Plastic surgery restores form and function through reconstructive procedures, cosmetic enhancements, and body contouring.
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Fat transfer procedures can be performed under local anesthesia with sedation or general anesthesia, depending on the volume of fat being moved and the patient’s comfort level. For minor facial procedures, local anesthesia is often sufficient.
For larger body contouring cases like a BBL, general anesthesia is typically preferred to ensure the patient’s airway is protected, and they are entirely comfortable during the extensive liposuction and grafting process. The anesthesia team continuously monitors vital signs to ensure patient safety.
The surgery begins with the infiltration of tumescent fluid into the donor area. This is a mixture of saline, lidocaine (a numbing agent), and epinephrine (a vasoconstrictor). This fluid firms up the fat, numbs the area, and shrinks blood vessels.
Tumescent fluid is critical for “clean” harvesting. It minimizes bleeding, ensuring the harvested fat is pure and free of blood contamination. It also provides pain relief that lasts several hours after surgery.
Harvesting is done using specialized cannulas with small holes. The surgeon uses a gentle back-and-forth motion to collect the fat. Low vacuum pressure is used to prevent damaging the fragile fat cells.
Unlike aggressive liposuction for weight loss, harvesting for transfer is a delicate process. The goal is to collect intact, living cells. Manual aspiration with a syringe is often used for facial fat grafting to ensure the utmost gentleness.
Once harvested, the fat must be processed to remove the tumescent fluid, oil from ruptured cells, and blood. There are several methods for this, including centrifugation (spinning), filtration (washing), or gravity sedimentation.
The goal is to concentrate the healthy fat cells and stem cells. Injecting oil or blood into the graft causes inflammation and reduces graft survival. Pure, concentrated fat packs the most volume and regenerative potential into the smallest space.
Injection is the artistic phase of the surgery. The surgeon uses tiny cannulas to place the fat into the recipient site. The fat is deposited in minute linear threads or microdroplets as the cannula is withdrawn.
This technique ensures that each line of fat is surrounded by healthy tissue that can supply it with oxygen. Large boluses of fat are avoided as they lead to necrosis (cell death) in the center. The surgeon builds the volume layer by layer to achieve the desired shape.
For facial grafting, the microdroplet technique is paramount. The surgeon places tiny amounts of fat at multiple levels deep near the bone for support, and more superficially for contour. This avoids a lumpiness and creates a smooth, natural transition.
The precision required here is high. Overfilling or placing fat too superficially can result in visible irregularities. The surgeon constantly assesses the symmetry and contour during the injection process.
After the procedure, the patient is monitored in the recovery room. The staff checks for stability and manages any immediate nausea or discomfort. The treated areas are checked for color and perfusion to ensure good blood flow.
Compression garments are applied to the donor sites to minimize swelling and support the skin. However, the recipient sites (where fat was added) are usually left uncompressed to avoid squeezing the new fat cells and cutting off their blood supply.
Pain is typically manageable with oral medication. The donor sites (liposuction areas) tend to be more sore than the recipient sites, feeling like a deep bruise or muscle ache.
Patients are advised to stay ahead of the pain by taking medication as prescribed for the first few days. Ice is generally avoided on the grafted areas because the cold can constrict blood vessels and harm the fragile new fat cells.
Compression garments are worn on the areas where fat was removed (liposuction sites). This reduces swelling, prevents fluid collection (seroma), and helps the skin retract smoothly.
Patients typically wear these garments 24/7 for the first few weeks. The garment mustn’t compress the area where fat was added. For BBL patients, this means wearing a garment with cutouts for the buttocks.
Many surgeons use drainless techniques for fat transfer. By leaving the small incision sites open for the first 24 hours to drain naturally, or by using progressive tension sutures, the need for cumbersome drains is eliminated.
This simplifies recovery for the patient and reduces the risk of infection associated with drain tubes. Absorbent pads are used to manage the drainage for the first day or two.
The most critical recovery instruction is to protect the graft from pressure. For facial fat grafting, this means sleeping on the back with the head elevated. For buttock grafting (BBL), this means avoiding lying or sitting on the back for 2 to 6 weeks.
Pressure kills fat cells by cutting off their blood supply. Patients must use special pillows or positions to offload the treated area. Compliance with this restriction is the most significant factor in graft survival that the patient controls.
While strenuous exercise is restricted, early mobilization (walking) is encouraged starting the day of surgery. This promotes circulation and reduces the risk of blood clots.
Gentle movement helps the lymphatic system reduce swelling. However, patients must keep their heart rate low to avoid elevating blood pressure, which can lead to bleeding or swelling at the fresh graft sites.
The incisions for fat transfer are tiny (2-3mm). They are usually closed with a single stitch or surgical glue. Care involves keeping them clean and dry.
Patients can typically shower within 48 hours, letting the water run gently over the areas. Submerging in baths or pools is restricted until the incisions are fully healed to prevent infection.
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You are under anesthesia during the harvesting, so you feel nothing. Afterwards, the donor area feels sore and bruised, similar to the feeling after a very intense workout. This soreness lasts for a few days to a week.
Most surgeons recommend avoiding sitting directly on your buttocks for at least 2 weeks, and ideally up to 6 weeks. You will need to use a special BBL pillow that places your weight on your thighs if you must sit.
Yes, facial swelling is significant, especially in the first week. You may look “puffy” or distorted. This is normal and necessary for healing. The majority of the social downtime (about 2 weeks) is waiting for this swelling to go down.
You should walk gently immediately, but avoid heavy lifting or cardio that raises your heart rate for at least 3-4 weeks. Burning too many calories or bouncing can negatively affect the fat graft survival.
Small lumps or irregularities can occur as swelling resolves. Most of these smooth out on their own over a few months. Your surgeon might recommend a gentle massage after the initial healing phase to help smooth them.
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