Fat grafting takes your own tissue by liposuction, processes it and places it where volume is missing. It is used for the face, the breasts, the buttocks and to correct contour defects.
It is one of the most versatile resources in plastic surgery today. Fat is your own tissue: it causes no rejection, it is not a foreign body and, where it takes, it behaves like the rest of the body's fat. In the face it restores volume to the areas that empty with age; in the breast it corrects asymmetries and contour defects; in sunken scars or irradiated areas it improves, as well as the filling, the quality of the skin covering them.
And the limitation, which has to come first: not all the grafted fat survives. Between thirty and fifty per cent is reabsorbed over the first three months. That is not a complication: it is the normal behaviour of a graft, and it is why a calculated excess is placed and why a second session is sometimes planned from the outset. Anyone who does not know this in advance experiences those three months as losing the result.
It usually helps when there is
- Loss of facial volume with age, in the cheekbones, temples or folds.
- Asymmetries or contour defects in breasts, buttocks or limbs.
- Sunken or tethered scars, including those from burns.
- Irradiated areas, where it also improves the quality of the skin.
- A preference for your own tissue over fillers or implants.
Worth discussing first if
- Being very slim, with no sufficient donor area.
- Unstable weight: grafted fat grows and shrinks with your weight.
- Expecting an exact, permanent result from the first session.
- Current smoking, which greatly reduces the survival of the graft.
- Needing a very large volume in one area, which forces it to be split.
None of these rules the procedure out on its own; all of them change the conversation.
Where it is used
The technique is the same; what changes is the volume, the plane and how finely the graft is placed.
Facial grafting
Small, fine volumes in the cheekbone, temple, tear trough or chin. It is often combined with a facelift, and it is what avoids the stretched, empty look.
Breast grafting
Corrects asymmetries, contour defects and the visible step over an implant. In reconstruction it improves irradiated skin and softens the result.
Grafting into scars
Releases tethered scars and fills them from within. As well as volume, it brings an improvement in texture and colour that other treatments do not give.
Everything depends on how the fat is handled
The survival of the graft is decided by how it is obtained and how it is placed. It is aspirated with fine cannulas at low pressure, so as not to break the cells; it is processed gently, removing blood and fluid; and it is placed in multiple small-volume passes, in different planes and as a mesh, not as a bolus. Every particle of grafted fat needs to be surrounded by vascularised tissue to survive; if a large clump is deposited, the centre receives no blood and turns into fat necrosis.
The volume each area will accept has a ceiling. Exceeding it does not give more result: it gives more reabsorption, more nodules and more oil cysts. When more is needed than the area will tolerate, two sessions months apart are planned.
In the buttock, the safety rule of this procedure also applies: exclusively the subcutaneous plane, never intramuscular, because of the risk of fat embolism.
What the process is like
From the first consultation to discharge, with the usual timings for this procedure.
Consultation
The area to be treated, the volume needed and the fat available are assessed. The percentage of reabsorption to expect is explained, and whether two sessions should be planned.
Before surgery
Tests according to the size of the procedure and anaesthetic assessment where appropriate. Stopping smoking. The informed consent is signed.
The procedure
Gentle liposuction of the donor area, processing of the fat and grafting in multiple passes and planes. Compression of the donor area at the end.
Follow-up
Reviews at one week, one month and the third month, which is when the volume that took is judged and whether a second session is needed.
Week by week
In the first days the area looks excessive; at three months you see what stayed.
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Days 1 to 7
Noticeable swelling in the grafted area and bruising in the donor area. Compression garment where appropriate. No pressure on the treated area.
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Weeks 2 to 4
The swelling subsides and the volume seems to drop: this is the point at which many patients become alarmed. No intense exercise.
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Weeks 6 to 12
The fat that did not take is reabsorbed. The graft settles and now behaves like your own tissue.
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Months 3 to 6
Final result. This is when it is decided whether the volume achieved is enough or a second session is worthwhile.
Risks, and what is not promised
Partial reabsorption is the rule, not the exception: between thirty and fifty per cent of the grafted volume disappears in the first months. It is compensated for by grafting a calculated excess and, if needed, with a second session.
Other risks: irregularities and asymmetry, fat necrosis with palpable nodules or oil cysts, calcifications — which in the breast can be confused with findings on a mammogram and need investigating — infection, and the risks of liposuction in the donor area. In facial grafting there is also the infrequent but serious risk of fat embolism from intravascular injection, prevented with a blunt cannula and correct technique.
In the buttock, the serious risk is fat embolism from intramuscular injection, avoided by placing the graft exclusively in the subcutaneous plane. No exact volume is promised, and no promise is made that the whole graft will survive. These risks are reduced by careful harvesting and processing, grafting in multiple small passes and respecting the plane. They are not eliminated. The ones that apply to your case are set down in writing in the informed consent.
The information on this page is for guidance and does not replace an in-person medical consultation. Medical practice is an obligation of means, not of result.
The questions we are asked most about fat grafting
Between a half and two thirds of what is grafted, as a rough guide. The rest is reabsorbed over the first three months, and that is part of the planning from the start.
That is why a calculated excess is placed and why, in some areas, two sessions are anticipated. It is not a complication: it is how a graft works.
It is different. Fat is your own tissue, permanent in the part that takes, and it works for larger volumes; hyaluronic acid is placed in the consulting room, with no theatre, shows the same day and can be dissolved.
For a small, reversible adjustment, filler. To restore volume durably, fat. It is decided in the consultation according to what is needed.
Grafted fat behaves like the rest of the body's fat: it grows if you put on weight and shrinks if you lose it.
In the face that can be quite noticeable with significant weight changes. It is one more reason to do it at a stable weight.
It can produce calcifications that show on the scan and that sometimes mean the assessment has to be completed. Experienced radiologists distinguish the benign calcifications of a graft from suspicious ones well.
What matters is always telling them you have had a fat graft when you go for a breast check.
Question not answered here? There are more answers in the frequently asked questions.
