Dr Adrian Brooks is a highly experienced practitioner in the field of fat transfer, having specialised in the procedure since 2010. His expertise was honed under the guidance of Drs Roger Khouri and Dan Del Vecchio, both widely regarded as pioneers of large-volume fat transfer. With over a decade of hands-on experience and advanced training from industry leaders, Dr Brooks offers his innovative approach to fat transfer procedures, ensuring safe, reliable and aesthetically pleasing results for his patients.

What is fat transfer?

Fat grafting, also known as autologous fat transfer or lipofilling, is a biocompatible procedure that utilises the patient’s own fat. Fat is taken from one part of the body (often from areas where it’s unwanted, like the abdomen or thighs) and injected into another area where more volume or contouring is desired. It’s commonly used in procedures like breast reconstruction, breast augmentation, and facial rejuvenation.

Facial fat grafting plays a significant role in facial rejuvenation, detailing the techniques employed and patient considerations necessary for successful outcomes.

The procedure begins with liposuction to harvest fat from the donor site(s). The harvested fat is then processed and purified to remove excess fluids and impurities, emphasising the importance of preserving healthy fat cells during these stages. Once purified, the fat is injected in small aliquots (usually 1-2 millilitres at a time) into the desired area, where it integrates with the existing tissue to augment the desired area.

History of Fat Grafting

Fat grafting, also known as fat transfer or lipotransfer, has a fascinating history that dates back to the late 19th century. The first documented fat grafting procedure was performed in 1893 by German plastic surgeon Gustav Neuber. He successfully transferred fat from a patient’s arm to the orbital region to correct scars caused by osteomyelitis. This pioneering effort marked the beginning of fat transfer as a viable medical technique.

Throughout the early 20th century, fat grafting was explored for various applications, including the treatment of facial deformities and breast reconstruction. However, the procedure faced significant challenges due to complications and inconsistent results, which hindered its widespread acceptance.

It wasn’t until the 1990s that fat grafting experienced a resurgence in popularity. Advances in modern liposuction techniques and the development of standardised methods for fat extraction, processing, and injection significantly improved the procedure’s safety and efficacy. Today, fat grafting is a well-established and widely used cosmetic procedure, offering natural-looking results and numerous benefits for patients seeking to enhance their appearance.

Where can I have fat grafted to?

Fat transfer surgery can be performed anywhere on the body and is particularly suitable for addressing issues related to uneven fat distribution and the effects of ageing. Common sites include breasts and face. It does require harvesting of fat from elsewhere on the body so if you are very slim it may be difficult to get a significant volume of fat to make a difference. We discuss this in detail at your consultation.

Why use fat instead of implants?

Breast augmentation and breast reconstruction with fat grafting offers several benefits, including:

  1. Natural-looking results: Since the fat used for the graft comes from the patient’s own body, it results in a more natural appearance and feel.
  2. Minimal scarring: Fat grafting involves small incisions for liposuction and injection, which typically result in significantly less scarring compared to traditional breast reconstruction techniques.
  3. Simultaneous body contouring: Liposuction used to harvest fat for the grafting can also contour the donor site(s), providing additional aesthetic benefits.
  4. Reduced risk of complications: Because the procedure uses the patient’s own tissue, there is a lower risk of complications such as rejection or allergic reactions.

However, the fat transfer procedure does come with potential risks and complications, such as unpredictable outcomes, unsatisfactory results, and the possibility of needing additional surgeries.

Types of Fat Injections

Fat grafting encompasses several types of fat injections, each tailored to specific needs and areas of the body. Understanding these different types can help patients and surgeons choose the most appropriate method for achieving desired results.

  • Autologous Fat Transfer: This is the most common type of fat injection, where fat is harvested from one area of the body and injected into another. It is widely used for various cosmetic and reconstructive purposes, providing natural-looking results with minimal risk of rejection.
  • Micro-fat Grafting: This technique involves using small amounts of fat to fill in smaller areas, such as the lips or nasolabial folds. Micro-fat grafting is ideal for subtle enhancements and fine-tuning facial features.
  • Nano-fat Grafting: Nano-fat grafting takes the process a step further by using even smaller amounts of fat to address very fine lines and wrinkles. This method is perfect for delicate areas that require precise and minimal volume adjustments.
  • Platelet-Rich Plasma (PRP) Therapy: PRP therapy involves using platelet-rich plasma, derived from the patient’s own blood, to stimulate collagen production and enhance the effects of fat grafting. This combination can improve skin texture and overall rejuvenation.

Each type of fat injection offers unique benefits, allowing for customised treatments that cater to individual patient needs and aesthetic goals.

