This procedure can also augment the cheeks, chin, jawline with your autologous tissue to further enhance your look.  Or quite simply restore your undereye fat or to fill areas where fat has been lost due to aging, trauma, disease or sickness.

Well Does It Work? 
Well that is controversial and averages differ from surgeon to surgeon.   It has been argued by some surgeons that it does not, in fact work, although time and time again there are patients who rave of facial rejuvenation or augmentation through autologous fact grafting.  Bottom line, if performed correctly - yes, it can last quite a long time. However, there are many variables:

• fat cell removal techniques

• handling techniques after removal

• spinning/emulsions/serums/etc.

• re-implantation techniques

• patient's metabolism

• patient aftercare of treatment area

• vascularity (blood vessel formation to the fat cell)

• hyperbaric oxygen therapy treatments (HBOT)

Are You A Candidate For Fat Grafting? 
When we age our underlying collagen and elastic begin to break down and wrinkles emerge.  This along with facial fat loss, brings about a haggard, hollow  or even skeletal look.  If you are not "overly" skinny, with a major metabolism and have a little extra fat somewhere on your body to spare you may be a good candidate but only if...

First and foremost, an individual must be in good health, not have any active diseases or pre-existing medical conditions and must have realistic expectations of the outcome of their surgery.   Although attempts can be made if a patient has lipodystrophy.  It is often the case that the fat does not remain and "injectable fillers" may be a viable option. 

Communication is crucial in reaching one's goals.  You must be able to voice your desires to your surgeon if he/she is to understand what your desired results are.   Discuss you goals with your surgeon so that you may reach an understanding with what can realistically be achieved.

You must be mentally and emotionally stable to undergo an cosmetic procedure.  This is an operation which requires patience and stability in dealing with the healing period.   There is sometimes a lull or depression after surgery and if there is already a pre-existing emotional problem, this low period can develop into a more serious issue.  Please consider this before committing to a procedure.

What Areas Are Usually Treated?
Almost all areas of the face and body can be treated but there are the usual requested treatment sites:

• correction of "hollow" eyes, visible vessels resulting in dark circles, as well as visible tear troughs

• correction after aggressive removal of undereye fat pads from lower blepharoplasty

• temple areas

• upper malar

• sub malar

• chin

• lips (it isn't a defining filler though)

• jawline

• forehead

• glabella (inbetween the brow)

• facial scars

• lower cheek after aggressive buccal fat extraction or natural loss

• area between upper lip and nose

• bridge of the nose and lateral fatty pads

• buttocks, hips

• sternum

• outer brow

• and anywhere else fat is needed or wanted

What To Expect At Your Consultation
After checking a few surgeons' backgrounds and credentials, you will make an appointment for a consultation.  You will meet with these surgeons and discuss your goals and you will disclose all information regarding your health; if you smoke, what medications or vitamins you presently take, etc. - this is very important.  You really should consider smoking cessation as this can significantly decrease the chances of longevity.  Visit the Medication & Supplements List for more information. 

You will discuss your complaints and concerns and discuss the various looks one can achieve, the amount that can be added, etc.  Your surgeon will explain the technique and incision placements for removal or re-implantation methods that may be most appropriate for you.  He or she should discuss the risks associated with the fat extraction and re-implantation with you, as well. 

You will also discuss the available anesthesia that will be used for your procedure.  Most fat grafting procedures are performed under Light Sleep Sedation, Twilight or regional - sometimes even local with oral sedation.  However, some docs may use General IV Sedation.  Either way, discuss this beforehand as many people are not aware of the risks of Anesthesia.  If you do go under Deep General, ascertain that the anesthesiologist is certified.   Please read the All About Anesthesia Page - the risks regarding anesthesia should be considered for a fully informed choice. 

If you would like more information on Consultations or a list of questions to ask your surgeon please visit the Consultation Help Page.  If you should choose to book or reserve a surgery date you will usually give a deposit to hold your surgery date.  Most times if you cancel a few days beforehand, this amount is non-refundable.  After paying your deposit and scheduling a surgery date, you will also schedule a pre-operative appointment...

