[Duhan Plastic Surgery Fat Grafting] - [Before/After Procedure, Post-Procedure Care Tips, Common Q&A, Misconceptions About Fat Grafting]

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Pre- and post-procedure steps for fat grafting

These are the steps before and after undergoing fat grafting surgery.

1. Make a consultation appointment by phone or online.

2. Visit at the scheduled consultation time and have a consultation.

3. If you want the procedure, make a surgery appointment right after the consultation and leave.

You can also make a surgery appointment later by phone or online.

4. Arrive 30 minutes before the scheduled surgery time, receive an explanation of the fat grafting procedure, and have the design prepared.

5. After the design is finished, change clothes and receive an intravenous injection for painless sedation anesthesia.

6. The procedure time for fat grafting differs by area, and if multiple areas are treated at the same time, it may take longer.

On average, it takes from 30 minutes to as long as 2 hours.

7. After the procedure, you will receive antibiotic and anti-inflammatory injections and rest in the recovery room for about 30 minutes.

8. You will be given post-procedure precautions and book your next visit date.

9. Visit two days after the procedure to check the progress of the fat grafted area, and disinfect the fat harvesting site.

You may shower starting two days after the procedure.

Visit again on day 7 to check the progress and remove the stitches from the fat harvesting site (navel).

If your home is too far away and it is difficult to come in, you do not have to visit.

Post-procedure care tips for fat grafting

Here are the care instructions after undergoing fat grafting surgery.

1. It is best not to walk excessively or exercise intensely right after the procedure.

If you exercise intensely, bruising and swelling at the fat harvesting site may last longer.

2. If fat was grafted to the cheeks, around the mouth, or under the eyes, it is not good to open your mouth too wide or laugh too broadly.

This is because the fat survival rate may decrease.

3. Makeup is allowed immediately, and washing your face is allowed starting the next day.

When washing your face, be careful not to rub the procedure area hard.

4. When sleeping, you should be careful not to sleep face down or with your hand on the area, because pressure may deform the fat and alter the shape or lower the survival rate.

5. Avoid alcohol and smoking for about one week.

Alcohol may cause inflammation in the fat grafted area, and smoking may interfere with blood circulation and lower the fat survival rate.

Reducing smoking as much as possible afterward also helps the fat survive.

Common questions and answers about fat grafting

What kind of anesthesia is used for fat grafting, and is there pain?

All fat grafting is performed under local anesthesia with painless sedation anesthesia.

Sedation anesthesia is not general anesthesia; it is an anesthetic that keeps you asleep for about 5 minutes only, to remove pain while local anesthesia is administered.

Therefore, you do not need to worry about pain.

How is the fat grafting process carried out?

All fat grafting is performed under local anesthesia with painless sedation anesthesia.

From fat harvesting to purification and grafting, every step is carried out delicately and precisely.

Fat is harvested with minimal damage to living fat cells, and to concentrate it as close to 100% as possible, the fat goes through centrifugation and oil-and-water removal steps.

Also, before the fat grafting, subcutaneous tunneling is performed to secure space for the fat to be grafted.

When grafting the fat, micro fat grafting is used to maximize the survival rate.

In some cases, it may be completed in as little as 20 to 30 minutes, and if multiple areas are treated simultaneously, it may take more than 2 hours.

After the procedure, you can go home right away.

From which area is it best to harvest the fat?

For fat grafting, fat must first be harvested from an appropriate area.

The donor site is determined by considering the amount of fat that needs to be suctioned. When only a small amount is needed, such as for the under-eye area, nose, or nasolabial folds, it is usually harvested from the lower abdomen.

The reason the lower abdomen is preferred is that it is easy to harvest, swelling and pain after the procedure are mild, and it is convenient for daily life.

If a large amount is needed, such as for the cheeks or forehead, you should check whether enough fat can be harvested from the donor area.

