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CosmeticSurg Blog

Dr. Rodriguez discusses Plastic Surgery, Medicine, and Stem Cell Research

How long do fat injections last? Are they permanent?

Although I have addressed this subject in the past, the question pops up so often means people are still confused about how fat grafts work. The question so often asked is “How long do fat grafts last?”.

The short answer is that when fat grafts are done with proper technique, they are permanent. This is not opinion, this is fact.

There is sufficient experimental and clinical data to to say what the proper technique is for doing fat grafts. Do not accept the word of a doctor that tells you fat grafts are temporary, or that you will need touch ups. The facts are otherwise.

Successful fat grafting depends on 4 things:
 

  1. Collecting the fat in a way that will keep most fat cells alive.
  2. Processing the fat in a way that gets rid of unnecessary elements, such as dead cells or excess fluids.
  3. Injecting the cells in a way that will optimize fat graft survival.
  4. Protecting the cells after they have been injected.

Collecting the fat has to be done in a way that does not harm or kill the fat cells. The fat cells are extracted by placing a hollow tube (cannula) with a hole near its tip into your fat tissues. You then apply suction thru the cannula so fat cells are sucked thru the cannula into your receptacle. Experimental evidence is clear that in order not to damage cells, suction pressure should be less than 20mmHg. Cells are gentle organisms and the suction exerted by most liposuction machines can damage cells. By using a syringe liposuction technique, where suction is applied just by drawing back on the plunger of a syringe, high suction pressure is avoided.

Processing the fat is another key point. The key is to separate out good live cells from all other components of the extracted sample. Some surgeons rinse the fat. This does not get rid of dead cells. Rinsing the fat also does not get rid of the rinsing fluid itself! Any graft cell takes best when there is a minimum of excess fluid around it. Some other plastic surgeon put the cells thru a strainer. This does not get rid of most of the fluid nor debris, nor dead cells. The worst (!) is when they put the cells on some gauze or fabric to act as a strainer. The fat can then pick up lint that acts as an irritant. Again, experimental and clinical evidence has shown that the best method to purify the fat cells is centrifugation. Centrifugation, where fat cells are spun at high speeds separates the cells from fluids, debris, and dead or weak fat cells. There are well defined parameters for speed and timing of centrifugation. Centrifugation also has the benefit of increasing the proportion of stem cells in your injectable fraction. 

cannulas used for fat injection

cannulas used for fat injection

Injection technique is important. Cells should be injected under low pressure, so as not to injure them. They should also be injected in very small droplets so the surrounding tissues can get the blood supply quickly into all the injected fat. When you inject fat in large clumps only the fat cells on the outside of the clump get blood supply on time. The rest of the cells inside the large clump starve of blood supply and die. When they die they release their contents, which in turn causes an inflammatory reaction in the tissues.This inflammatory reaction can interfere with the blood supply of the cells which had taken, and cause scarring. Injecting in small droplets is slow and tedious, but necessary to ensure graft survival.

Protecting the cells after they have been injected is the last step in ensuring graft survival. The key is to prevent swelling and trauma to the area. In the body, I use compression garments and give instructions to the patient not put pressure or lay on the area where we grafted. The area is protected for three weeks. Three weeks is important not just because of the time needed for the graft to take, but for the supporting tissue scaffold to mature. In the face, I advise patients to sleep with the head of the bed elevated to prevent swelling, and to sleep on their back so as to avoid trauma from awkward sleeping positions. Finally, I prescribe a short course of steroids, as it cuts down on local swelling and acts as an antiinflammatory.

All the problems encountered by different practitioners, such as infections, fluid collections (seromas), scarring, disappearance of graft. etc., can all be traced to technical deviations to the steps described above. There are many who say fat grafts are temporary or they don’t last. Don’t take their word, there is plenty of accumulated laboratory and clinical data to refute them.

By Ricardo L Rodriguez MD
Baltimore, Maryland
Ricardo L Rodriguez on Google +

Posted in Fat Stem Cells General

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28 Comments

  • wrote
    November 3, 2013 at 1:13 pm

    Esther:
    Decanting means to let the fat separate from the liquid phase.
    Centrifugation does it too. If you do not decant before, you end up with syringes that are mostly liquid and very little fat. It is not a problem, you just have to spend more time processing. For that reason I prefer decanting before, to get rid of a lot of fluid before centrifugation. Centrifugation removes the remaining fluid.

    I don’t know how much fat I could extract from your body as I would need to see pictures.
    Contact Kelly at kelly@cosmeticsurg.net and she will be happy to give you more information about cost, technique, etc.
    She can help you set up a Skype or FaceTime session if you want to discuss further.
    Hope to hear from you soon!

