Fat Grafting (Fat Injection)

1. What Is Fat Injection (Autologous Fat Transfer)?

Fat injection is a procedure in which fat tissue taken from the patient’s own body is:

• Purified with special processes, and
• Injected into the face, hands, buttocks, breasts or other selected body areas

to restore volume, correct contour irregularities and improve tissue quality.

This method:

• Removes fat from unwanted areas (abdomen, waist, hips, inner thighs, etc.), and
• Uses it as a natural filler to shape areas that need volume.

Because the material used is your own fat:

• It is biocompatible,
• The risk of allergy or foreign body reaction is low,
• It may have positive effects on skin quality and tissue vitality.

2. In Which Situations Is Fat Injection Preferred?

Fat injection is frequently used for both face and body.

For the face:

It is preferred to address:

• Volume loss in the cheeks,
• Definition of the cheekbones,
• Hollowing in the under eye–midface region,
• Nasolabial folds (lines between the nose and mouth),
• Hollowing in the temples,
• Projection and definition of the chin tip and jawline,
• Overall facial rejuvenation by restoring age related volume loss.

For the body:

It can be used for:

• Buttock shaping (as part of a BBL concept using fat transfer),
• Modest breast augmentation in suitable candidates,
• Softening and reshaping areas such as the hip dips and outer thigh contour,
• Adding volume to the backs of the hands to mask prominent veins and tendons.

In addition, fat transfer can be performed for tissue support and repair in some cases of scarring, depressions or contour irregularities after trauma or previous surgery.

3. Who Is a Suitable Candidate for Fat Injection?

Suitable candidates are typically:

• Individuals whose general health allows surgery,
• Those who have sufficient fat reserves in at least one donor area,
• People with volume loss, contour irregularities or specific areas that would benefit from added fullness,
• Patients who prefer to use their own tissue rather than a permanent synthetic filler,
• Those who understand that part of the injected fat will be reabsorbed by the body over time and accept the possibility of needing a repeat session,
• Individuals with realistic expectations.

In very slim patients with minimal fat stores, planning large-volume fat injection may be difficult, and alternative or additional strategies may be needed.

4. Advantages and Limitations of Fat Injection

Advantages:

Because the material is your own fat:

• The risk of allergy and foreign body reaction is low.

Fat not only restores volume:

• It can also improve skin quality thanks to accompanying stem cells and growth factors,
• It can offer a more economical and widespread volume enhancement option for larger areas compared to synthetic fillers,
• When performed with proper technique, it provides a natural look and feel.

Limitations:

• Not all of the injected fat becomes permanent; a certain proportion is reabsorbed by the body over time,
• The remaining fat is usually considered permanent after about 3–6 months,
• A second fat injection session may sometimes be needed to achieve the desired volume,
• Weight gain or loss can also affect the transferred fat,
• Factors such as smoking and circulatory problems may reduce fat survival.

5. Preoperative Evaluation and Planning

Before surgery:

• The patient’s medical history, medications, allergies and smoking status are evaluated.

Both the fat donor areas (abdomen, waist, hips, inner/outer thighs, etc.) and the recipient areas are analysed together.

• Facial or body proportions are examined from different angles with photographs,
• The planned volume for each area and the expected effect of the fat in that area (more youthful, more contoured, fuller, etc.) are discussed.

Previous treatments such as fillers, botox or surgery are recorded.

The following are clearly explained to the patient:

• Fat survival rate,
• The possibility of needing a second session,
• The impact of weight changes on the result.

The goal is to create a plan that restores required volumes naturally and in balance, without disturbing overall body proportions.

6. How Is Fat Injection Performed?

Fat injection consists of three main stages:

a) Donor Areas (Where the Fat Is Taken From)

Fat is most commonly harvested from areas such as:

• Abdomen,
• Waist (love handles),
• Hips,
• Inner / outer thighs

using thin cannulas with a liposuction technique.

The aim is to:

• Harvest the fat as gently as possible,
• Minimise trauma,
• Keep the fat cells alive and viable.

b) Processing (Purification) of the Fat

The harvested fat is separated from blood and fluid components.

• Using methods such as centrifugation, filtration or decanting, the fat is prepared to an appropriate density for injection,
• In some protocols, micro– or nano–fat preparations are used, especially for delicate facial areas, to achieve a smoother and more homogeneous appearance.

c) Injection Technique to the Target Area

The prepared fat is injected into the planned areas using fine cannulas in multiple tunnels and layers.

The aim is not to leave the fat in “lumps” in one place, but to:

• Spread it like a network,
• Maximise contact with well vascularised tissues,
• Improve fat survival and achieve a natural appearance.

This process is tailored to the specific region being treated—face, buttocks, breasts or hands.