If there is excess fat in the lower abdomen, it is harvested there. If there is no fat in the lower abdomen, or if abdominal elasticity has decreased significantly due to aging or childbirth, then it cannot be harvested there even if there is fat elsewhere.

This is because the lower abdomen may sag after fat harvesting.

In such cases, fat is harvested from the thighs. The thighs are divided into the inner, outer, and back areas when determining the harvest site, and the area with the most excess fat is selected.

Fat is harvested carefully so that no distortion or indentations occur at the donor site.

In some cases, if the patient has a particular area they specifically want, fat may be harvested from that area whenever possible.

How many sessions of fat grafting are usually needed?

Depending on the area, satisfactory results can sometimes be achieved with a single session.

Fat survival rates differ by area, and there are individual differences. If the result after the first session is satisfactory, there are cases where a second session is not needed.

For the cheeks, since the survival rate is relatively good at about 50 to 70%, the first session is usually slightly overcorrected so that a second session is not needed.

For the lips or nose, the survival rate is about 30 to 50%, so a second session is usually needed.

Because survival rates differ by area, there are individual differences, and the number of sessions varies depending on how satisfied you are with the result, the number of sessions also changes according to the situation.

On average, one to, at most, two sessions are enough to achieve a satisfactory result.

How much swelling and recovery time is there after fat grafting?

Swelling and bruising vary depending on the area and the individual’s constitution.

The area with the most swelling is the lips, and the area with the most bruising is under the eyes.

Areas with little to no swelling or bruising are the bridge of the nose, the temples (temporal area), and the forehead.

In general, it is not very common for fat grafting to cause significant swelling or bruising.

On average, there is some slight swelling that feels a bit unnatural for 1 to 2 weeks before it settles.

The recovery period can be considered about one week, during which swelling and bruising are present.

Does the second fat grafting have to be done exactly after 3 months? Can it be done earlier or later?

A second procedure is not mandatory; it is performed only when necessary.

On average, the second fat grafting is scheduled after 3 months.

The reason is that fat survival occurs over 3 months, and after 3 months there are almost no further changes in appearance. Therefore, deciding whether a second fat grafting is needed based on the shape at that time allows for a more accurate judgment.

Another reason is that if the second fat grafting is done too early, the fat that was grafted during the first procedure may be damaged during the second procedure before it has fully survived.

Having the second procedure after 3 months, or even after 5 or 6 months, is not a problem.

However, after 10 months the stored fat is discarded, so having the second fat grafting within 10 months makes the procedure more convenient.

If you come for a second procedure after 10 months, the stored fat has already been discarded, so fat must be harvested again.

How long does the effect of fat grafting last?

Up to about 3 months, while the fat is surviving after grafting, some of it is absorbed. But after 3 months, the fat that has survived is no longer absorbed and remains permanently as your own tissue.

However, the shape of the grafted area is not maintained forever.

As time passes and you age, skin sagging, wrinkles, and skeletal changes occur, so the area that received fat grafting does not stop aging.

For that reason, the effect of fat grafting is also described as semi-permanent, but more precisely it can be said to be permanent.

It is a difference in wording, but you can think of the effect as lasting until significant aging progresses.

What is the difference between fat grafting and micro fat grafting?

Fat grafting is a general term used to describe the entire process of harvesting fat and transferring it to the area to be grafted.

In other words, surgically removing fat in a lump and grafting it is also called fat grafting, and harvesting it with a syringe and grafting it with a syringe is also called fat grafting.

Micro fat grafting is a method of fat grafting using a syringe. In order to improve the survival rate of the fat, even when the same amount is grafted, it is divided into tiny rice-grain-sized portions and grafted into multiple places to increase precision and survival.

What is the difference between 2D fat grafting and 3D space fat grafting?

So-called 3D fat grafting means grafting fat evenly across multiple layers.

Under the skin, there are several tissue layers, such as the subcutaneous fat layer, fascia layer, muscle layer, and periosteal layer.

3D fat grafting means grafting fat evenly across these layers to maximize space usage, improve fat survival, and allow for a soft and uniform graft.