  • wrote
    October 20, 2013 at 4:10 pm

    Dear doctor,
    in one of your video http://www.cosmeticsurg.net/procedure-videos/watch/brazilian-butt-lift/ you spoke about decantating the fat before the centrifugation. You didn’t mention this here. Is this step unimportant ?
    I’m personnally interested in breast enlargement by fat graft. I saw a surgeon who told me that in all he could extract from my body about 1.5 liters of fat.
    What kind of augmentation would such little amount of fat allow ?

    How much would the operation cost in your clinic ?

    Thank you in advance

  • wrote
    April 20, 2013 at 4:59 pm

    Lana:
    The bluish discoloration is due to two things, one is hyperpigmenation from chronic irritation, or thinning of the dermis layer letting the underlying eyelid muscle color show thru the skin. I have done this several times with young people.
    It is safe when a surgeon is skilled in the procedure.
    We’d love to help you, we have had several Canadian patients.
    Contact Kelly at kelly@cosmeticsurg.net

  • wrote
    April 1, 2013 at 11:09 pm

    Hi Dr Rodriguez,

    I’m a 27 year old woman from Toronto, Canada and I was considering getting fat grafts (not in TO as I’m afraid the technology for this procedure isn’t up to snuff like in Europe and the US) for my blueish under eye hollows. Would you recommend it for someone my age and for under the eyes and is it SAFE? Thank you in advance!

  • wrote
    February 24, 2013 at 1:22 pm

    Claudia:
    I have done patients from Hawaii and even Singapore.
    When you want things done right, go to someone who does it a lot and does it in a reliable way.
    I don’t know who does it reliably in your area. It is delicate and time consuming work so not many people do it well.
    Even in the east coast, lots of people charge very low fees, but they warn patients that they “may” need a “touch up”.
    If they are saying that, it means their grafts are a crap shoot.
    I can tell you this, I have done over 350 of these, and I have not had graft failures. Patients who have come back for more (literally a handful- not more than 5) have gained weight on purpose so I can do extra lipo and add grafting to the buttock.
    Contact Kelly at kelly@cosmeticsurg.net we can always do a virtual consult
    Oh and by the way sorry for the delay, we get a lot of posts and sometimes I forget to check the back pages. I hope this helps!

  • wrote
    February 4, 2013 at 2:08 pm

    Hello Dc.Rodriguez
    I would love to have fat grafting done to my hips.
    I live out in Hawaii and I’m not sure if the doctors out here will take the time to do the grafting the right way. How can I make sure the doctor I end up with will take the time to graft the fat with care. I feel this way because most doctors do say the fat will die and you will end up having to do this again.

    I just want it done right the first time…

    Than you for reading!

  • wrote
    August 2, 2012 at 2:24 pm

    Connie:
    Yes, we have done it several times. It is not as common as you would think because it is more expensive than just breast implants and most people are just happy with implants. Of course, fat injections are a lot more natural and they are your own tissue, so I think it’s better, but each patient has to decide for herself.
    We’d love to help you and you can contact Kelly at kelly@cosmeticsurg.net for more info.

  • wrote
    July 30, 2012 at 3:34 pm

    I want to know can the same injections be used for breast enlargement?

  • wrote
    February 4, 2012 at 6:01 pm

    Shosho:
    Surely it was not done by us.
    There are many reasons why a fat graft won’t last.
    The fat has to be removed carefully at low enough pressure. It has to be processed the right way. It has to be injected the right way.
    Any deviation from proven methods means reduced survival of the fat cells.
    Let us know if we can help you.

  • wrote
    February 4, 2012 at 5:45 pm

    i had butt fat injection but it didn’t last why??????

  • wrote
    June 26, 2011 at 10:00 pm

    Kawthar:
    We do a lot of it, we see great results, and the patients love it.
    It really is one of the most satisfying things we do.
    Contact Kelly at kelly@cosmeticsurg.net, she’d love to help you!

  • wrote
    June 20, 2011 at 4:27 am

    hi i want to know more abot fat transplat for face

  • wrote
    March 29, 2011 at 4:13 pm

    Hi Jauana, thank you for posting regarding your interest in the tummy tuck and brazilian butt lift procedure. Dr. Rodriguez specializes in multiple procedure surgery performed with iv-sedation (twilight anesthesia) and would be delighted to meet you in his new facility. Yes, you may have more than 3 areas of liposuction and specify where you want to have the fat transferred, the procedure is unique to everyone. The cost range for tummy tuck with the brazilian butt lift/fat injections (all inclusive) is $23,000 to $28,000. Please call the office for more details and to schedule a personal consultation with Dr. Rodriguez.
    Thank you,
    Kelly Warner
    Patient Coordinator
    410-494-8100

  • wrote
    March 29, 2011 at 9:29 am

    Jodie:
    It will probably resolve gradually. 3 weeks is very soon after surgery, swelling is still not down.
    What happens is muscles are surrounded and sometimes even infiltrated with newly injected fat. They will take a while to regain full motion, but they will.
    Cheer up, I bet you will look great and it will be alright very soon!
    God bless you!