7. Anaesthesia Options

For small–volume areas such as face and hands:

• The procedure can usually be performed comfortably under local anaesthesia with sedation.

For buttocks, breasts and extensive body contouring combined procedures:

• General anaesthesia is generally preferred.

The type of anaesthesia is determined by the surgeon and anaesthesiologist based on:

• The area to be treated,
• The duration of the procedure,
• The amount of fat to be harvested and injected,
• The patient’s medical condition.

8. The First Postoperative Days: Swelling, Bruising and Tenderness

In the first days, two regions are important:

1. Donor areas (where the fat was taken):

In liposuction areas:

• Swelling, bruising and tenderness are normal,
• Wearing a compression garment (for areas like abdomen, waist, hips) supports oedema control and contouring.

2. Recipient areas (where the fat was injected):

• Face:
  1. In the first days, the face may look “fuller than planned” and swollen,
  2. As the swelling decreases, the targeted volume becomes clearer.
• Buttocks / breasts:
  1. Sitting, lying position and bra use are carefully planned to support healthy fat survival.

In general:

• Pain is usually mild to moderate and can be controlled with prescribed medications,
• Swelling is most pronounced in the first 48–72 hours and then gradually subsides.

9. Staying in Istanbul, Follow Ups and Returning Home

For patients coming from abroad or other cities:

• A stay of about 3–5 days in Istanbul is usually sufficient to:
  1. Perform initial dressings,
  2. Assess the liposuction and injection areas,
  3. Explain compression garment / bandage use and positional instructions.

During this period, your doctor will inform you about:

• From which day and how you can shower,
• How to protect and position the area where fat has been injected (with special instructions for buttocks, breasts and face),
• Recommendations that may help reduce swelling before and after flights.

10. Returning to Social Life, Work and Sports

At home:

• The first 1–3 days are mostly spent resting, paying attention to positioning and managing swelling.

Return to work:

• For small–volume facial procedures, desk-based workers usually return to work within 3–5 days,
• For patients who have undergone extensive liposuction + fat injection, this period often extends to around 5–7 days.

Social life:

• On the face, bruising and swelling are often coverable with make up after about 7–10 days,
• Swelling in body areas is more easily hidden by clothing; here, comfort and mobility limitations are more critical than appearance.

Sports:

• Light walking is encouraged early on (within limits set by your doctor),
• For intensive exercise, running, weight training and exercises that place pressure on the buttocks, a waiting period of approximately 4–6 weeks is generally recommended.

11. Fat Survival Rate, Need for Repeat Sessions and Permanence

A certain proportion of the injected fat is reabsorbed by the body during the first months.

• The remaining fat is generally regarded as permanent after about 3–6 months,

This rate depends on:

• The technique used,
• Smoking,
• The blood supply of the treated area,
• The patient’s general health and lifestyle.

Therefore:

• A single session is sufficient for some patients,
• In others, a second fat injection session may be planned to achieve the desired volume.

Weight changes:

• Weight gain can increase volume in the areas where fat was injected,
• Weight loss can reduce the volume in these areas.

For more stable outcomes, maintaining a relatively stable weight is important.

12. Possible Risks and Complications

Like any surgical procedure, fat injection carries certain risks.

At the donor site (where fat is harvested):

• Bleeding, bruising, infection,
• Irregularities, contour deformities, asymmetry.

At the recipient site (where fat is injected):

• Swelling, bruising, asymmetry,
• Residual volume being more or less than desired.

Less commonly:

• Infection,
• Firmness, cyst formation, small areas of fat necrosis.

A very rare but serious complication reported in the literature is fat entering a blood vessel when injected in the wrong plane or with incorrect technique. Therefore, it is essential that fat injection is performed by an experienced surgeon using appropriate technique and safety measures.

To minimise risks, it is critical to ensure:

• Proper patient selection,
• Appropriate technique,
• Strict adherence to hygiene protocols,
• Smoking cessation or reduction,
• Good compliance with postoperative follow ups and instructions.

All these possible scenarios should be discussed in detail with the patient before the procedure.

13. Results and Expectation Management

The goals of fat injection are to achieve:

• A younger, more rested and fuller appearance in the face,
• More balanced body contours,
• Healthier and more vibrant-looking tissues.

Important points to remember:

• In the first days, especially in facial procedures, the face may appear “overfilled” due to swelling; this is normal,
• As the swelling subsides and the amount of absorbed fat becomes apparent, the permanent volume reveals itself over 3–6 months,
• The result is perceived with the more natural and soft feel of your own tissue rather than that of an artificial filler.

The most satisfying outcomes are obtained in patients who:

• Have realistic expectations,
• Maintain a stable weight,
• Reduce or quit smoking,
• Do not skip follow up appointments with their doctor.