Your Preoperative Appointment
This appointment addresses more questions you may not have thought to ask at the initial consultation, such as more surgical details, concerns and even ascertaining that your surgeon is aware of what you desire from your procedure.   Just as your surgeon will make certain that you know what it realistically possible from this procedure.

You will also discuss your pre-operative instructions and speak about the recovery period instructions and what to expect in the months ahead.  You will be given prescriptions for antibiotics, pain relievers, perhaps blood pressure medicines, prescription anti-inflammatory drugs and perhaps a box or directions for gaining a box of SinEcch - a pharmaceutical grade form of Arnica montana.   Would like to know more on the benefits of Arnica montana?   Perhaps you will be instructed to obtain Bromelain or other types of remedies, although many surgeons would rather have you not take ANYTHING other than your prescription medications, please do not go against your surgeon's wishes. Remember, always ask your doctor before taking any of these products. 

Please do not hesitate to address any concerns that you may have during this time and even after your pre-operative appointment. If you remember something when you get home or the next day or even the day of surgery - don't be afraid to ask. 

Preparing For Your Procedure
You should be given a pre-operative information packet that explains everything you should do and know before your surgery date.   The packet should include a list of all the medications you should not take starting usually at 2 weeks before your surgery.  These medications will include, but are not limited to, aspirin containing products, stimulants, seratonin supplements, etc. Would you like to view a typical Medication & Supplements List?  Also, if your surgeon advised that you may take Arnica montana, Bromelain, Vitamin K, etc. for swelling and bruising you should either have this in your packet or begin shopping for your necessities.

It is quite possible that you will have "blood work" performed.  This is normally an extra out-of-pocket expense that the patient must participate in to check your white and red blood cell count and check for disease or disorders beforehand. If you are a female they may take an extra vial for a pregnancy test.  Some surgeons ask that you have physical.  This can be yet another out of pocket expense so ask at your consultation what will be needed when you are quoted a price.

So many things to do... so little time.  Surgery will be here before you know it so visit the Preparing For Surgery page and relax.  This section contains, printer-friendly pre-op lists, tips and advice as well as things you must do to prepare for your big day.

How This Procedure Is Performed 
If going for just fat grafting and depending upon your surgeon you may be given an oral sedative (valium) and receive injections of sterile saline, Lidocaine, and possibly epinephrine as a vasoconstrictor and bicarbonate (to neutralize the acidity of the preservative in the Lidocaine) in your treatment area(s) and your donor site.  If you are having liposuction for body contouring you will probably be under IV sedation or other and can have the fat "harvested" during your procedure although usually the liposuction/fat removal is removed with more suction pressure than 1/2 atm. (a measure of pressure).  Thereby traumatizing the fat cells.  If the fat cells' membranes are destroyed during the removal then fat cell survival is compromised.  But if the removal can be performed without rupturing the membrane with the use of a special 3mm titanium cannula specifically for fat removal for reimplantation, then liposuction should be fine.

If primarily for fat grafting, the fat will more than likely be removed with a local anesthetic only although some surgeons may prefer performing the procedure under an oral sedative,  light IV sedation or "Twilight" Please see the All About Anesthesia page to better understand the effects and types of available anesthesia. 

This fat will be removed from the donor site (usually the buttocks, abdomen or the saddle bags - although the saddle bags can be quite fibrous) with a small hypodermic needle using 1/2 atm. (atmosphere) of suction as so not to damage the membrane of the fat cell.  The fat is then spun in a centrifuge to remove excess fluids and the damaged fat cells are "picked out" and only whole, undamaged  fat cells would be used.  But don't count on this with all surgeons - choose your surgeon wisely.  The fat is then injected with the use of a separate smaller hypodermic either just under the wrinkle or deep within the muscle (in SOME areas) as their is a higher vascularity within the muscle increasing the longevity of the fat graft.  With very superficial use of large amount of fat - lumpiness and calcifications can occur.

To increase longevity, some surgeons spin a vial of your own blood to remove proteins, add a vitamin C complex to this mixture to create PlasmaGel®, oxygen rich serums, some even add albumin [: serum albumin : a crystallizable albumin or mixture of albumins that normally constitutes more than half of the protein in blood serum, that serves to maintain the osmotic pressure of the blood (or fat cells), and that is used in transfusions esp. for the treatment of shock] The use of PlasmaGel® or albumin sort of shrinks the fat cells or toughens their membrane to prohibit membrane destruction during re-implantation and less trauma to the fat cell. Of course there may be differences in surgical technique depending upon the preference of your surgeon.

