Fat Grafting Today
Like most Board Certified Plastic Surgeons, I perform fat grafting for selected patients. Facial Augmentation, Brazilian Butt Lifts and to help with contour deformities (indentations) are the most frequent reasons. Dents left after surgery, like a large breast biopsy, do not respond well to Breast Implants, but Fat Grafting can fill in the area nicely. On the other hand, for normal breasts that need significant enlarging, Breast Implants remain the safest and most reliable choice. Fat transplantation, or Lipofilling, for Facial Augmentation, the Brazilian Butt Lift and Breast Enhancement are discussed below.
Fat For Facial Augmentation
Fat is still used most commonly for Facial Augmentation, especially dents or wrinkles caused by aging, injury or disease. Fat has been replaced by Dermal Fillers for most routine facial age management. Restylane, Juvederm, Perlane, Voluma, Radiesse and others provide clean, convenient, readily available stuffing for lips, cheeks and facial wrinkles. Plus, for the HA based fillers, bad results will go away with time, or can be reversed more quickly by injecting hyaluronidase. For selective patients, fat grafting may provide longer lasting results. However, poor results from fat grafting is also more permanent, so choose your procedure and your plastic surgeon wisely.
The Brazilian Butt Lift
In experienced hands, Fat Grafting to the buttocks often gives better results than butt implants. This is especially true when the goal of a Brazilian Butt Lift (BBL) is more than just to increase the size of the bum. BBL fat grafting can be contoured to change the shape of the buttocks, rather than just to enlarge them. Other fillers have been tried, but none are FDA approved. Off-the-shelf products, like PMMA and silicone, have lead to many disastrous results and should be avoided.
Breast Augmentation With Fat
For routine Breast Augmentation, Breast Implants are still superior to fat grafting. Fat grafting has been an option since long before Breast Implants were invented early in the 1960’s.
Did you know that the poor results achieved with previous methods of Breast Enhancement is why breast implants were invented? Over 50 years ago, breast implants quickly replaced all other techniques, including fat grafting, because of the implant’s enhanced safety and predictability. I am not saying Breast Implants are perfect. Even with the latest advancements in silicone technology and manufacturing they are not, but they remain the best method for Cosmetic Breast Augmentation.
Limitations of Fat Transfer to the Breasts
The limitations of fat grafting are well documented, but here some of my concerns with fat grafting to the breast:
- You need some fat to graft. Many of my patients with small breast also have very little fat. Often, there is not a large enough volume of spare fat available for Breast Augmentation. On the other hand, there is almost always an appropriately sized breast implant available.
- The amount of fat that can be transferred is limited by the available blood supply. Even with unlimited fat, the breast augmentation that is reliably achieved with fat is often smaller than the augmentation that can be provided with breast implants. I have done breast augmentation for women who were disappointed by the amount of augmentation provided by fat grafting. Breast Implants were able to provide them with a more desirable breast size.
- Fat is unpredictable. Sometimes, 100% of the graft takes, sometimes only 50% takes. As a result, fat grafting does not always fill uniformly. This often leads to irregular contours and the need for additional fat grafting. Breast Implants come in predictable sizes with specific dimensions.
- When fat grafts fail, cells die. Sometimes, after a period of inflammation, the dead cells just go away. Sometimes, they form hard lumps which can be felt, and calcifications which can be seen on a mammogram. The calcifications from dead fat are usually larger than the calcifications seen from cancer, but occasionally the calcified areas need to be biopsied to be certain they are not cancer. If there are many calcifications, this may interfere with the screening for breast cancer. Breast implants can fail too, but they can be removed and replaced with a new one.
- When fat grafts fail, cells live. Now I know this is the desired result. It is important to realize that the fat cells that survive the transplantation procedure do not know that they are in a new place. They will continue to shrink and enlarge as your weight changes. If you lose weight, you will also loose fat graft volume. Alternatively, if you gain weight, your grafts will enlarge and not always evenly. Breast implants do not change volume.
- Donor sites need to heal, too. Fat grafting requires fat harvesting. With the advent of Liposuction, fat harvesting has become much simpler and efficient. On the other hand, removing the fat for grafting has all the risks associated with Liposuction. The donor site will be sore. It needs to heal, and just as importantly, needs to have an aesthetic contour. Breast Implants do not have a donor site.
Plastic Surgery Consultations
There are many more specifics to discuss. I will continue the discussion next week. If you would like to get the specifics that apply to you, schedule a consultation appointment by calling (925) 943-6353. Our San Francisco Bay Area Plastic Surgery office is open weekdays 9 AM to 5 PM, and we offer a wide variety of Cosmetic Plastic Surgery procedures.