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Information for patients undergoing fat transfer ("fat grafting") surgery


"My husband and I are really delighted with the outcome of my procedure. It’s great not to look permanently tired. You were right in that it is not overdone which does give a more natural fresher look. It took longer to heal than I had expected and after three weeks the scarring was quite white and raised but now very smooth." (From a patient who underwent ptosis correction, upper blepharoplasty and fat transfer to face)

Review from a patient who underwent fat transfer to the face and eyelid region: http://www.realself.com/review/sloane-street-clinic-in-london-fat-transfer-briliant-facial-rejuvenation

Volume loss around the region of the eyelids and cheeks may occur as a result of trauma (including facial fractures or previous surgery), radiotherapy, soft-tissue and inflammatory diseases, including hemi facial atrophy or as a result of ageing.


In addition to skeletonization of the orbit, fat atrophy can influence stability of eyelid position and eyelid blink or closure. Restoration of this loss of volume can be achieved through placement of syringe-based fillers, autologous (an individual's own) fat, or implants. Each product has advantages in its use.


Risks and Benefits


Benefits: The technique of autologous fat transfer is used to restore a natural appearance to the periorbital complex. One's own fat will not cause an immunogenic reaction and is usually abundant. Fat also has the advantage of durability, with its potential for long term graft survival. Autologous fat transfer has been established as a stable adjuvant technique in facial reconstructive procedures in addition to aesthetic surgery. Autologous fat transfer can be also used in other areas of the face to restore volume loss.


Potential Risks:

  • Prolonged oedema and bruising (rarely lasting more than 2 months)
  • Contour abnormalities: lumps, bulges
  • Visible fat deposits
  • Under correction
  • Overcorrection
  • Migration of the transferred fat
  • Fat necrosis
  • Infection
  • Nerve injury (has been reported but extremely rare)
  • Blindness (has been reported but extremely rare)
  • Stroke (has been reported but extremely rare)
  • Harvest site complications:  scarring, dimpling and extremely rare bowel perforation.

On the day of surgery

Autologous fat transfer is performed in the operating room under general anaesthesia. The abdomen is the first choice of donor area, if available, followed by inner and outer thigh. Mr Malhotra's technique is based upon a standard Coleman-type technique for fat grafting. Fat is collected using a blunt-tipped cannula and a liposuction-type technique. It is centrifuged to drain any undesired contents before transferring the fat to the face and periorbital region using thin cannulas through small needle-size entry points.


Post operative instructions

Postoperatively, the patient is asked to sleep with the head slightly elevated and apply cool-packs over the treated area. Patients experience a variable amount of bruising but a consistent amount of swelling. The patient should expect significant disfiguring swelling in the first week that decreases substantially by the end of the second week. Return to social activities can usually be achieved in the second week. Some swelling will occur usually for up to 12 weeks and then stabilize. Fat loss occurs over a year. Long term results can be expected with continued improvement in skin tone and texture even beyond 12 months. Occasionally, a repeat fat transfer procedure may be recommended.

Paracetamol – should this be required
• Two 500mg tablets every 4 hours while awake for any discomfort (should not be necessary)

Cold compresses
Chilled, moist flannel over face four times a day as a guide;  however, patients may wish to apply this more often but for no more than 15 minutes in every hour.  It is not unusual for patients to find that light icing for up to two weeks will help reduce oedema (swelling) and alleviate common flushed sensation.
Observe for discharges around incision sites.
Sleep with at least 2-3 pillows, in order to keep the head elevated.
Please rest quietly all day following surgery.
You do not have to remain in bed. A comfortable armchair is OK.
Do not take a shower for 24 hours post surgery.
You may have been given special instructions about other pain or anti-inflammatory medication that you may require.
You should resume taking medications in your regular routine.
No specific skin cleansing regime is required. 
Avoid vigorous exercise for at least one week and preferable two weeks.  If  you notice significant facial swelling after a work out then you should reduce the amount of exercise you engage in.  Light exercise with half to one third of your normal regime and with only slow muscle contractions is allowed.  There are no restrictions in activity with the body part from where the fat was harvested however you should avoid straining and raising stomach pressure as this can lead to an increase in facial swelling.
Keep Steri-strips on face for a minimum of five days, then remove by moistening and peeling gently off, thereafter apply Vaseline or moisturising cream (e.g. Bio-oil, or Manuka honey twice a day) to stab incision sites.  
FAT HARVESTING SITES (abdomen or thighs)
Keep Steri-strips on for seven days.  Sutures are normally sutures underneath, which will disappear over two weeks.  Remove strips by moistening and gently peeling then apply cream as instructed above.
You may have bruising and mild discomfort around the face or body where the fat was harvested.  This is normal and will gradually resolve over a period of a few days to weeks.
Any Irregularities or Bumps - Patients may note fluctuations in the swelling that may worsen when they wake or after increased activity.   Do not try and massage  for one week: at seven days, any areas can be lightly massaged with gentle finger tip application over any lumpiness.  Avoid applying firmer massage until you have seen Mr Malhotra for first review. 
You may also notice some pressure and tightness in your face after surgery.  This is normal and should resolve over a period of the first two weeks.  You will notice that you will look more swollen in 2-3 days post surgery and this appearance should be expected and should not raise any alarm or concern.  The swelling should continue to decrease after the first several days.  You may notice that one side of the face is more swollen or “lumpy” than the other.  This again is normal. Swelling resolves unevenly in most cases and you may notice these imperfections even for several weeks after surgery. Dietary salts should be limited if possible in order to reduce facial swelling.  During your rest and recovery at home, you should avoid the temptation to do a lot of household work such as gardening that involves bending over and straining.  This can lead to pronounced or prolonged swelling.  
You may notice ongoing changes for up to a year after surgery.  This does not mean that your fat is reducing but typically a little swelling can persist even up to six months after surgery.





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Ptosis surgery


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