Fat Transfer is a relatively new procedure that has become a powerful technique in facial rejuvenation surgery. The procedure involves liposuction from the belly, thighs or buttocks and transfer of the harvested fat to the face. The aim of the surgery is to restore a youthful appearance by adding volume to areas of the face that have lost their shape with time.
With aging, the general shape of the face transforms from a youthful heart shape to a more rectangular shape. This is usually due to a combination of volume loss as well as laxity of the skin. The loss of fat is most noticeable around the cheeks and temples, though many areas of the face are affected. Traditional facelift techniques, wonderful for improvement of the jawline, neck, and jowls, are therefore extremely well complemented by fat transfer.
The initial procedure is usually performed under light IV or “twilight” sedation. One to three additional sessions of fat placement may be required in the subsequent months, as the survival of the transferred fat varies from patient to patient. The benefit of fat transfer versus injectable fillers is that the surviving fat cells offer a much more long-lasting restoration of facial volume.
Your fat transfer consultation with Dr. Mehta will last approximately one hour. Dr. Mehta will begin by asking you what exactly bothers you about your appearance and what improvements you would like to achieve. There are numerous nonsurgical treatments that Dr. Mehta utilizes extensively, including Botox and Dysport, injectable fillers, laser/intense pulsed light treatments, and peels. If you are a candidate for any of these treatments in lieu of or in addition to surgery, he will discuss these with you as well.
Dr. Mehta will then obtain a careful history, including medical conditions that may affect your ability to undergo and recover from surgery. Any history of adverse reactions to anesthesia or medications commonly given before, during, and after surgery is also determined.
This discussion is followed by a thorough examination of your face and neck. Dr. Mehta will then examine your abdomen and thighs, to determine the quantity of potential donor fat. Following the examination, Dr. Mehta will photograph your face from several different angles.
After your consultation, Jill, our Office Coordinator, will assist you with scheduling your surgery, pre- and postoperative appointments and schedule a second consultation for you, should you so desire.
After this initial consultation, you would return for a preoperative visit, two or three weeks before your surgery. At this visit, Dr. Mehta will again go over your list of medications and supplements, as it is usually necessary at this time to discontinue any products that can increase the risk of bleeding during or after the surgery. These include, but are not limited to, aspirin, ibuprofen, heparin, warfarin (Coumadin), Plavix, vitamin E, fish oil and numerous other supplements. The decision to stop any of these prescription or over-the-counter products is made in conjunction with your primary physician. Medical clearance and other tests may need to be obtained, depending on your age.
Dr. Mehta will give you prescriptions for your pain medication (or call your pharmacy) at this visit as well. This allows you to pick up these important medications prior to your surgery, so that postoperatively, you and your caretakers can rest and concentrate on your recovery. Dr. Mehta will advise you to pick up Arnica Montana and Bromelain, two homeopathic products which reduce bruising after surgery. These are taken as directed, beginning immediately after surgery. You will be given detailed preoperative and postoperative instruction pamphlets, to read prior to your surgery. It is important to minimize salt intake and avoid alcohol for three days leading up to your surgery.
Lastly, you will have the opportunity to spend time with the office coordinator, to answer any logistical questions related to your surgery. Your final surgical fees are settled at this visit as well.
On the day of surgery, you will arrive at the surgical center with a friend or family member who will drive you home and care for you after your surgery. It is imperative to come in on an empty stomach, not eating or drinking anything for at least 8 hours prior to your surgery. This includes water and chewing gum. You should wear loose and comfortable clothing, including a shirt that buttons in the front to avoid having to pull anything over your head after surgery.
The operating room nurse will meet with you first to go over your instructions in detail. You will then meet your anesthesiologist, who will have carefully reviewed your medical and surgical history. You will have the opportunity to ask the anesthesiologist any questions you may have at this time. Finally, Dr. Mehta will meet you and your friends/family to answer any last minute questions as well.
For his fat transfer surgeries, Dr. Mehta uses either IV sedation or “twilight” anesthesia, in which the patient is completely unconscious but breathing on his or her own throughout the surgery. This prevents the need for placement of a breathing tube, paralysis or use of a ventilator. Additionally, patients awaken more quickly after the surgery and have less nausea and “hangover” effect.
The surgery is performed by first gently harvesting fat from the abdomen, thighs, flanks or buttocks in a liposuction technique. The fat is isolated and then carefully injected into the face with small needles. No incisions are made and no sutures are required. Your donor sites are dressed with Band-Aids while no dressing is required for the face, unless other procedures are performed simultaneously.
After surgery, you will awaken in the recovery room, where your vital signs are carefully monitored by the anesthesiologist and recovery room nurse.
After approximately one to two hours in the recovery room, you will be discharged home, in the care of a responsible adult for the first night. Your friend or family member will help ice your face and donor areas, assist with your pain medications, and help you with your normal daily activities. You will sleep with your head elevated at 30-45 degrees. At this time, you will begin taking your prescribed medications as well as the Arnica Montana and bromelain. Eating fruits such as pineapple and papaya are encouraged as well, as they are thought to help minimize bruising.
You will return to the office the following morning to be seen by Dr. Mehta. He will check your face and donor sites and go over your instructions in detail. Over the next 48-72 hours most patients develop bruising around the areas injected, though pain and discomfort are usually mild. Patients are up and around during this recovery period and usually Tylenol provides enough pain relief. Often patients will work from home though most avoid work or social situations for around 8-12 days.
Your diet should be soft, mild in flavor and with minimal salt for the first 10-14 days after surgery. To minimize swelling and the risk of complications, you should avoid any vigorous activity or heavy lifting for this same period of time.
Your next visit will be 6-7 days after surgery, to check your progress. Your face may be mildly swollen and bruised at this time, though this can usually be covered with makeup. The majority of the swelling and bruising disappears over the subsequent few days. On average, patients return to work at 8-12 days after surgery though this certainly varies depending on one’s degree of bruising/swelling and comfort level.
The next visit will be at 3 weeks, followed by every 3-4 months, at which time additional fat transfer sessions may be performed in the office, under local anesthesia. Typically, the final “after” photographs are taken at 12-18 months following surgery.
Fat transfer yields natural-appearing rejuvenating results by restoring volume to the face. It can complement other facial cosmetic surgery, such as facelift or blepharoplasty. The procedure is well tolerated by most patients and has a brief recovery period afterwards.
If you have any more questions or would like to schedule your own personal consultation, please feel free to contact us.