Some surgeons implant or "thread" individual "strands" of fat cells one by one. This procedure takes time but is often thought to last the longest. Of course this results in minute incisions but the rewards are said to be a longer lasting graft.

You are then gently awakened and brought into the recovery room where the recovery nurse will monitor your vital stats until you are ready to be released.  This is dependent upon the individual but may take up to two hours.  Your face may feel tight and quite tender as the anesthesia wears off.  Your donor site may be be sore as well.  You may even feel emotional or upset - this will depend upon your body's reaction to anesthesia.  You may also experience "rigors" or shivering.  This may feel uncontrollable and is usually from the medications - more than likely epinephrine that is used as a vasoconstrictor.  The recovery nurse usually has wrapped you in a warm blanket but if not, request one.  It certainly makes things more tolerable. You may be fortunate to have access to a heat lamp in some recovery rooms.

Some patients feel nothing different although if you have had General you may feel a little sick - hopefully your surgeon gave you something to lessen this.  Your prescribed medication should alleviate this pain and discomfort.  However, if you believe your pain to be out of the ordinary once you get home, call your surgeon or the on call staff immediately.  You will be driven home by your spouse, significant other or friend as you will not be able to see, much less drive yourself home.

The Road To Recovery 
You shouldn't wear cosmetics until at least the day after.  You may be swollen and pink so it may be in your best interest to take off the rest of the day.  If you were given any type of sedative you will be groggy and this can be a very good thing. 

Some patients report mild to even above moderate bruising although swelling can be pretty moderate to severe.  Most of the swelling may last anywhere from 24-72 hours; although the swelling should completely be gone in 2 - 4 weeks.  Although any discomfort should be alleviated by your prescribed pain medication if you have excessive pain, redness, pus or other symptoms that do not appear normal, contact your surgeon immediately!  Take your temperature regularly.  An elevated temperature could mean an infection.  Take those antibiotics on time.  Also, don't forget if you are a female taking birth control pills that some antibiotics can interfere so in the event that you do have relations, use another form of protection as well.

Usually, although this in individualistic, anywhere from 10 - 90% of the fat may last.  Towards the "high-end" if the surgeon uses a conservative "micro-droplet" or "threading" technique.  Most patients receive up to 4 and 5 treatments (at a discount) although the average is 3.  Although we know surgeons whose patients need only one session.

The effects can last anywhere from 3 months to 3 years (maybe more).  As I said this procedure is highly technique sensitive so choose your surgeon wisely.  Or you will be wasting your money.  Fat transfer if done correctly can be wonderful!  You may require a few more treatments but determine the cost of additional sessions beforehand. 

KEEP YOUR TREATMENT AREA AS IMMOBILE AS POSSIBLE.  In fact, some surgeons recommend having BOTOX® in the forehead, brow, temple or eye area (if this is where you will be having treatment) a few weeks beforehand so that the movements do not compromise the graft or cause lumpiness.  The stability of the newly, traumatized fat cell can be given a better 'chance at life', if you will.  If you are careful not to move it around so much to give it ideal conditions for gaining proper vascularity.  Just as when some surgeons overstuff too much, the inner fat cells have a very difficult time at gaining vital oxygen unless the blood vessels can grow rapidly towards the middle of the graft to increase the fat cells' lives.

Some surgeons do not recommend icing to relieve swelling because they believe that the cold, being a vasoconstrictor as well, will impede your body's circulation and cause oxygen depletion of the newly transplanted fat cells.  Some believe that the cold will hinder angiogenesis - thereby decreasing vascularization of the fat graft.  Please discuss this with your surgeon.

* Please note the prices charged for surgeries represented in the documentations of the links above are representative of what an American doctor would normally charge. Of course, our fees are lower but our doctors are more experienced because more patients come to us due to the affordable prices. Thus, the doctors work on more cases (especially oriental patients and many Caucasians).