Fat Grafting (Lipofilling)

Fat grafting uses the patient’s own tissue, processed after harvesting and transferred in small amounts to the face, breasts, buttocks, calves or another indicated area.

The procedure, also known as lipofilling, has two stages: harvesting fat from an area where it is in excess, such as the abdomen or thighs, and reinjecting it where volume is needed. Because the patient’s own tissue is used, the risk of an allergic reaction or rejection is very low. Fat transfer can be used to correct asymmetry, depressions or loss of volume. At Detalii Med in Baia Mare, the procedure is performed by Dr Marius Pruna and Dr Valeria Pruna, plastic surgeons.

It may suit patients with adequate donor tissue who seek a moderate volume correction using autologous material.

It is usually considered for:

• loss of facial volume with age;
• contour asymmetries or depressions, including after previous liposuction;
• moderate volume corrections of the breasts, buttocks or calves;
• patients who prefer their own tissue to a synthetic material.

In very slim people, the amount of available fat may be insufficient for the desired correction.

It can improve volume and contour, but some fat is absorbed unpredictably. An exact volume cannot be guaranteed and further sessions may be needed.

Fat transfer usually provides a moderate correction that feels natural to the touch. It cannot produce a large increase in volume in a single stage, does not correct significant skin laxity and does not lift a sagging breast. If weight changes significantly, the volume of the transferred fat may change too.

Consultation assesses donor areas, tissue quality, required volume, asymmetry and risks specific to the recipient region.

The surgeon discusses the patient’s goal, medical history, medication, smoking and any previous surgery. For transfer to the breasts, the history of breast imaging is also discussed; imaging may be recommended before the procedure, and the radiologist should be told about the fat transfer at future examinations. It is explained that several sessions may be needed and that the degree of fat integration varies.

Fat is gently harvested, processed and injected through fine tunnels to encourage even distribution and blood supply.

Harvesting is done by liposuction with fine cannulas and low pressure to protect the fat cells. The fat is then separated from fluid and cellular debris. Reinjection is carried out with thin cannulas, in small amounts distributed over several layers, because fat needs contact with well-vascularised tissue in order to integrate. In certain areas, such as the buttocks, fat is injected only into the layer beneath the skin for safety reasons. The duration depends on the number of areas and the volume transferred.

Anaesthesia depends on the treated surfaces and may range from local anaesthesia with sedation to general anaesthesia.

Small corrections, for example to the face, can often be done under local anaesthesia, possibly combined with sedation. Larger-volume transfers are usually performed under general anaesthesia. The decision is made after the pre-anaesthetic assessment.

Swelling and bruising affect both donor and recipient areas. Direct pressure on the treated region may be restricted temporarily.

• The donor area is cared for as after liposuction, usually with a compression garment.
• The area where fat was injected is not massaged or compressed in the first weeks, so as not to affect tissue integration.
• After transfer to the buttocks, sitting may be limited for a period, as instructed.
• Facial swelling typically settles within one to two weeks, while larger areas may take longer.
• Strenuous physical activity resumes gradually, with the surgeon’s approval.

Risks include infection, cysts, calcification, fat necrosis, asymmetry, irregularity, excessive resorption and complications specific to injection in certain areas.

Fat necrosis may appear as firm lumps that sometimes resolve on their own and sometimes require investigation or treatment. In the breasts, calcifications may be visible on imaging and must be distinguished from other changes, which is why the radiologist should be informed. Accidental injection into a blood vessel is a rare but serious complication, the risk of which is reduced by careful technique and choosing the correct tissue plane. Contour irregularities may occur in the donor area, as after liposuction.

Early volume is increased by swelling. A stable result is assessed after several months, when successfully integrated fat remains relatively durable.

In the first weeks, the area may look fuller than the final result, as swelling subsides and some of the fat is absorbed. Volume usually stabilises within roughly three to six months. If the result is not sufficient, a further session may be discussed after this period. Integrated fat behaves like the patient’s own fatty tissue: it increases or decreases with body weight, and the natural ageing process continues.

Autologous fat transfer uses the patient’s own tissue to restore volume and correct contour, usually with a natural appearance. Some of the fat is absorbed, so the final volume cannot be guaranteed and several sessions are sometimes needed. Donor and recipient areas, volume and the type of anaesthesia are agreed individually at consultation.