will go over the preoperative instructions with you in detail and answer all your questions. They will obtain a detailed medical history and perform a physical examination to ensure you are a good candidate for aesthetic fat grafting. It is normal for the surgeon to take "before" photos for comparison after the lipofilling .
In preparation for your fat grafting, you should stay well hydrated. This can help ensure a safe recovery and good outcomes from the lipofilling.
If you are a smoker, you should stop smoking at least 6 weeks before your scheduled lipofilling. Your surgeon may also ask you to stop taking aspirin and NSAID medications like Advil and Motrin in preparation for the lipofilling because these medications can increase the risk of bleeding.
On the day of your lipofilling treatment, you should arrange for someone to drive you home after the fat grafting. It is also recommended that you have someone stay with you at least for the first 24 hours.
What happens during the lipofilling procedure?
The time it will take to complete your lipofilling fat grafting will depend on how much fat needs to be removed at the liposuction donor sites. A smaller amount of fat is needed for facial correction as opposed to breast reconstruction or buttock augmentation.
You will be given medications to keep you comfortable. Fat grafting can be performed under local anesthesia, but intravenous sedation or general anesthesia may be necessary for larger volume fat grafting procedures. The type of anesthesia will depend on the extent of the lipofilling.
During the lipofilling procedure, your plastic surgeon will follow the surgical plan discussed with you but may make changes along the way to ensure the best results.
Once the fat injections are completed, you will be taken to a recovery area for close monitoring. You will be allowed to go home after a short period of observation, unless your surgeon decides otherwise.
What should you do after lipofilling surgery?
Your doctor will tell you when it is okay to return to a normal level of activity after lipofilling. You will receive instructions about caring for the donor area and treatment site. This includes the care of drains, if any drains have been left in place at the site of the fat grafting. You will also be informed about the normal symptoms to expect, such as tenderness and swelling. Your doctor will talk to you about potential signs of complications that you should be vigilant about.
After about a week of the lipofilling, the swelling and bruising will subside and you will be able to go out professionally and socially. Most patients take one week off work, but if you can afford to take two weeks that is even better. By the third week after fat grafting, you will start to look and feel like yourself again. You can camouflage any remaining bruising with makeup at this point.
Can I get this surgery if I'm a cis woman?
The typical male and female bodies are different in terms of shape and silhouette. Lipofilling fat grafting can be effectively used to feminize a person's body shape, including cis women. The lipofilling technique is often used in transgender patients to contour the shape of the buttocks and hips. The same can be done for a cis woman to achieve a more feminine shape and curves.
Breast reconstruction with lipofilling
When the lipofilling technique was first developed, it was not recommended for breast reconstruction or breast augmentation for fears that the fat grafts would lead to scarring. However, over time doctors realized that other procedures performed on the breast also lead to scarring, often more than what occurs after lipofilling fat injection. Doctors also studied case reports and found no definitive evidence to support these concerns about breast scarring. Over the years, there have been significant refinements in the breast lipofilling technique in terms of how the injected fat is obtained, processed, and transplanted.
Obtaining adipose tissue for autologous fat grafting in the breast
Tumescent fluid consisting of IV saline, local anesthetic, and epinephrine is injected into the donor area. A blunt cannula is used to suction adipose tissue (fat cells) from the area. Some doctors use a dry method without tumescent fluid.
Improving the viability of the fat graft
Following the harvesting of the fat cells, several strategies are employed to ensure the survival of the autologous fat. These include centrifugation to obtain a concentrate of viable fat cells and reduce the incidence of post-procedure volume loss. Other methods of processing the autologous fat include sedimentation and rinsing the fat cells with saline to remove debris.
Role of stem cells in fat harvesting and fat grafting
Doctors are increasingly recognizing the role of stem cells in promoting the viability of structural fat grafting. Stem cells are progenitor cells that can mature into various types of body tissues. Some of the techniques used during autologous fat transplantation, therefore, aim to retain adipose tissue stem cells. Sometimes, doctors use a technique in which the fat graft is enriched with adipose derived stem cells. The ultimate goal is to increase the viability of the fat grafts at the recipient site.
Mega-volume autologous fat transplantation
Another method that has been described involves pre-procedure tissue expansion over several months followed by mega-volume fat grafts. It is believed that this lipofilling technique leads to an increase in vasculature (number of blood vessels) that can support larger volumes of fat transfer. This is a cumbersome process and requires a fair bit of dedication from the patient but may be useful for patients needing large-volume breast reconstructions after breast cancer surgery.
Safety of lipofilling in patients with breast cancer
Some concerns have been raised about the effect of fat harvesting and autologous fat grafting in the breast in terms of oncological safety. There is, however, no scientific evidence to support these concerns. Studies have found that there have been only a handful of patients who developed breast cancer after a lipofilling procedure in the breast. There is no evidence that the fat transfer was a causative factor in these cases. Hundreds of patients have been followed for a decade or more and there is no evidence to suggest that lipofilling or grafting of adipose tissue in the breast can lead to breast cancer or increase the risk of recurrence of breast cancer. Therefore, breast cancer patients can undergo lipofilling safely without risk of locoregional recurrence.
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