Several people have asked me if fat grafts are permanent. They keep reading from other sources that fat grafts are not permanent or that they may need another procedure.
In my experience, when done correctly, fat grafts are permanent, and I have yet to do a second procedure to add more fat in any of my patients. This is because of the way fat is harvested and the choice of sites for harvesting fat are crucial to the success of the Brazilian butt lift or any other Fat injection procedure.
Fat harvesting, processing, injection, grafting and choice of harvest site
1) The fat has to be aspirated properly
Higher pressure suction disrupts and kills a certain percentage of fat cells. For this reason, I use a manual syringe technique, because the pressure generated by a syringe is much lower than that generated by a suction machine. Thus, right from the start, I have a higher chance of success. Is there an advantage to using a regular suction machine? Yes, it’s quicker and is less taxing to the surgeon. But its worse for the fat cells. So–If you hear of somebody doing a Brazilian butt lift in less than four hours, chances are the grafts may not take and his patients are coming back for touch ups.
2) The fat has to be processed properly
I let the fat sit in a cool environment (slows down the fat cell metabolism) so the fluid separates from the fat. Then the fat is transferred to smaller syringes where it is then put in a centrifuge. The centrifuge has to spin long enough to separate fluid and contents of dead and disrupted cells from the remaining live cells, but not so long as to disrupt live cells. We then separate the live fat cells from the body fluid and contents of disrupted cells by a decanting process which does not touch the live cells. What is left is a slurry of almost 100% live cells. There are very little contaminants that may irritate the surrounding tissues. You want the recipient tissues to deal only with live cells, because any inflammation may end up destroying live cells.
3) The fat has to be injected properly
Think of the fat graft as a tender seedling that has to be planted in the ground, but instead of the roots growing out, the “roots” (blood vessels) from the surrounding tissues grow into the fat graft. If you inject a thick wad of fat cells, the cells in the center of the wad will starve before the blood vessels reach them. Thus the fat grafts have to be injected with very fine needles in small quantities. This is a very painstaking and slow process. If you inject a lot at a time, many cells will not survive. Thus some surgeons may say “most of the fat got reabsorbed”, whereas in reality, most of the fat never took in the first place.
The postoperative period is as important as the surgery
I tell all my patients that they should not sit at all for three weeks after surgery. Think again of the tender seedlings. Once the fat grafts are in place, they are not likely to take root if they are being mashed on with all your body weight. You want to keep those grafts completely free of pressure until blood vessels grow into them and until those vessels are hardy enough to withstand the pressure and shearing effects of sitting on them. Wearing compression garments is very important, as they cut down swelling tremendously. When there is swelling, oxygen delivery and evacuation of toxins are impaired. This in turn reduces likelihood of fat graft cell survival.
In conclusion: Fat grafts are permanent when done correctly
In the past 2+ years since I have been doing the Brazilian butt lift, I have yet to do a touch up. It should be evident that when done properly, fat grafts have a high likelihood of being permanent. See my Before and after Brazilian butt lift photos to see how great large volume fat grafting can look.
UPDATE: I wrote this article in 2006, I have now been performing BBL’s for over 15 years. I am a board certified plastic surgeon, boarded by the American Society of Plastic Surgeons, and I have been in practice for more than 25 years. I am also a member of the Gluteal Safety Task force, which issues recommendations for safe BBL procedures.