Procedure

Fat transfer, also referred to as fat grafting and lipofilling, has become widely accepted as the optimal means of soft-tissue filling in all areas of the body, including the face.

The method involves the strategic replacement of body's own naturally occurring fat resources to add volume in ageing areas of the face, and simultaneously rejuvenate the overlying skin.

Fat transfer to the face (or 'fat transplantation' or 'fat injection' to the face) uses processed fat to re-contour and restore volume to the face, particularly in areas that have become sunken with age. Fat transfer rejuvenates the face and restores a more youthful overall appearance.

Between 50 and 70 per cent of fat cells survive the transfer process meaning the results are permanent, and such is the organic ('autologous') nature of the donor material and the minimally invasive nature of the procedure, recovery times are minimal.

The Cadogan Clinic are specialists in this innovative field of fat transfer, and host the leading conference in the UK on the topic each year. Having performed hundreds of such procedures, we are the leading centre of excellence in the country for this treatment.

How does fat transfer to face work?

The procedure involves the removal of fat from areas where it is either unnecessary or unwanted via liposuction, and the re-injection of it into the face.

Fat cells are first removed by liposuction from the donor area – usually the stomach, thighs or buttocks. These cells are then cleansed and processed via centrifugation, before being injected into the facial area – a process that's very quickly carried out by your expert surgeon, and takes between 30 and 45 minutes.

It is performed under local anaesthetic and is a day-case procedure, with no need for an overnight stay. Results are long-lasting, natural and immediate.

What are the benefits of fat transfer to the face?

  • Quick 30-45 minute treatment
  • Minimally invasive
  • Long – lasting results 
  • No need for general anaesthetic
  • Smoother, rejuvenated appearance 
  • Dual weight loss effect via micro-liposuction
  • Improved sense of emotional wellbeing

Who performs fat transfer in the UK?

Fat grafting or fat transfer is most commonly performed by plastic surgeons, as liposuction is a primary component of the procedure and it requires surgical skill and precision to ensure the fat graft 'takes' in its new site.

In the UK, fat grafting should be performed in a facility or hospital such as the Cadogan Clinic that is inspected at regular intervals by the Care Quality Commission (CQC), to ensure patient safety and best practices, by plastic surgeons who are on the specialist General Medical Council register for plastic surgery.

At a glance

  • Surgery Time: 30 – 45 minutes
  • Hospital Stay: 1 to 2 hours
  • Time Off Work: a few days (if needed)
  • Reasonably Mobile: Immediately
  • Washing: Shower after 1 day 
  • Driving: a few days
  • Exercise Including Gym: 2 - 4 weeks
  • Sexual Activity: a few days
  • Full Recovery: 1 week
  • Sleeping Position: Sleeping on back recommended for 1 week

Who is suitable for fat transfer to face?

Fat transfer to face or fat grafting to face is a highly personal procedure and should only be undertaken if you feel strongly that you would benefit from either the volume enhancing or rejuvenating properties of fat transfer your facial area

You may be a suitable candidate for fat transfer to face if:

  • You are in good psychological and physical medical health
  • You are at your ideal body weight
  • You have a positive outlook and realistic expectations of what can be achieved via fat transfer
  • You are seeking to improve the contours of your face 
  • You are seeking to rejuvenate the appearance of your overlying facial skin 
  • You are seeking to reduce fine lines and wrinkles 
  • You are looking for longer lasting results that can be achieved by dermal filler 

What to expect

CONSULTATION

The first step for all of our fat transfer patients is to meet with the surgeon we feel is best placed to perform your procedure for a consultation. At the consultation you will be able to discuss with your surgeon what your hope to achieve from the procedure, as well as discuss in detail what may or may not be possible given your existing anatomy.

Your surgeon will take you through the options available to you, and which is the most preferential for you given your stated ambitions. Having established this, several key measurements will be made and standard clinical photography will be taken.

One of the key considerations at consultation for fat grafting involves making an assessment of the volume of fat required—approximately twice the volume of fat needed for injection needs to be harvested as the volume is reduced by half during preparation.

