10 Questions to ask your surgeon about Fat grafting

From Healing scars, to Breast reconstructions, to Brazilian butt lifts, fat grafting (also referred to as fat injection or fat transfer) is an exciting new frontier in plastic surgery and regenerative medicine.

Plastic surgeons have been performing Fat grafting surgeries for over a hundred years, but ground-breaking strides have been made over the past decade that have adipose stem cells (stem cells from your own fat) front and center in the news (Wired Magazine, Science Daily) and in the minds of patients.

Patients interested in having a procedure involving fat grafting should be familiar enough with the process to ask questions above and beyond the usual questions they might ask when consulting with Plastic Surgeons. The success of fat grafting is highly dependent on the skill and technique of the surgeon as well as the patient’s attention to detail and instructions during post-op.

Here are 10 questions to arm yourself with prior to a consultation for any plastic surgery involving a fat transfer:

1) Are you board certified?

A list of points explaining what "Board certified" means.

The gold standard for Board certification in the US is the American Board of Medical Specialties (ABMS). The ABMS is composed of 24 medical boards. Each of these 24  Medical Boards issue Board certification in medical specialties and subspecialties. Each medical board sets standards of care for their respective medical specialty and subspecialty.

There are only two medical specialties that are doing Fat Grafting which are recognized by the ABMS. These medical specialties are Plastic surgery and Dermatology. The Board Certification certificate that hangs in your surgeon’s office would display either: American Board of Plastic Surgery or American Board of Dermatology.

Outside of these two ABMS approved specialties, the American Board of Facial Plastic and Reconstructive Surgery  also supervises residency programs where fat grafting is taught.

Check your surgeon’s credentials and be sure that your surgeon is Board Certified by one of these three Medical Boards. (Learn more about Board certification)

2) How do you process the fat?

Purified fat sample in syringe.

The purpose of this question is not to get a yes or no answer, but to get an idea of how much thought the surgeon has given to the process, as fat grafting is highly process dependent.

If the surgeon says he does not process the fat, or gives a very short answer, listen politely and start thinking which doctor you are going to be seeing next.

3) What vacuum pressure do you use for fat removal?

A patient undergoing liposuction surgery.

The first step of fat grafting is the extraction of the fat by Liposuction. The surgeon controls the extraction pressure of the fat removal and he should know what it is. If the doctor draws a blank to this question it’s not a good sign. Low extraction pressures are best to get healthy, viable, fat cells. An ideal range is 400 millimeters (400mm) of mercury, or half atmospheric pressure.

If the doctor says he doesn’t know because he uses a syringe, that is also not a good answer.  Syringe pressure can be measured and you can read my publication in PubMed which describes how to know what pressure you are using with any syringe extraction.

4) What size cannula do you use for Liposuction?

Different liposuction cannulas.

The cannula is the long slender piece of equipment used to extract the fat during liposuction. Even if the doctor does not have a cannula handy, he should be able to tell you the diameter of the cannula and what types of holes it has.

Ideally, the cannula should have a 3 millimeter (3mm) diameter because it will ensure the smoothest possible result in the liposuction area. Big cannula diameters  ( 4-5 mm) are more likely to leave uneven lumps and bumps. I usually have several different sizes of cannulas in hand to show patients what this surgical instrument looks like. (Learn more about cannulas)

5) Do you wash the fat or centrifuge it?

Fat processing in centrifuge.

This is a complicated subject which involves many variables, and right now there is not an official consensus. However, a surgeon who goes into great detail explaining why he chose his method is probably very meticulous with his process and has thought a lot about the issue. A surgeon who gives a very definitive short answer or is dismissive of the other ways is probably not well informed.

I have always preferred centrifugation, but recognize that washing done a certain way can be effective.

6) What cannula do you use to reinject the fat?

Dr Rodriguez holding a tiny fat injection cannula.

The cannula used to reinject the fat should be 2 millimeter (2mm) diameter or less. The reason is that a bigger cannula will deposit chunks of fat that are too big to be absorbed properly by the body, resulting in an uneven or lumpy fat graft.

In addition, the surgeon’s cannula should have a treated lumen on the inner surface because smooth surfaces help the good fat cells avoid mechanical damage.

7) What are the fat graft post op instructions?

A yellow square road sign with the text:"Take care".

During the postoperative period, the idea is not to put pressure on the fat grafts as this can cause partial reabsorption of the graft. Your surgeon’s post operative instructions should include certain basics like not sleeping on the grafted area for at least 2 weeks.

