Information for patients undergoing fat transfer ("fat grafting") surgery

"My husband and I are really delighted with the outcome of my procedure. It’s great not to look permanently tired. You were right in that it is not overdone which does give a more natural fresher look. It took longer to heal than I had expected and after three weeks the scarring was quite white and raised but now very smooth." (From a patient who underwent ptosis correction, upper blepharoplasty and fat transfer to face)

Volume loss around the region of the eyelids and cheeks may occur as a result of trauma (including facial fractures or previous surgery), radiotherapy, soft-tissue and inflammatory diseases, including hemi facial atrophy or as a result of ageing.

In addition to skeletonization of the orbit, fat atrophy can influence stability of eyelid position and eyelid blink or closure. Restoration of this loss of volume can be achieved through placement of syringe-based fillers, autologous (an individual's own) fat, or implants. Each product has advantages in its use.

Risks and Benefits

Benefits: The technique of autologous fat transfer is used to restore a natural appearance to the periorbital complex. One's own fat will not cause an immunogenic reaction and is usually abundant. Fat also has the advantage of durability, with its potential for long term graft survival. Autologous fat transfer has been established as a stable adjuvant technique in facial reconstructive procedures in addition to aesthetic surgery. Autologous fat transfer can be also used in other areas of the face to restore volume loss.

Potential Risks:

• Prolonged oedema and bruising (rarely lasting more than 2 months)
• Contour abnormalities: lumps, bulges
• Visible fat deposits
• Under correction
• Overcorrection
• Migration of the transferred fat
• Fat necrosis
• Infection
• Nerve injury (has been reported but extremely rare)
• Blindness (has been reported but extremely rare)
• Stroke (has been reported but extremely rare)

On the day of surgery

Autologous fat transfer is performed in the operating room under general anaesthesia. The abdomen is the first choice of donor area, if available, followed by inner and outer thigh. Mr Malhotra's technique is based upon a standard Coleman-type technique for fat grafting. Fat is collected using a blunt-tipped cannula and a liposuction-type technique. It is centrifuged to drain any undesired contents before transferring the fat to the face and periorbital region using thin cannulas through small needle-size entry points.

Post operative instructions

Postoperatively, the patient is asked to sleep with the head slightly elevated and apply cool-packs over the treated area. A short course of oral antibiotics may be prescribed. No wound care is necessary other than a small dab of ointment over the insertion sites. Patients experience a variable amount of bruising but a consistent amount of swelling. The patient should expect significant disfiguring swelling in the first week that decreases substantially by the end of the second week.

Return to social activities can usually be achieved in the second week. Some swelling and fat loss will occur up to 12 weeks and then stabilize. Long term results can be expected with continued improvement in skin tone and texture even beyond 12 months. Occasionally, a repeat fat transfer procedure may be recommended.