Donor sites (where the fat is taken from) will also be assessed and agreed on with you. This may involve taking fat from more than one area; typical donor areas for fat grafting are the flanks, abdomen, lateral thighs ('saddle bags') and inner thighs, but fat can be taken from anywhere with excessive deposits.

Finally a comprehensive discussion regarding risks and complications will take place, alongside a discussion regarding what to expect in the post procedure and recovery phase. Your previous medical history will also be recorded (including previous surgery, medications, allergies etc.) and an assessment of your fitness for surgery.

If your surgeon feels you are a good candidate for surgery, you are then invited to consider whether you would like to proceed for surgery or otherwise following a two week 'cooling off' period.

Within this period you are welcome to come in and discuss your potential surgery with your surgeon as many times as you like.

PRE – PROCEDURE

If you choose to proceed with surgery, the next time you come into the Clinic after your final consultation will be the day of your procedure. Before admission the following behavioural changes are recommended / required:

  • In the 6 weeks before your procedure we recommend smoking is discontinued as patients who smoke have a higher risk of healing more slowly and complications (see FAQs)
  • In the week before your procedure you must cease taking Aspirin or any medication that contains Aspirin
  • In the 6 hours prior to surgery you must not consume food or any drink, other than small sips of clear fluid (e.g. still water, black coffee, black tea) which are allowed up to 2 hours before admission

We advise all of our fat grafting patients that smoking is a particular contra-indication to this procedure (even more than with other surgical procedures) as fat viability is materially reduced after transfer in smokers, and the effectiveness of the procedure is significantly reduced.

DAY OF THE PROCEDURE

On the day of your procedure we ask that you arrive for your admission an hour before the agreed start time of surgery. At this point a nurse will come and record blood pressure and other relevant vitals, you will meet with your anaesthetist and your surgeon who will make the final mark-ups.

The procedure itself takes place under local anaesthetic or Sedation over the course of 30 minutes to 1 hour. The fat is first removed via liposuction, then prepared via a centrifuge in order to separate the fat from blood and other oily fluids, and then re-injected to the treatment site with a needle and syringe. The injections are given through tiny holes in the skin, so stitches are not usually needed. If a large area is being treated, your may require 2 or more sessions.

POST PROCEDURE & RECOVERY

You should not feel any pain during the procedure, but you may have some for a few days afterwards. You'll be given painkillers if you need them.

Following the procedure, you will recover in our ambulatory recovery rooms for between one and two hours, dependent on the scale of the procedure. Once our specialist nursing team are happy that your initial recovery is complete and you are safe to return home, you will be allowed to leave the Clinic accompanied by a friend or member of your family.

Once home you will have access to our dedicated on-call nursing team 24 hours a day, 7 days a week. This team of specialists are dedicated to your comfort and pain control, and are there to field any questions you may have in the immediate post operative phase.

We ask that you come in and see our nursing team 1 week after surgery to ensure your incision sites have been properly reviewed. At this juncture we also recommend you meet with one of our on site aestheticians to discuss ongoing treatment to support the healing and scarring process.
We ask that you come in to see your surgeon after 6 - 8 weeks for a final check up.

What can I expect from my surgery?

Why come to the Cadogan Clinic

The Cadogan Clinic is the leading centre of excellence in the UK for fat transfer and fat grafting techniques.

Each year we host a leading global faculty of the top global practitioners in this cutting edge field at the Royal Society of Medicine in London to discuss and debate the latest innovations in the fat transfer sector.

Our fat grafting conference runs over two days of lectures, talks and roundtables, and represents the largest conference of its kind in the UK with 150 leading specialist delegates from 25 countries including the USA, Belgium, France and Israel.

What are the side effects and risks

Fat grafting is a safe procedure, but it is common after a surgical fat transfer to experience:

  • bruising and swelling
  • temporary numbness
  • a small amount of scarring 
  • loss of some of the fat from the injected area during the first few months

As with all surgical procedures, fat grafting carries some risk and it is possible that you might experience:

  • Nausea 
  • Bleeding or Infection 
  • Poor healing of incisions and scarring
  • a collection of blood underneath the skin (haematoma)
  • death of fat tissue (fat necrosis) or embolism

Your surgeon will discuss these risks comprehensively at your consultation and explain how likely these risks and complications are, and how they would be treated.