My personal recommendation to my fat transfer patients is to not sleep on the grafted area for 3 weeks.

8) Can you give me references of 2 patients who had this procedure?

A 3D illustration of 3 text balloons, symbolic for 3 patient testimonials.

The reason for 2 names is that anybody can produce one loyal patient. You need consistency of results, good rapport with your patients, and a certain number of cases to be able to give multiple references.

Understandably, not all patients allow plastic surgeons to give out their names and contact information for reference. Be appreciative of the ones who do by letting them know how much it has helped you in your decision making process.

9) How many fat injection procedures to this body area have you performed?

A hand reaching out to grab a case folder from an archive.

While many surgeons have performed some type of fat grafting, be sure to understand whether your surgeon has expertise with fat grafting in the particular area of the body you’re interested in.

For example, if you’re interested in a Brazilian butt lift, be sure your surgeon is experienced in that specific procedure.

10) What percentage of patients require touch ups or revisions?

A pink percent sign.

Fat grafting to the buttocks, face, and hands should be a one-session surgery. You should expect the touch up rate to be no greater than 5-10%. Ask the surgeon what  his touch rate is. If he has no idea, that is also not a good sign.

With fat injection to the breast, things work a little differently because of  breast tissue composition.  This is because there is a limit to how much fat can be injected to each breast in one operative session. Fat grafting to the breast may require 2 or 3 operative sessions to get the final volume desired.

If you’re considering any procedure that involves fat grafting, you should know exactly what to expect before, during, and after your surgery. If you ask the questions outlined above, the surgeon will know you are a well-informed patient and will be very careful to answer more completely.

A surgeon who seems annoyed with detailed questions and a thorough discussion shouldn’t make the cut. Find a surgeon who loves fat grafting and enjoys talking about it!

By Dr. Ricardo L. Rodriguez MD Board Certified Plastic Surgeon Cosmeticsurg Baltimore, Maryland Ricardo L. Rodriguez on American Society of Plastic Surgeons.

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24 thoughts on “10 Questions to ask your surgeon about Fat grafting”

  • virginia jorge says:

    Hello I'm a female that has alot of extra fat in the belly flanks arms, but I'm lacking volume in my legs such as thighs knees calves ankles, I dont wear skirt because I have thin chicken legs and I'm very uncomfortable with them, can you make my legs nice and fatter fuller by transfering fat from my belly flanks arms etc.. and then injecting it into my thighs and lower legs and ankles, I wish i had fat legs and thinner waist, also I would be interested in buttock implants, I want a dramatic noticeable butt like XL size and fat injected into my hips.
    • Dr. Ricardo L Rodriguez says:

      Virginia: We can do fat grafting to legs. We have done it many times in the thighs, less frequently on the lower legs. But we definitely can help you. Contact Kelly at kelly@cosmeticsurg.net so we can help you. Thanks for contacting us!
    • Dr. Ricardo L Rodriguez says:

      Saeed: Although obviously not as common as females, I have several males that have had BBL done.
  • Susanne says:

    Hi Dr. Rodriguez, Tank you very much for this very helpful article. Do you know any doctors in Germany, specializing in fat transfer to the breast? Last week I had an appointment with Dr. Dalia Sattler/Hamburg. I had a good felling after the consultation. She told me, that she uses Tulip-canulas (hope, I understand it right...). Do you know Dr. Petra Berger, she practices in Frankfurt and Zurich? Wich method do you prefer for liposuction (WAL, ultrasound)? Wich one is the best for fat transfer to the breast? Thanks a lo for answering and help! Susanne
    • Dr. Ricardo L Rodriguez says:

      Susanne: It is impossible for me to know the quality of another surgeons work even in this country unless I directly observe them. But I can tell you that both ultrasound and laser liposuction kill the fat cells. Water assisted liposuction is OK.
  • Daniel R Nevarre MD says:

    Hi Dr. Ricardo L Rodriguez, Thankyou, thankyou, thank you for your insight into fat grafting. From reading your comments, I see you are detailed and this gives you great results that don't require touch-ups. After graduating Harvard with Dr Murray, I now find myself at the end of my reconstructive surgery career , and I am probably going to start into cosmetics. I have kept my training up with Breast and intimate area surgery, but I have avoided fat grafting because of unpredictability of results. May I spend a day with you observing a Brazilian butt lift? I could help offset the patient cost say $1000 to make it worth your and your patients time. Kindly, Dan Daniel R. Nevarre MD Johnstown, PA
    • Dr. Ricardo L Rodriguez says:

