Autologous fat transfer, also called fat grafting, is a procedure in which a limited amount of the patient's own fat is harvested by gentle liposuction from a donor area such as the abdomen or thigh, then processed and injected in small aliquots and multiple layers into the area that needs volume restored. It is used for hollows of the face, temples and under-eye area, for the back of the hands, to correct deformities after surgery or trauma, and to lift depressed scars and irregular contours after liposuction. The advantage of using your own fat is that it is living tissue from your body, so there is no risk of a reaction to a foreign material, and the result can be long lasting once the volume settles. However, a proportion of the injected fat is reabsorbed in the first weeks and only the remainder can be relied on, which is why the final volume is usually judged three to six months later and a top-up session may be needed. No specific volume and no perfect symmetry between the two sides can be promised. The limits must be stated clearly. Fat grafting is not a treatment for obesity and not a slimming procedure: the volume harvested is small and its purpose is restoration, not weight reduction. It restores lost volume but does not tighten loose skin, so it is not a substitute for a lifting operation when there is significant laxity. It does not necessarily correct fine superficial wrinkles, it does not change bony structure, and lumps, contour irregularity or oil cysts can occur and may need treatment. Very lean patients may simply not have enough donor fat. Candidacy is determined by clinical examination and your doctor's assessment of your skin quality, donor areas and goals. Tell your surgeon if you are planning to lose weight, because weight loss after grafting reduces the volume that remains. If fat is grafted to the breast, you must inform the radiologist at any later imaging, since grafted fat can produce calcifications or oil cysts that complicate interpretation. Fat injection to the buttocks carries serious risks related to fat embolism and should only be performed by a trained surgeon using a safe technique.
Procedure steps
- 1
Assessment, planning and choice of donor area
The volume deficit, skin quality, degree of laxity and availability of donor fat are assessed, and realistic goals are clarified along with the difference between restoring volume and tightening skin. Documentation photographs are taken and the recipient and donor areas are marked before the procedure.
- 2
Harvesting the fat at low negative pressure
After local anaesthesia, local anaesthesia with sedation, or general anaesthesia depending on the extent of work, the donor area is infiltrated with an anaesthetic solution that also limits bleeding, and fat is then aspirated through fine cannulas at low negative pressure to keep the fat cells viable.
- 3
Processing and purifying the graft
The fat is separated from fluid, blood and free oil by decanting, washing or gentle centrifugation, and the graft is prepared with the particle size suited to the target area, finer for the eyelid and delicate lines and larger for deep volume.
- 4
Injecting small aliquots in multiple layers
Fat is injected through fine cannulas along multiple passes, depositing very small amounts with each pass, because contact between every part of the graft and well-perfused tissue is what allows it to survive. Dense deposits in one point and intravascular injection are avoided, and symmetry is corrected gradually.
- 5
Follow-up and judging volume after it settles
You are observed briefly and usually discharged the same day, then reviewed during the first weeks to assess swelling and symmetry. The final volume is normally judged after three to six months, and the need for a top-up session is discussed at that point rather than earlier.
Before the procedure
Stop smoking and all forms of nicotine, usually for two to four weeks before and after the procedure, because nicotine reduces perfusion and lowers the survival of grafted fat. Tell your surgeon about every medicine and supplement you take, especially blood thinners, antiplatelet drugs and supplements that increase bleeding, and do not stop anything on your own. Report any previous cosmetic procedure or material injected into the area, any autoimmune disease or diabetes, and any active skin or dental infection. Keep your weight stable beforehand and do not try to gain weight to provide donor fat. Fast according to the anaesthetic instructions, usually six to eight hours. Bring the compression garment for the donor area if requested, wear loose front-opening clothing, and arrange for someone to take you home.
After the procedure
Expect swelling and bruising at both the donor and recipient sites, peaking in the first two days and easing over one to two weeks, with the volume initially looking exaggerated. Do not press or massage the grafted area and avoid sleeping on it for about one to two weeks, and avoid sauna heat, direct sun and vigorous exercise for the period your surgeon specifies. Wear the compression garment over the donor area exactly as prescribed, avoid smoking, and keep your weight stable, since losing weight reduces the volume that remains. **Seek care immediately if you develop fever, spreading redness, pus or odour, severe pain out of proportion, pallor, a bluish or mottled appearance of the grafted skin, shortness of breath, chest pain or sudden neurological symptoms, or loss of vision or severe eye pain after facial injection, as these are emergencies that must not wait.**
Expected duration
A session usually takes one to three hours depending on the number of areas and the volume required, and most patients go home the same day.
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