Frequently Asked Questions

Fat transfer to the face is an advanced surgical treatment which involves harvesting and filtering unwanted fat cells through liposuction techniques, then reinjecting them to either help rejuvenate and restore lost volume in the face.

The same technique can be used to improve the natural contours of the body and do the breast. This is most usually performed under either a local or general anaesthetic depending on the patient and surgeons' preferences and suitability.

Three things happen during the fat transfer to face procedure

+ Fat is taken from elsewhere by liposuction. This could be anywhere, but for convenience is often the abdomen or thighs and most commonly under local anaesthesia or sedation.
+ The fat is then processed by filtration and centrifuge spinning and put into small syringes for injection
+ The fat is then injected into the face

It is possible to combine this treatment with innovative rejuvenative stem cell treatments. Fat contains Stem Cells and their close relatives, Mesenchymal Stromal Cells (MSC) which enhance fat transfer and improve skin and scar quality.

These can be extracted in the Cadogan Clinic from the fat and added to supercharge the fat to be transferred. Alternatively, they can be used on its own as a stem cells suspension or MSC enriched Nanofat.

When combined with more comprehensive liposuction, the donor site can be sculpted and contoured during the same procedure.

Fat transfer procedure times vary according to the amount of fat that needs to be harvested and then injected to deliver the desired results.

In practice, this is typically between 30 minutes and 1 hour for treatments to the face that do not require large volumes of fat to be harvested.

+ First the fat is harvested from elsewhere - often the tummy or thighs. If the aim is only to provide a little fat for the face then this might take as little as 20 minutes (this can take up to an hour for other fat transfer procedures where the donor area is sculpted following harvesting)
+ Then there is the processing of which there are several methods - washing, filtering and spinning. This takes no more than 5 – 10 minutes, although if refining stem cells for later injection, this can take much longer
+ Finally precise fat placement into the face can be done in 10 minutes, although for larger areas in the face this can take longer

There is a technique available at the Cadogan Clinic where a large quantity of fat is taken and then frozen and stored. Small amounts can then be taken from the store over months or even years to layer the fat, building up the contour. Each of these injection sessions can be carried out swiftly in a matter of minutes.

Fat obtained by liposuction can be grafted to the breasts, buttocks or anywhere in the body, but the commonest, and by far the most important area, is the face. But why the face?

Gravity was thought to be the major factor in facial ageing, with all soft facial tissue descending vertically as a result of thinning and sagging of retaining ligaments. In recent years, surgeons have now understood that the majority of the volume loss actually occurs at the bone and deep fat compartment level, which causes the ligaments loosen and the superficial layers to sag since the existing bony structures are no longer there to support them.

Fat is therefore an excellent volumizing resource to restore both structure and volume to the face. The ligaments face and skin in the mid face can be lifted back upwards, to rest on these restored structures.

Whilst fillers deliver a similar action in the early stages of ageing, such solutions are only temporary corrections given the dissolvable nature of dermal filler. By contrast the patients own fat is not only permanent, but it is often enriched with stem cells, meaning it can permanently replace volume and have regenerative effects on the overlying skin.

Some common treatment areas in the face include

+ Fat transfer to the cheek to restore volume lost by the resorption of bony and fat deposits with the passage of time, and restore the prominence of the cheek bone structure
+ Fat transfer under the eyebrows to lift both them and the upper eyelids, thus restoring the brow and opening the eye. This technique is now a standard adjunct to blepharoplasty (upper eyelid reduction)
+ Fat grafting of the ageing hollowness of the temple and adjacent forehead to restore that youthful shape.
+ Fat grafting to the pointed chin of older people to restore tissue loss and correct the shape

Fat grafting (fat transfer) of the face can be carried out as a procedure on its own or combined with other procedures on the face, such as face and neck lifting and blepharoplasty (upper and lower eyelid reduction). A useful thought is to consider fat grafting if you are having liposuction elsewhere since this fat can be usefully employed elsewhere in the body, and not simply thrown away.

The fat is taken from anywhere convenient or somewhere that you would like reduced. Generally, we use the lower abdomen, inner and outer thighs.