Indications and Contraindications

Fat grafting is a versatile procedure with a wide range of applications in both cosmetic and reconstructive surgery. Here are some common indications for fat grafting:

  • Facial Rejuvenation: Fat grafting can restore lost volume, smooth out wrinkles, and enhance facial features, providing a more youthful and refreshed appearance.
  • Breast Augmentation: Fat grafting can enhance the size and shape of the breasts, offering a natural alternative to implants.
  • Body Contouring: Fat grafting can improve the shape and appearance of various areas of the body, including the hips, thighs, and buttocks, by adding volume and contour.

However, there are certain contraindications for fat grafting that must be considered:

  • Active Infections: Fat grafting should not be performed on areas with active infections, as this can increase the risk of complications.
  • Bleeding Disorders: Patients with bleeding disorders, such as haemophilia, should avoid fat grafting due to the increased risk of bleeding complications.
  • Cancer: Fat grafting should not be performed on areas with cancer, as this can increase the risk of spreading the disease.

It is crucial to discuss these indications and contraindications with a qualified surgeon to determine if fat grafting is the right option for you.

Can I combine fat injections and other procedures?

Yes, potentially any procedure that involves liposuction can be combined with fat grafting as we can process the fat harvested and utilise it to fat graft other places on the body. It takes longer to harvest the fat for grafting than to dispose of it therefore there is increased cost. We are happy to discuss these at your consultation.

The fat transfer procedure

Fat needs to be harvested and processed before it is injected. This involves using liposuction to collect the fat and a series of steps to remove unwanted fluid and purify the fat for injection.

The steps are:

  • Make small stab incisions < 10mm over predetermined donor sites -commonly abdomen and thighs
  • Insert a liposuction cannula tube
  • Suction the fat
  • Transfer the fat to special syringes for processing
  • Syringes are spun in a centrifuge to separate out excess fluid and remove impurities
  • The fat tissue is then moved to another type of syringe via a filter to break it down into smaller pieces
  • The fat is now ready for injection

Once processed, small stab incisions are made near to the desired areas for injection, usually only 5mm or less in diameter. The amount of fat injected varies by patient specifics and the target area. It is important to inject small droplets throughout the recipient area to ensure a good blood supply and the survival of the fat graft. Injected fat plays a crucial role in enhancing facial features by transferring fat from one area of the body to another.

Locations for these incisions are designed to be hidden and cause minimal scarring. Examples of these locations are:

  • Breast – the crease below the breast
  • Forehead – hairline or outside of the eyebrow
  • Cheeks – natural crease lines including the nasolabial fold
  • Chin – just underneath the jaw

Preparation and Recovery

Proper preparation and recovery are essential for achieving the best results from a fat grafting procedure. Here are some key steps to consider:

Preparation for Fat Grafting:

  • Informed Consent: Patients should be fully informed about the risks and benefits of fat grafting and provide consent before undergoing the procedure.
  • Pre-Procedure Evaluation: A thorough medical evaluation is necessary to ensure the patient is healthy enough for the procedure.
  • Selection of Donor Site: The donor site should be selected based on the patient’s individual needs and preferences, typically areas with excess fat such as the abdomen or thighs.

Recovery from Fat Grafting:

  • Rest: Patients should rest for several days after the procedure to allow the body to heal.
  • Ice Compresses: Applying ice compresses can help reduce swelling and bruising.
  • Follow-Up Appointments: Regular follow-up appointments with the surgeon are important to ensure the graft is healing properly and to address any concerns or complications.

By following these preparation and recovery guidelines, patients can enhance their chances of a successful fat grafting outcome.

What impacts fat cells’ survival or ‘take’

Fat grafting has a variable amount of success. Not all the fat will “take”. Every stage of the process impacts the outcome:

  • Fat quality – Not all fat is created equal. Fat has varying degrees of quality which can impact take. We cannot predict your fat type before harvesting it during the liposuction.
  • Fat harvest – The low-powered suction via Water Assisted Liposuction (WAL) that Dr Brooks uses minimises damage to the fat
  • Fat processing – We filter and process that fat to rid it of impurities before insertion
  • Fat insertion – Dr Brooks injects fat in small volumes to maximise fat ‘take’. The smaller volumes or ‘aliquots’ are usually only 1 millilitre at a time. This maximises the chance of fat surviving when it is transferred and injected.

A qualified plastic surgeon performs fat grafting, highlighting their training in liposuction techniques.

  • Fat care – how you take care of yourself after the operation is a major factor in intake. You should pretend your fat graft is similar to a skin graft and take care of it in a similar manner. Not being too active, avoiding trauma to the area, eating and sleeping well, not smoking or drinking alcohol. In plastic surgery, the role of plastic surgeons in managing complications and ensuring patient safety is crucial.

Complications and Risks

As with any surgical procedure, fat grafting carries certain risks and potential complications. It is important to be aware of these and discuss them with your surgeon: