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The procedure

Lipofilling describes the process of taking fat from one part of the body (the donor site) using special techniques, processing it, and injecting it into another area of the body (the recipient site) for aesthetic or functional reasons. It often requires more than one session (procedure) to produce the final desired result. This is because the fat needs to develop a blood supply from its new “home” and if too much is put in at any one time, problems can occur (see below). Therefore as much as is safe is injected at any one time to avoid complications, but often this is not enough to complete the final desired outcome in one sitting.

 

What does it involve?

Small volume lipofilling may be performed under a local anaesthetic (with you awake), but it is normally performed under a general anaesthetic (with you asleep). First of all, fat is harvested from previously agreed areas, such as the abdomen, the flanks or the thighs. This is done through very small incisions using a technique similar to liposuction.

Subsequently, the fat is filtered and washed in saline, to purify it and remove any blood or excess oil. Once ready, it is put into syringes and can then be injected via tiny “stab incisions” into the desired location. Common sites for injection include the face, the breast, and for use to address contour irregularities on various other areas of the body.

What are the benefits?

Lipofilling uses your own fat, which is therefore 100% natural. Once injected, a proportion of the fat will be reabsorbed by the body (up to 50% in some circumstances), however the remainder will last as a permanent filler. The final consistency is soft and pliable, replicating the areas where it is administered.

How long does the surgery take?

The length of surgery depends upon the volume of fat to be transferred and may take between 1-3 hours.

What is the recovery period?

Initially there will be bruising in the area that fat was harvested from (this may last 2-4 weeks but continues to improve with time), and you may have some straw-coloured fluid oozing from the donor site wounds temporarily. Wearing a supportive pressure garment for 6-weeks following the surgery may help to speed up the resolution of any swelling at the donor site.

At the site of fat injection, there will be swelling which lasts around 6-weeks. It is important to be aware that this swelling will subside, which then shows the amount of fat that will permanently remain – if you are not aware of this, it can be disappointing to see the swelling disappear! As mentioned above, it is usual for more than one session of fat grafting to be needed to achieve the final desired result.

Most people will be able to return to work at 1-2 weeks following surgery, but you may need longer if larger volumes have been transferred. Any discomfort and pain may be relieved with painkillers and you are encouraged to gently walk after the operation.

How long before daily activities may be resumed?

Strenuous activity should be avoided for at least 2-weeks. You may be able to drive from 48-72 hours after surgery, but remember that you need to be comfortable in performing an emergency stop or similar manoeuvre.

What are the success rates?

Lipofilling has a good success rate, albeit over an appropriate number of procedures, tailored to you personally.

Lipofilling to the breast

Lipofilling to the breast deserves special mention. There is a role for lipofilling in both aesthetic and reconstructive breast surgery. It can be used to shape the breast, to add volume (enlarge) the breast, to correct any contour deformities and for the treatment of particular conditions, such as tuberous breasts. Whilst it is an excellent tool for this particular use, and has been deemed to be safe when used subcutaneously (under the skin); the interaction of the transferred fat and breast tissue itself is less well understood. What this means, is that if the fat is injected into the breast tissue itself (where the milk ducts are), how the fat placed into this new area behaves is not fully understood. There are some theoretical changes that may occur that have a bearing on the development or recurrence of breast cancer. However, fat grafting to the breast has been one of the most popular recent innovations in plastic surgery the world over. Studies are underway in several countries to try to understand this better, but no firm data has come out either way.

Therefore, if you are considering fat grafting that may need to go into the breast itself (such as a breast enlargement by fat grafting), please consider this important aspect. Mr Pacifico understands the science behind this well, and has even published scientific articles on this topic, so he will be happy to discuss this with you in more depth, and would encourage you to reflect on this before deciding on whether to go ahead.

If you have a mammogram after this procedure, it is vital to let the doctors know that you have had fat grafted to your breast, as sometimes the fat can mimic the appearance of cancer on mammograms. If the doctors are aware, they are easily able to distinguish the appearance of the grafted fat from cancer – if they are unaware, then this can lead to confusion and misdiagnosis.

What are the possible complications?

Complications may occur at the donor site (where the fat was taken from) or at the recipient site (where the fat has been placed).

General complications:Some people can feel dizzy after the procedure, which usually settles with rest and fluid intake. As mentioned above, the post-operative swelling may take some weeks to settle down. Other general complications include infection and bleeding, both of which are fortunately unusual with lipofilling. Deep vein thrombosis (DVT) and pulmonary embolus (PE) describe blood clots that may occur in the leg (DVT) and travel to the lung (PE) which may be very serious – fortunately they are uncommon in lipofilling.

Donor site complications:Over-emptying of the donor site area of fat may occur occasionally: if there are any small contour irregularities from over-emptying, a combination of careful refining liposuction with additional fat transfer into the donor area may be used. This can always be done at a second sitting of lipofilling.

A rare, but dangerous complication is the damage to internal organs by the fat harvesting liposuction instrument. If this were to happen, further surgery may be required to explore and repair the organs damaged. As stated, this is a very rare complication. Another unusual complication is fat embolism – fat entering the blood stream and lodges at a distant site in the body. If this is in the lungs it can be extremely serious. Fortunately, this too is extremely rare.

Recipient site complications:Problems with the fat not surviving at the recipient site can cause fat necrosis and oil cysts. These complications typically occur if too much fat has been injected at any one time, which is why Mr Pacifico is careful to transfer only as much fat as is safe in any single session. Fat necrosis may present as hard lumps (which if minor will soften with time as well as massage to the area). In the worst-case scenario, the area may become red, and an infection can develop. This may be treated with antibiotics, but may also require a wound washout in the operating theatre. Oil cysts are a form of fat necrosis where the fat liquefies. If this occurs, a discharge may occur from the wounds. Often this settles by itself, but occasionally it may also need a washout in theatre.