Surgery performed by Dr. Schenden and Dr. Elswick
Concepts of beauty have continuously evolved throughout history. With fashion promoting body-revealing attire and the emphasis on fitness and good health, people have sought to reflect these trends by demonstrating youthfulness and vitality in their bodies. Lifestyle, diet, genetics, pregnancy, and the aging process contribute to alterations that result in the loss of the individual’s body image.
Our objective is to provide you with a cutting-edge surgical approach that combines safe and efficient surgical techniques, resulting in a high degree of patient satisfaction. This is exemplified by our approach to fat grafting, which transfers fat cells from one part of the body to another part of the body. Our precise methodology for fat grafting is to individualize the surgical technique while optimizing aesthetic outcome, safety, and down-time.
Fat grafting is a way to transfer fat cells from one part of the body to another part of the body. This is desirable to those who like the idea of using their own body’s cells. The fat is collected via liposuction, processed, and then injected into the desired location. The fat can be harvested from any area with excess or undesirable fat. Typical locations include the abdomen, flanks or love handles, and inner thighs and knees. The fat can be transferred to most parts of the body, the most common locations being the face, breast, and buttocks.
The fat can be utilized in multiple different ways. First and foremost it is used to correct areas of volume loss, which commonly occur as patient’s age. It can also be utilized to enhance areas where patients would like to improve fullness, smooth contour irregularities, or correct asymmetries. Similarly, it can be used to camouflage the edges of a breast implant or improve the appearance of rippling from an underlying implant. If a large volume of fat is required, multiple fat grafting surgeries may be required.
Fat grafting can be used as an alternative, or compliment, to facial fillers, breast implants, and buttocks implants. An advantage of using it in the face is its longevity compared to dermal fillers; this is your own living tissue so once it establishes a new blood supply it lasts forever. If you are having large volume fat grafting, you also have the advantage of removing a substantial amount of unwanted fat with liposuction.
THE BEST CANDIDATES FOR FAT GRAFTING
The best candidates for fat grafting are men or women who have adequate donor sites for their desired results (you must have enough excess fat in your body to transfer to the desired location). For the face, this is typically less than 50 cc of fat (around 2 ounces) but for the breast and buttocks this may require several hundred or even 1000 cc. Patients should be relatively healthy to undergo fat grafting.
The results at the liposuction donor site depend on the volume of fat that is removed. The goal of fat grafting is to obtain an adequate amount of fat to transfer while optimizing the contour of any remaining fat left at the donor site. While you will experience some reduction in volume and improvement in contour at the liposuction donor sites, the results may not be the same as they would be if you were undergoing liposuction for cosmetic purposes.
PLANNING YOUR SURGERY
During the consultation your areas of concern, previous treatments, and plans for weight loss should be discussed in great detail. Patients will have the best long term result from their fat grafting if their weight is stable and they are at their goal weight. A thorough physical examination of your areas of concern will be performed, including an analysis of the amount of excess fat and the quality of the skin.
Any major medical problems will be evaluated and should be optimized prior to surgery to minimize complications. Your surgeon will ensure your questions are answered and your goals are understood. Patient expectations are important to discuss at the consultation.
PREPARING FOR YOUR SURGERY
It is important to maintain a healthy diet prior to your surgery to optimize the healing capabilities of your body. Your surgeon will give you specific instructions to prepare for the procedure, including guidelines on diet and medications. Patients using tobacco or other nicotine-containing products must stop at least four weeks before and after surgery. Carefully following these instructions will help your surgery and your recovery proceed more smoothly.
WHERE YOUR SURGERY WILL BE PERFORMED
Your surgery can be performed at Columbia Surgery Center (our private outpatient surgical suite adjacent to our office) or at one of the local hospitals. Dr. Schenden has privileges at William Beaumont Hospital of Troy, where he is currently Chief of Plastic Surgery, and Dr. Elswick has privileges at William Beaumont Hospital of Troy, William Beaumont Hospital of Royal Oak, and McLaren Macomb Hospital. Fat grafting is usually an outpatient procedure unless you have another surgery that requires an overnight stay in the hospital.
TYPES OF ANESTHESIA
Fat grafting can be performed under local anesthesia with or without sedation or general anesthesia depending on your preference and the other procedures being performed.
To begin, liposuction is performed at the donor site where you have unwanted fat. To access the fat, several small incisions are made surrounding the area that will be liposuctioned. The incisions are typically about 5-7 mm in size and are hidden in normal skin creases. A solution called tumescent is injected in the fatty deposits to help break up the fat, provide anesthesia (numbing of the area), and help minimize. After the tumescent solution takes effect, the liposuction cannula is used to break up and remove the fat. Taking the appropriate amount of fat and blending it with the surrounding tissue is extremely important so you end up with a nice contour.