  • wrote
    March 26, 2011 at 10:30 am

    Had fat injections on cheek bones, smile lines and either side of mouth, been 3 weeks, still can not smile and move upper lip? what is causing this and will it ever go away? Been very depressing.

  • wrote
    March 24, 2011 at 9:43 pm

    Jauna:
    That depends on the patient. I would have to see pictures of the patient and then decide.
    I have done cases where I inject just into the hips, most of the time I inject into hips and buttocks.
    Thanks for visiting our blog!

  • wrote
    March 24, 2011 at 9:41 pm

    Jauna:
    The patient in this video had exactly what you are thinking off- tummy-tuck, lipo of 3 areas, and brazilian butt lift. You too could have a great result!
    Kelly should be getting in contact with you soon. We’d love to hear from you!

  • wrote
    March 22, 2011 at 8:23 pm

    Dr. How much fat grafting can go in the hips? Can 700cc also?

  • wrote
    March 22, 2011 at 8:20 pm

    Do you perform hydrogel injections. Can I have more than 3 areas lipo to round the hips off for the brazilian buttlift also i want a tummy tuck with this procedure.

  • wrote
    December 21, 2010 at 10:22 pm

    Danielle:
    If done correctly, you should need only one procedure. Having said that, I have had a few patients that just wanted a very big butt, and gained weight on purpose to get a second procedure done. That works, if you are comfortable at your new weight.
    The way I evaluate a person before I do a fat graft is to ask the person what is the area they have most difficult time losing weight. This is the area I will targert first for grafting. The fat will behave the same way once it has been grafted into the buttock, that is, the patient will lose weight everywhere else before they lose it in the buttock. See this postabout this very same question.
    Cheek implants are nice, but they have a totally different look and feel than fat grafts. BTW, is that butt cheek or face cheek?
    Contact Kelly at kelly@cosmeticsurg.net

  • wrote
    December 16, 2010 at 5:26 pm

    hey Doc, thnks for all the precious info
    1: is it true that sometimes more than a fat injection procedure is needed to get the aimed look ?? and wut if we lose weight,do we lose these fats?

    2: wut r the disadvantages of the cheek implant? do they cause infections or move from there place after long time?and the long term body reaction towards them??

    thanks

  • wrote
    July 7, 2010 at 8:19 am

    Mary:
    Depending on the technique used, fat can either be temporary, or stay on for many years.
    I have treated 2 patients with fat injections that were over done, and in both cases it was the same as in yours. The surgeon misunderstood the wishes of the patient.
    Luckily, I was able to treat them successfully using liposuction with a microcannula. Don’t despair, your problem has a solution.
    If you want more in depth analysis, you might want to do a virtual consult where I can look at your pictures and tell you what the way forward is. You can contact Kelly at kelly@cosmeticsurg.net.

  • wrote
    July 4, 2010 at 10:16 am

    My doctor told me my fat injection would not last more than 4 years.. I absolutely hate my injections in my face.. I told him I did not want that and he did it anywaylll… I am so depressed alll the time..He took the fat from my abdomin… Would that change anything.. I don’t know what he did to the fat other than transfer it from my agdomin to my fact.. thanks

  • wrote
    July 17, 2009 at 3:48 pm

    A lot of the issue about Buttocks augmentation has to do with proportions between waist dimension and buttock size. One may not need a lot of fat to get a desirable result if the proportions are altered the right way.
    To make a proper judgement, one would have to evaluate you individually, but I have done it on a very slim woman who weighed 98 pds, and she was happy with the result.

  • wrote
    July 16, 2009 at 9:09 am

    hello doc ,

    i have a question , i m a male who is willing to do the buttocks augmentation , imy only concern is that i dont have enough fat in my body to use i work out frequently and my body fat is really low however my butt is not shaped at all ! i dont want to go for the implant procedure any advices !

    thanks

  • wrote
    May 13, 2009 at 11:18 am

    I do not do hydrogel injections. I do get plenty of emails and pictures from patients who have been disfigured by it. I cannot tell you what to do, but please investigate carefully before you commit to hydrogel injections.

  • wrote
    May 13, 2009 at 1:26 am

    do you do hydrogel injection if so email me

  • wrote
    May 6, 2009 at 2:31 am

    Do any Dr’s offer free procedures on butt lift? in exchange of promoting their business? does this exist? if so I will like to get more info

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