We only need small amounts for the face but may have to search harder for the larger amounts for augmenting the breasts or buttocks. Very slim patients may present a problem.

These donor areas will be bruised for three weeks and completely settle over three months.

Large amounts are of fat are not required, but it is nevertheless an opportunity to remove unwanted or stubborn fat from your body if you have some.

The fat is processed and sometimes enhanced with extra stem cells also obtained from fat to ensure a better take of graft, which will be important in smokers and those with poor healing.

To deliver the best results a certain level of fat is required and your specialised surgeon will be able to assess this during your initial consultation and examination.

The volumes required a very minimal however for an effective solution to the face, so it is very rare that we are unable to find sufficient deposits somewhere in the body.

On the rare occasion, very slim patients can present an insurmountable problem, but you will be advised by your surgeon at your consultation.

Obtaining (harvesting) the fat usually from the tummy of thighs is usually required before fat transfer to the face, and will be a required stage of your procedure.

The only instance when this is not the case is for those who have previously had liposuction or fat transfer procedures and who have stored their own fat stored from this previous procedure. In which case it is simply defrosted and injected without loss of potency.

Fat transfer is not a painful procedure. You will be under the influence of anaesthetic or fully sedated during the procedure and will not feel anything.

Afterwards you will be given paracetamol to manage any mild discomfort you may experience.

For patients worried about pain, it is always possible to have the procedure either fully sedated or under general anaesthetic.

After your surgery, you will be asked to come in for a post-operative appointment to come back and see our nursing staff at the Clinic between 1 and 2 weeks after your surgery. At this point your incision sites will be reviewed, and your preliminary healing will be assessed.

After 6 weeks your surgeon will personally review your progress – again at the Clinic - and make sure you are recovering as expected. In addition, they will remove any stitches and advise you on the need for further dressings.

Throughout the recovery period you will have full access to our 24/7 on call nursing service, and full access to the Clinic and our post-operative facilities.

Our aim is to make you feel as comfortable as possible during the entirety of your recovery period.

As your anaesthetic or sedation wear off you will wake up in our recovery facilities at the Clinic. You may feel a little drowsy but this often wears off within a few hours. After several hours in recovery, you will eat and hydrate. At that point, you will be allowed to leave the Clinic by our nursing staff.

It is common to feel a little pain and discomfort in the immediate aftermath of surgery. This will wear off in due course. Our 24/7 on call service is open to all patients for any question or query they may have at this time.

You will not be able to drive yourself home after the surgery. You should arrange for someone to pick you up and take you home. In addition, you will need to ask someone to stay with you for the first 24 hours after your procedure.

Fat transfer (fat grafting) is a minimally invasive surgical procedure. It is often done under local anaesthesia and always as an outpatient.

Downtime is therefore minimal. Whilst there may be a little swelling and bruising, you should be back to your daily routine within a few days. We suggest a few days off work to allow for the swelling to settle. We suggest you avoid exercise for a couple of weeks.

One of the major benefits of fat transfer is that recovery is typically very swift and patients can be back at work and active very shortly after the procedure. Whilst the extent of such activity should be gradually phased in, you should be back at work within a week and exercising within two weeks.

We always advise that you return to low impact activities first like walking and cycling before you are able to reintroduce more strenuous activity such as lifting heavy weights and doing intense aerobic activities.

Final results are typically first seen a few weeks after your procedure, with ongoing improvements beyond this point likely as the healing process fully completes over the coming 3 to 6 months, and as your fat continues to re-distribute itself and settle.

Your surgeon will be able to give you specific guidance at your consultation.

Fat transfer to the facial areas is also a long-term solution which will last for many years as your consultant will discuss with you in your consultation.

