What is fat transfer?
In fat transfer (autologous fat grafting, lipofilling) the body's own fat is aspirated from a donor area with fine cannulas, carefully processed and injected into the target area in several micro-deposits. In its present form the procedure goes back to the Coleman technique and has been clinically established in plastic surgery for decades.
Unlike hyaluronic acid fillers, no foreign substance is used — the transplanted fat is genetically and immunologically identical to the recipient tissue. Allergic reactions are ruled out, and it is biocompatible by definition. Where vascularisation is successful, the fat cells survive permanently.
How the procedure works
The procedure takes place in three steps. First the aspiration: the donor area is typically the abdomen, the hip, the inner thigh or the outer-thigh fat pad; fatty tissue is harvested gently with fine liposuction cannulas (2–3 mm in diameter) under low negative pressure. Second the processing: the aspirate is filtered or gently centrifuged, so that intact fat cells are separated from blood, anaesthetic solution and damaged cells. Third the micro-injection: the cleaned fat is distributed with very fine cannulas into many small deposits in the target area — decisive for the take rate is the small size of each deposit, because every fat cell has to build up its own blood supply.
Depending on the volume and the location, the procedure takes between 60 and 180 minutes and is carried out under local anaesthetic, twilight sedation or general anaesthesia — we discuss the choice of anaesthesia in the initial consultation (€100).
Advantages over hyaluronic acid fillers
Fat transfer uses the body's own material — no foreign substances, no possibility of allergy, no approved maximum quantities of active substance as with injectable preparations. Where the graft takes well, the result is permanent; hyaluronic acid is absorbed after 6 to 18 months and requires regular top-ups.
There is also a double benefit: the donor area — usually a region with a moderate excess of fat — is contoured at the same time. With combined indications (building up the cheeks + reducing the hips) both can be achieved in one session.
Fat transfer also goes a long way: several areas can be treated in one session, which with pure filler treatments often requires several appointments because of the maximum quantities of active substance.
Absorption rate — a realistic expectation
An absorption rate of 30 to 50 per cent is typical: not every transplanted fat cell builds up its own blood supply within the critical first 7 to 14 days. What does not take, the body breaks down over the following weeks. What does take stays permanently.
We therefore plan the initial volume with an overcorrection: 30 to 50 per cent more fat than the desired final volume, because part of it is absorbed. The final result stabilises after three to six months and is then no longer variable in volume — the fat cells that remain behave exactly like the rest of the body fat (they change in volume with marked weight gain or loss, but they do not break down spontaneously).
In some patients a second session after 3 to 6 months makes sense in order to reach the final contour — particularly with larger volume goals such as breast augmentation with fat transfer.
Where fat transfer is used
In the face: cheeks (emphasising the cheekbones and mid-face volume), temples (age-related hollowing), tear trough (a very selective indication — a fine hand is required), chin (contouring), lips (building volume with the body's own material instead of hyaluronic acid). Fat transfer in the face is particularly suitable for patients who reject the foreign-substance concept of the hyaluronic acid filler on principle.
At the breast: breast augmentation with fat transfer as an alternative to implants — scar-sparing, the body's own material, around half a cup size of volume gain per session. Also for contouring after breast operations or for subtle volume compensation in asymmetries.
On the body: after a liposuction, fat transfer can be used to contour neighbouring areas — e.g. to refine the shape of the buttocks or to correct small dents after trauma or previous surgery.
When fat transfer does NOT make sense
In very slim patients without a sufficient donor area — if the BMI is below 19 or there is no moderate fat pad, the starting material is missing. Here hyaluronic acid is often the better choice.
With very thin skin over bony structures (e.g. the forehead), contouring with fat transfer is more difficult than with hyaluronic acid, because the micro-deposits can be palpated through the thin skin. Here we often prefer hyaluronic acid or a combination.
With advanced skin laxity in the face, building up volume alone is not sufficient — here a facelift in SMAS technique is the actual procedure. Fat transfer can build up mid-face volume in addition, but it does not replace the tightening of the slackened structures.
Recovery and result
After the procedure both areas — donor and recipient — are swollen for 7 to 14 days. In the donor area the swelling is as after a small liposuction: blue-green discolouration, tenderness to pressure, compression for 2 to 4 weeks. In the recipient area — typically in the face — the swelling is a desired part of the healing process: the volume looks considerably larger at first than the final result.
Social recovery 1 to 2 weeks; visible bruising has faded after 10 to 14 days. Return to sport after 4 weeks. Final assessment of the result after 3 to 6 months, when absorption is complete.
Frequently asked questions
What does fat transfer cost? The costs depend on the volume, the number of areas and the extent of the anaesthesia and are calculated specifically in the personal initial consultation (€100). All prices are starting prices, net, plus 19% VAT; clinic fees are stated separately.
How long does the final result last? Where the graft takes, permanently — the fat cells that have grown in behave like the rest of the body's fat. Hyaluronic acid, by comparison, lasts 6 to 18 months.
Do I need a second session? In about 20 to 30 per cent of cases a second session after 3 to 6 months makes sense in order to reach the target contour — particularly with larger volume goals such as breast augmentation with fat transfer. For purely facial indications one session is usually enough.
Fat transfer or hyaluronic acid — which method is better? It depends on the indication. Hyaluronic acid is the first choice for localised volume indications, very fine lines, in very slim patients and when a reversible result is wanted (hyaluronic acid can be dissolved with hyaluronidase, fat cannot). Fat transfer is the first choice for larger volume indications, when the body's own material is preferred and when a permanent result is the goal.
What experiences are there with fat transfer in the face? Patients typically report a naturally appearing build-up of volume without the "filler feeling" — the treated areas feel like the body's own tissue, because after the graft has taken that is what they are. The initial overcorrection can look too "full" in the first weeks; that is intended and settles to the final volume after 3 to 6 months.
