As with Dermal Fillers, Lipofilling is a surgical procedure performed on patients who are seeking to enhance or correct certain areas that may displease them due to ageing, accidents or defects that need some filling out and plumping up. Although both techniques aim to achieve similar results, they are intrinsically different from one another.
What is Lipofilling?
Also known as fat grafting, lipofilling incorporates fat injections and fat transfer to enhance areas of the face and body, using the patient’s own fat to fill in undesirable irregularities, indentations and also to enhance certain features or areas. Lipofilling has been popular since the 90’s and with medical advancements, has become a popular and well-established practice.
Why Lipofilling?
Aesthetic issues such as sunken cheeks, the disappearance of fat from the cheekbones, deep grooves running from the nose to the corners of the mouth, lines between the lower eyelids and the cheek can all be addressed and treated with lipofilling. In addition, lipofilling has also become one of the most popular methods used for lip enhancement procedures. It can also smooth out all types of irregularities such as those resulting from poorly performed liposuction or injuries. The technique can furthermore be used to augment the breasts.
The procedure
In my practice, I’ve come across patients that often don’t consider lipofilling as an option as they feel that they may not have enough fat to get the desired results, but in my experience, even thinner patients have enough fat cells for transplantation.
The necessary fat for the procedure is obtained via one or several 2 to 3 mm incisions from excess fatty areas on the patient’s body. This procedure doesn’t leave any visible scars and the most common areas where fat is harvested are the abdomen, inner thighs and inner knee areas. The extracted fat is processed by centrifuging, filtering or rinsing, resulting in a pure liquid fatty tissue ready for injection into the desired areas. This fat commonly regarded as “liquid gold” amongst us plastic surgeons due to its richness in stem cells and volume that can be filled.
The fat is injected and evenly distributed into the new area by injecting minute amounts in the tissues so that the injected fat is well surrounded by healthy tissue. This ensures that the transplanted fat remains in contact with the surrounding tissues supplying it with oxygen and nutrients.
Lipofilling is often combined with liposuction as it helps to achieve an excellent aesthetic outcome and assists with improving the patients’ desired shape.
Which type of anaesthesia is needed?
Lipofilling can be performed under either local or general anaesthesia. The following criteria are taken into account when deciding which anaesthesia is best:
- The amount of fat that is needed for transplantation and re-distribution
- The size of the area to be treated
- Lipofilling and liposuction combination if required
- Patient’s personal wishes
At my practice, we always consider our patients’ wishes when selecting the type of anaesthesia, however, it is recommended that a local anaesthesia be used if the treated areas are not too large. Local anaesthesia also does not include some of the risks that general anaesthesia does.
The recovery
Lipofilling is considered to be a non-invasive surgical procedure and generally does not take too much time to perform. Since lipofilling does not need any post-procedure treatment, there is no need to remain in a hospital. Most of my patients go home on the same day. Swelling can be experienced but fades within 6-7 days and generally patients return to normal everyday life within 3-5 days after the procedure.
In the case of fat transplantation only 60-70% of transplanted fat cells are viable and therefore more fat is extracted and transplanted than is needed. The final result of lipofilling is noticeable within 4-5 months and as with any surgical procedure, no strenuous exercise is recommended for at least a week after the procedure has been performed. My experience has shown me that at about 6 everything seems to “pop”. The volume looks better once there is full fat integration and the overall skin quality is even better. This is presumably from the effects of the stem cells inherent in the lipofill.
What are the risks of lipofilling?
As with all cosmetic procedures there are risks and it is important that my patients understand them. Together we’ll carefully weigh up the risks versus the benefits in order to come to an informed, educated and most suitable decision.
In general lipofilling risks are few, rare, and minimal. Below I have listed a few:
- Soreness and swelling are possible, but they’re not experienced by every patient.
- Reabsorption of the fat by the body which may affect the desired results.
- Allergic reactions to anaesthetics.
- Permanent discolouration caused by a ruptured blood vessels at the treatment site.
- Calcification
- Peri-operative bleeding
- Blood clots at the donor site
- Blood-borne infections
- Scar tissue
The Benefits of lipofilling
Fat injection as a cosmetic treatment is natural, adaptable, long-lasting, and relatively safe. Lipofilling has become a preferred method of facial volume enhancement for patients who are allergic to traditional dermal fillers such as bovine-derived collagen. One of the biggest benefits of volume enhancement via fat injection is that there is little chance of an adverse allergic reaction as your own fat cells are being used in the procedure.
- Allergic reactions
Many patients feel more at ease using fat transfer as this minimises the worry about a possible adverse reaction. Traditional collagen injections are derived from bovine tissue, so patients should undergo an allergy test and wait for the results before undergoing this type of treatment. Even more modern facial rejuvenation products, such as those that use hyaluronic acid, carry a slight risk of reaction in people who have multiple allergies.
- Duration
Another popular reason for choosing fat transfer/injection is longevity of the results. Whilst hyaluronic acid based dermal fillers have a duration of between 12-18 months, lipofilling is a more permanent result.Occasionally an additional lipofill may be required to fine tune the final outcome.
- Easy to combine
Lipofilling is easily combined with other facial rejuvenation procedures such as BOTOX®, or a body procedure such as abdominoplasty (tummy tuck) or liposuction. Many patients find that undergoing facial fat transfer in addition to one of these mentioned procedures is more cost-effective than undergoing these treatments separately.
Now let’s review lipofilling versus dermal fillers
| Lipofilling | Dermal fillers | |
| Wrinkle reduction | Yes (nanofat grafting) | Yes |
| Volume enhancement | Yes | Yes |
| Swelling | Longer | Shorter |
| Allergy | None – minimal | Possible |
| Downtime | 1 – 5 days (procedure dependent) | Hardly any |
| Results | Immediate noticeable results; final results only after swelling subsides and the fat graft has taken. | Final outcome is immediately noticeable bar minimal swelling
|
| Duration of results | Can be indefinitely, making it essentially a permanent form of treatment | Temporary: 6 months to 2 years. |
| Number of treatments needed | Usually one treatment but minor touch ups might be required. | Need to be administered regularly to maintain the results |
In Conclusion
It’s rare that patients come to my surgery insisting on lipofilling but rather come because they want my opinion on how to improve their appearance or address their physical aesthetic issues.
The first step in the process is to book a consultation where we discuss options and the best course of treatment. I will advise if lipofilling is the correct treatment method or discuss alternative solutions that would produce desired results.
I hope that this blog post has provided some insight into the ‘what’ and ‘how’ of lipofilling/fat grafting /fat transfer. Please feel free to contact me should you wish to discuss further regarding a lipofilling procedure. I look forward to seeing you at my practice.
Have a spectacular day,
Dr Sean Moodley