Between 50–70% of the transferred fat is retained long term, and will last just like normal fat. It will even grow with weight gain. With time however, it will begin to wane alongside your other fat deposits. This should not happen before many years, however.
Some factors will impact the longevity of your results:

+ The skill of your surgeon - hоw thе fаt was harvested аnd purified, and hоw аnd whеrе it was іnjесtеd all impact longevity. The more skilled the surgeon and the better his/her understanding of the technique, the longer lasting the results
+ The technique employed - a process саllеd mісrоfаt grаftіng, although lаbоr іntеnѕіvе, is the bеѕt way tо еnѕurе thаt thе hіghеѕt percentage оf grаftеd fat wіll tаkе.
+ How well your body adapts to the transferred fat - thе іnjесtеd fаt must еѕtаblіѕh a nеw blооd ѕuррlу frоm уоur bоdу and receives thе nourishment іt nееdѕ for ѕurvіvаl. Whеn this hарреnѕ, rеѕultѕ can аnd оftеn are реrmаnеnt; hоwеvеr, thеrе mау bе a percentage оf fаt that does nоt tаkе, whісh іѕ whу tоuсhuр рrосеdurеѕ are ѕоmеtіmеѕ nесеѕѕаrу. Lifestyle factors such as smoking can impact this

Generally, fat survives best when put into areas with its own abundant blood supply. The face, which is so well vascularised, picks up a new supply quickly and the majority of the fat survives. Results are often at their best in the facial region, as a result

Yоu can expect the аrеаѕ to which thе fаt wаѕ transferred tо appear ѕоftеr аnd fullеr, gіvіng уоu a rеfrеѕhеd and rejuvenated арреаrаnсе. Yоu should also nоtісе аn improvement іn ѕkіn tеxturе.

Certain lifestyle factors can increase the risk of complications during and after your surgery. These include smoking, drinking alcohol, being overweight and taking drugs (for medical or recreational use.)

The most common impact of smoking before your surgery is that it increases your chances of developing an infection and inhibits your body's natural healing processes. We insist that all patients stop smoking and using nicotine products at least six weeks before surgery. Reducing alcohol intake is also strongly advised. This is particularly important for fat grafting surgery in which the fat's viability post-procedure is materially reduced in a smoker population.

Your doctor will discuss your current BMI and drug use at your consultation and advise you further on this.

Not only is the fat relatively easy to harvest via liposuction, but the transferred fat is biocompatible, non-allergenic, non-toxic and relatively easy to obtain in meaningful volumes.

More recently surgeons have used the therapeutic and rejuvenating benefits of fat grafting in the healing of wounds and scars, as well as fat's ability to repair damage to breast tissue following radiation treatment.

The rejuvenative effects are due to the high concentration of mesenchymal cells present in the fat tissue.

This natural 'autologous' resource is therefore readily accepted in the treatment area, is easily topped up and can provide additional rejuvenating benefits.

The benefit of fat transfer to the face over dermal fillers is that the results of the procedure are long lasting and permanent.

70% of the fat will 'take' in the face and continue to behave exactly like normal fat. This fat will be long lasting, add structure and, because of the included stem cells, improve skin and scar quality. It is also possible to inject higher volumes of fat into the face, given its natural ('autologous') properties.

By contrast, the results of dermal fillers tend to fade after 6 months of your treatment and there is only so much that can be injected at any one time.

Whilst there are always risk that present during surgical treatment, fat transfer procedures are generally a very common and safe group of procedure.

Please see our risks and complications section for more information about risks and side effects.

Your surgeon will be delighted to talk you through these comprehensively at your consultation.

This treatment is particularly appealing due to the low risk it presents since we use the patient's own tissue is used to reshape and re-contour their body in a natural way. We not using implants or artificial filler, which for some people is important.

The most common side effects are temporary bruising and swelling, but infection can also occur. The graft not 'taking' properly is also a risk, so we ask you not to exercise strongly for a week or two to allow the new fat graft to take up a new blood supply.

Patients do need to discuss with their consultant the range of possible results carefully before surgery, since expectations will vary. Some will be happy with a slight improvement and others will need more significant changes to be satisfied.

The most significant risk of fat transfer is fat embolization in which fat enters the blood stream and interrupts an otherwise healthy blood supply, with associated risks including blindness, stroke and death.

Whilst rare, this emphasizes the importance of establishing your surgeon's credentials. It will always be a risk, in untrained hands. The Cadogan surgeons will avoid injecting in certain areas and use safer cannulas.

We also do not practice riskier procedures such as fat transfer to the buttock (BBL) given the higher incidence rate of embolism in other countries where it is practiced, caused by the higher volume of fat injected into the target site and the large arteries in the buttock.

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