American society of plastic surgeons - Member

General Concepts and Overview of Fat Grafting – Transfer

Welcome to the new era of fat grafting! Fat is natural and it’s yours…never to be rejected. It’s soft and pliable with results that usually cannot be distinguished from the areas into which it is placed. It’s virtually scarless using access sites that are practically nonexistent. Finally, fat can be taken from almost anywhere on the body and placed almost anywhere else – even achieving liposuction contouring from the donor sites in larger volume procedures!

Restoring or enhancing volume is not a new concept but is receiving a greater degree of the attention it deserves. A myriad of new fillers continue to flood the market all with the intent of restoring or enhancing lost volume. However, all fillers have drawbacks by either being substances that are not natural and/or of limited lifespan. Is there another alternative?

Actually, there is. It’s called fat. Fat is natural and it has the potential to last a lifetime. Of course, fat is simply not a filler that is injected during your lunch hour like the many products that are available in the marketplace; it’s living tissue and, therefore, needs a healthy environment to take root, not unlike a farmer sowing seeds in a field, so technique can be important (please visit the series of surgical videos discussing the details of the fat transfer and its applications).

If this is true, then why isn’t everyone using it? Actually, many surgeons do, but unfortunately with results that are often inconsistent, unpredictable and disappointing. Using fat is not a new concept, either, and attempts to perfect the permanence and consistency have been investigated for years.

The key point of its use lies in the fact that fat, unlike other fillers on the market, is living tissue so it requires a blood supply to exist, otherwise it will simply die, resulting in either loss of the filling effect or complications such as hard and lumpy irregularities. So, unlike other fillers, it cannot be simply “injected” but rather has to be transferred as a living substance (called a “graft”) in a manner that does not result in its destruction and, at the same time, allow its “transplantation” to result in new blood flow to it.

Using a syringe attached to a special blunt (never sharp) hollow metal tube – called a cannula – that fat grafts are collected in a way that minimize injury to them thereby allowing them to remain intact. Then, after processing, the fat is placed back into the body at the desired areas to be filled. These special blunt cannulas are again used to deposit hundreds of very small parcels or “seeds” of fat (each one smaller than the period at the end of a sentence), within its own nest of living recipient tissue so that new blood vessel growth can occur. Once integrated, fat has the potential to last a lifetime!


Fat can be retrieved from any number of donor sites in the body (an aspect that most people are totally happy with) and used in any number of other sites that require volume. Volume replacement with fat can include the breast, buttocks, face, cheek, and lips, hollow of the eye regions, and temples, but other areas as well. For example, the aging hand also looses volume and as this occurs, prominence of veins, bones, and tendons occur. Even defects resulting from previous procedures such as liposuction or blepharoplasty (eyelid surgery), can be improved if not fully corrected, with the use of fat (as seen here).

For women seeking larger, fuller breasts, implants have become a reliable long term solution. Recently, however, patients have been interested in more natural alternatives. We now have the ability to safely transfer a patient’s own fat from one area of the body (that she may not want) to another region where volume enhancement is desired. In the breast, enhancement with fat is becoming more popular. Unlike traditional breast augmentation, where a fixed volume implant is placed in a large pocket through scars that are often visible, fat has the advantage of being able to be placed throughout the entire breast as countless minute parcels (seeds) using injection sites that virtually disappear. These seeds then become integrated into the surrounding tissue never to migrate out of place like an implant often does. The results can be astounding revealing naturally soft and supple breasts that women can enjoy for many years without the concerns of implant leakage or capsular scar problems often seen with implants. The procedure is performed in the outpatient setting and recovery is often no less uncomfortable than with traditional implants.

For women who have had traditional breast augmentation, concerns regarding visible or palpable irregularities may be a real problem. Although implants are typically placed under the muscle, this can create issues such as muscle animation or contraction deformities, which can be particularly disturbing in lean, athletic women. With fat transfer, implants can now be relocated above the muscle to provide enhanced coverage over the implant. This not only improves contour, and decreases visible irregularities, but can actually help to improve cleavage as well!

The use of fat in breast reconstruction after mastectomy is also becoming more utilized, not only as a supplement to expanders (temporary implants placed at the time of mastectomy to recreate the breast mound), but also for patients needing revisional surgery as well. But there’s more. Plastic surgeons now have the ability to make the entire breast mound itself from fat alone! The idea of creating an entire breast without the use of implants or even remote soft tissue flaps (skin transferred from other areas of the body) was practically science fiction just a few short years ago, but is now a reality, elevating breast reconstruction to a whole new level!

For the buttocks (Click Here for Brazilian Butt lift), fat has practically become a Hollywood fad where countless stars are vying for a more fashionable derrière. The application of fat not only enhances its contour and volume but does so by removing fat from the adjacent areas such as the hips and thighs, making for an even more dramatic change in a woman’s shape.

In the face, fat transfer has added another dimension to volume restoration. This can be especially impressive in the aging patient where volume loss has such an impact, and why face-lift type procedures alone do not fully restore the more youthful appearance that patients often seek.

Finally, fat grafting can be a very powerful tool in correcting previous liposuction defects, which, unfortunately, are becoming more common as less trained (and often non-board certified) surgeons are performing liposuction in their offices. There are virtually no limits to the applications in which fat can be used.

No procedure is perfect and fat graft enhancement in the breast is not for everyone. Certain women, for many reasons, may not be good candidates. In other patients, the use of an expanding dome called BRAVA® will be necessary to “grow” the breast prior to fat transfer. In most cases, breast augmentation with implants will likely be a better choice as the results are usually consistent and implants have a well proven safety record. In the right patient, however, fat can be an option that is simply unmatched by other methods of enhancement. This is an exciting new frontier in plastic surgery and is becoming adopted by more plastic surgeons as we continue to understand its biology and use.

I am fortunate to have embraced fat grafting and its techniques when I began my practice nearly 20 years ago and I have never looked back!

I invite you to call our office at 586-776-3223 and speak with any of our delightful staff or go directly to our website at imagebydesignmd.com to learn more about this new frontier in plastic surgery.

M. Kayser, MD – Your Michigan Plastic Surgeon

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