The fat is then processed using various filters to remove excess fluid and unusable fat. It is transferred to small syringes and then injected into the desired location through small incisions or needle holes in very small volume aliquots, which enhances survival of the fat.
Studies show that approximately 60-80% of the fat that is injected survives. There are several reasons for this. Some of the fat that is injected also contains fluid that was utilized during the collection period. Also, the new fat cells must obtain their nutrition from the surrounding tissue where they are injected and not all the cells will have the ability to do so. Hence, your surgeon may slightly overfill the area to compensate this so you get the desired outcome.
Since fat grafting is performed in conjunction with other procedures the length of the procedure depends upon what additional procedures are being performed. In general, fat grafting takes anywhere from 45 minutes to 1.5 hours.
AFTER YOUR SURGERY
Dressings at the fat grafting sites vary and may include no dressing or a combination of Steri strips, gauze, and tape. If you have facial fat grafting, no sutures are utilized on the face, but if you have fat grafting in the body, you will typically have sutures in place that are removed one week after surgery.
Dressings at the liposuction donor site consist of some combination of gauze, tape, absorbent pads, large pieces of foam, and a compression garment or ACE bandages. The compressive garment or ACE bandages should be worn for 2-4 weeks after surgery. The compressive garments are an essential component of the surgery as this minimizes fluid buildup in the surgical sites, which facilitates skin contraction, limits scarring, and speeds up the healing process.
Usually patients have minimal pain at the fat transfer site. Moderate discomfort, pain, and numbness at the liposuction sites is expected after surgery, which will usually subside in the first few days to weeks after your surgery. You will likely to feel tired and sore for 1-2 weeks after fat grafting. Most of your discomfort can be controlled by medication prescribed by your doctor in addition to taking regular Tylenol.
Bruising and swelling is expected after surgery. Generally the major bruising and swelling subsides 2-3 weeks after surgery. However, the final result of your fat grafting and liposuction donor sites will not be evident until 3-6 months after surgery. If you had fat transfer to the body, you should wait at least 6 to 12 weeks after surgery before purchasing new clothing because this will give time for the swelling to resolve.
You should not participate in any strenuous exercise or heavy lifting for 2-4 weeks after surgery. Strenuous exercise includes any activities where your heart rate exceeds 100 beats per minute. We highly encourage our patients to remain active post-operatively, doing activities such as walking. You can slowly work back into your normal activities at 2-4 weeks post-operatively.
When you can return to work depends on the location and volume of the liposuction, how you are healing post-operatively, and what you do for work. Patients with sedentary jobs can return to work as early as a few days post-operatively. Patients with active jobs may require additional time off work.
We highly encourage you to maintain a stable weight, healthy diet, and consistent exercise plan after surgery to maintain your aesthetic outcome.
YOUR NEW LOOK
Fat grafting helps restore a more youthful appearance and enhance areas of volume deficiency. The removal of the excess fat is a bonus to the procedure. This surgery may help your self-esteem and improve your confidence. The scars can usually be placed so that they are well hidden. Once the fat is established at 3-6 months after surgery, it will last forever, but you will continue to follow the normal aging process.
RISKS ASSOCIATED WITH FAT GRAFTING
Every surgical procedure involves a certain amount of risk and it is important that you understand these risks and the possible complications associated with them. In addition, every procedure has limitations. An individual’s choice to undergo a surgical procedure is based on the comparison of the risk to potential benefit.
Complications of fat grafting can be related to the donor site or the injection site. While not a complication of the surgery, it is a known fact that not all of the fat that is transferred survives; this is accounted for as best as possible during your surgery. It is also important to realize that the face and body will continue to age and you will continue to experience loss of soft tissue and boney structures that occurs during the normal aging process.
Generally patients experience more pain at the donor site where the liposuction was performed compared to the injection sites in the breast. At the fat transfer and donor site, there can be bruising and swelling; most of this will resolve in the first three weeks but the final contour may not be appreciated until 3 to 6 months after surgery. Rarely patients can experience masses at the fat injection sites (known as fat necrosis or oil cysts), which is more common with large volume fat transfer like that performed in the breast or buttocks. While extremely rare, there is also the possibility of injection of fat directly into a blood vessel, which will be discussed in further detail at your consultation. There can also be contour irregularities, divots, lumps, and asymmetry associated with liposuction, all of which are minimized with the proper technique. Rarely there is loose skin after liposuction, which is secondary to poor skin elasticity. This can be treated with non-invasive skin-tightening modalities or via skin excision but is best if prevented by not removing too much fat.
INTERESTED IN SETTING UP A CONSULTATION?
To find out more about this exciting alternative to filler and to correct areas of concern, call today to set up your consultation with one of our surgeons and learn how fat grafting can help you achieve your aesthetic goals. 248-524-0620.