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Historically, the treatment of this imbalance has been simple: use fillers. Fillers like Juvederm, Radiesse, Restylane and Sculptra, are great for plumping up areas. On a daily basis, I use these fillers in my practice with great success. They are safe, reliable and in the right hands have reproducible results. But there are negatives. Over injection can look unnatural and cause distortion. The over injection of fillers in my opinion is an epidemic in this country. Most fillers only last up to 1 year. They are expensive and there is a limit to the volume that can be filled. In areas like the breast or buttocks, it would be extremely cost prohibitive to use fillers due to the volume required. It is due to these reasons that we have moved so aggressively toward using a patient’s own fat for volume enhancement. It is abundant, it last indefinitely and you can fill in larger areas like the breast. It offers the best alternative to fillers.
Patients have been flocking to offices like mine that offer this procedure. When considering the theoretical benefits of stem cells, which are present in the transferred fat, it is clear why this alternative is so compelling. I commonly combine liposuction with fat transfer procedures. This allows me to use the fat removed from a patient to augment different areas of their body like the face, breast and buttocks. Most importantly, there is real potential for permanent change when the fat is transferred. It is a natural alternative that has single handedly changed the way we approach aesthetics.
Fat transfers can last indefinitely. That is the benefit of using your own fat for volume enhancement. Once it takes, the fat in most cases will persist. But, there is a lot of misinformation regarding the lasting effects of fat transfer in the field of aesthetics. Specifically, it is extremely unlikely that all the fat transferred will take. Peer reviewed research does show that only 50% to 70% of fat will survive the transfer. Therefore, the results do change over time. Initially, the patients really love their results. The areas of injection are nice and plump, making the face seem youthful. This plumpness inevitably decreases with time, usually within 1 to 2 months of the procedure. The fat that doesn’t survive the transfer is absorbed by the body and will not alter the treatment area. Although the initial excitement does wane as the plumpness recedes, the patients are still very happy with their results. This is the main reason that some patients need more than one fat transfer procedure. It ensures that the plumpness they desire will be achieved. In other words, rarely will one transfer provide all the volume that is required. This doesn’t mean that one transfer won’t be enough. In most of my cases, greater than 70%, the patients are pleased with the volume enhancement from only one transfer and they do not desire another procedure. I just think it is important for patients to be prepared for the possibility of 2 procedures.
The recovery for these types of procedures is fairly well tolerated. Even when it is combined with liposuction, as I do most often in my practice, the recovery averages around 7 days. Most patients return to normal activities in 1 week and begin exercising at 2 weeks. In regards to fat transfer to the face, bruising and swelling can persist past 7 days, so in this instance, return to work duties may be delayed. In regards to discomfort, this is a fairly well tolerated procedure. In most cases, patients only require pain medication for 2 to 3 days after the procedure. By 1 week, the pain medications are almost universally discontinued.
Historically there has been some concern with fat transfers to the breast altering the ability of mammograms to screen for breast cancer correctly. With the advent of MRIs and more effective mammograms, this concern has been somewhat alleviated. Most patients are excellent candidates for this procedure and should feel confident that breast cancer screening in future will not be disrupted. In my opinion there is only one group of patients who should take caution with this type of procedure: patients with a strong family history of breast cancer. In these cases, any alteration of the mammogram may lead to an unnecessary procedure like a breast biopsy. The threshold for a breast biopsy in this group tends to be lower than the standard population.
A majority of my fat transfer cases are completed in the office without general anesthesia. For small areas like the face, this is easy to facilitate and comfortable to the patient. In regards to larger areas like the breast and the buttocks, I.V. sedation is most often required in an operating room setting.
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