      Dr. Nevarre: Honestly, I think your time would be better spent by attending the IFATS meeting where you will learn a lot of different perspectives from people really involved in the science of fat grafting rather than the usual cast of lecturers. Processing is paramount as well as meticulous injection technique. I would be happy to talk to you at the IFATS meeting in Miami in person. Apologies for the delay in answering.
  • Claudia says:

    Hi Dr. Rodriguez, This is a very helpful article, thank you. Do you know any doctors in Dallas, TX specializing in fat transfer to the breast. Do you know Dr. Sacha Obaid? Thanks for your post and help! -C.C.
    • Dr. Ricardo L Rodriguez says:

      Claudia: I do not know that Doctor. It is difficult to know how other people do fat grafting, your best bet is to ask around in your local area. You have to be specific as to who does good fat grafting. Otherwise, we do get a lot of patients from out of town, precisely because a really good fat grafting surgeon is hard to find.
    • Dr. Ricardo L Rodriguez says:

      Yocheved: Sorry I have not answered before. This blog is answered by me personally, not by my staff. I will have Kelly kelly@cosmeticsurg.net contact you this coming week.
  • Tina says:

    Dear Dr. Ricardo L Rodriguez I have been in your consultation one year ago in Yerevan/Armenia/. I would like to know will you come here again? I'm planning to do the surgery in the beginning of october.... if you could do my surgery (Butt Augmentation) it will be great,but if not please tell me your opinion about doctor Gagik STAMBOLCYAN, can I trust him or it will be better to wait for your visit to Armenia? Thank you beforehand Tina
    • Dr. Ricardo L Rodriguez says:

      Tina: Did you have the surgery? I know Dr. Stambosltsyan well and taught him my techniques. He is a good surgeon and I trust him.
  • Sunita says:

    Hi Dr. Rodriguez! Do you have any recomandations on a surgeon in LA or Orange County CA for fat transfer/grafting? I would love to be your paciant but it's to far to come to ur office. So it would be great if u have a recommended surgeon her in my area.
    • Dr. Ricardo L Rodriguez says:

      Sunita: I don't know who does this procedure routinely in LA, but I now a surgeon I trust and he will recommend you a quality guy in LA. The Doctor is Brian Kinney MD.
  • Eileen Bedinghaus says:

    I am looking in to having my breast implants (that are more than 20 years old) removed and having a fat transfer. Can you tell me what questions about this type of procedure I should ask? I have heard it can be done in one surgery but two is best? Any thoughts?
    • Dr. Ricardo L Rodriguez says:

      Elleen: The questions listed in the blogpost are a good start. I can get my fat grafting done in one session usually, but it all depends on your particular case and how much breast tissue you have. If you want more information you may want to set up a virtual consultation. I'll give Kelly at kelly@cosmeticsurg.net your email address
  • Paul says:

    Hi Dr Rodriguez This info on what to ask a surgeon when considering fat graft/transfer is very helpful to patients. Thank you. It is so refreshing to come across someone like you, who is obviously not only experienced and knowledgeable expert about this, but also an enthusiastic one in the field of fat transfer. Your passion can be felt, through this blog.
  • Nikita says:

    Hi Doctor lm in need of this procedure....... I'm 87kgs and l don't have a beautiful body structure..... And l need a nice butt,flet stomach,and curves please help wht do l do...,soon lm getting married and l need to look good and feel happy.but lm in South Africa Though so l dont know how you going to help me.but please please help
    • Dr. Ricardo L Rodriguez says:

      Nikita: I have operated on many people from all over the world. If you came here I could help you like I helped them. So happy for your wedding!! Maybe the surgery could be a wedding present...
  • Juliana says:

    Is Naturalfill just a technique, a method of preparing the fat or are they adding stem cells? Thank you~
    • Dr. Ricardo L Rodriguez says:

      Julianna: Naturalfill is just a technique for preparing the fat. They do not divulge many details at the web site. They do mention the use of Aqua lipo to harvest the fat. There is good evidence that this is not good for the fact graft. You should know it is illegal in the US to separate the stem cells from fat tissue and reinfect them without proper FDA approval. Nobody has FDA approval in the states yet. I would be careful about this group. Dr. Bassin, who heads the group is not board certified by the American Board of Plastic Surgery which is the only Board approved by the American Board of Medical Specialties to do Plastic Surgery. I do not know if they vet their physicians to be board certified. I will have Kelly from our office contact you about our techniques- kelly@cosmeticsurg.net