2D fat grafting means grafting only into one layer, such as the muscle layer or the fat layer, among the multiple layers.

However, not all 3D fat grafting is good.

Depending on the area to be grafted and the amount to be grafted, some areas require 3D grafting, while others require 2D grafting.

For example, the upper eyelid should be grafted beneath the muscle layer; if it is grafted in 3D, the shape becomes lumpy and a heavy eyelid may result as a side effect.

Therefore, 2D planar fat grafting, in which fat is grafted only into the fat layer, is better for the upper eyelid.

For areas such as the chin or cheeks, if a relatively large amount is grafted, evenly grafting into the muscle and fat layers is better for a smooth appearance and helps survival, so 3D fat grafting is preferable.

It is important to choose the appropriate method for each area.

What methods are used to increase the survival rate of fat grafting?

To improve fat survival, the harvesting process itself is important first.

Fat should be harvested carefully so that fat cells are not damaged as much as possible, and all impurities should be filtered out as much as possible.

To do this, fat is carefully harvested using a small liposuction cannula, and the harvested fat is centrifuged for only about 3 to 4 minutes at an appropriate rotation speed.

In addition, after centrifugation, the fat undergoes a second purification process in which oil and moisture are removed by placing it on sterilized gauze.

Only through this process can fat that is close to 100% pure be obtained.

The fat must be concentrated to near 100% for the result after fat grafting to be good.

Even if the same amount is grafted, if 50% of it consists of impurities such as oil or moisture, it is as if only half the actual amount is grafted, so the effect is reduced by half.

It is no exaggeration to say that the key to the effectiveness of fat grafting depends on whether the fat is properly concentrated.

Some say that fat grafting often ends up having almost no effect because most of it gets absorbed. Is that true?

The fat grafting method differs by clinic, and the results vary greatly depending on the technique.

If fat grafting is performed carelessly and against the basic principles, most of the graft may be absorbed, making it seem almost no different from having done nothing at all.

Only when the entire process, from harvesting and purification to grafting, is performed accurately and according to the principles can a high survival rate and a uniform, smooth contour be achieved.

Is it true that the face can become lumpy after fat grafting?

The principle of fat grafting is to achieve a uniform and smooth contour.

If a lumpy side effect occurs, it is the result of incorrect fat grafting that goes against the principles.

There are several causes of lumpiness.

These include grafting fat irregularly right under the skin, grafting too much fat in one place, grafting unevenly instead of distributing it evenly, and not performing molding properly after the fat grafting.

Therefore, to achieve a uniform and smooth contour, the fat should not be grafted too superficially, it should be micro-grafted evenly and uniformly, and the procedure should be finished with molding to achieve the effect of smooth facial contour correction.

How many times do I need to visit the clinic after fat grafting?

Two days after fat grafting, you visit the clinic to check the progress.

You will also visit about twice a week.

If your circumstances are difficult or your home is too far away, you do not necessarily have to come in after the procedure.

If needed, the stitches at the fat harvesting site can be removed at a nearby clinic after one week, so for those living far away, it is enough to visit only on the day of the fat grafting procedure, and afterward, if you judge that your recovery is going well, you do not have to visit again.

What side effects can occur after fat grafting?

Because fat grafting uses your own fat, unlike commercial filler materials, it has almost no side effects.

Except for some swelling and bruising after the procedure, you could say there are essentially no side effects.

Therefore, it can be said to be safer than any other cosmetic procedure.

However, this applies only when fat grafting is done properly. If the procedure is performed against the principles, side effects can sometimes occur, such as lumpiness, fat necrosis and hardening, inflammation, or an unnatural appearance due to excessive injection.

How long can harvested fat be stored?

Any fat left over after grafting is stored in sterile frozen storage for 10 months.

After 10 months, the stored fat is discarded.

Because of storage capacity limits, it is not stored for more than one year.

If you undergo a second fat grafting within 10 months, the procedure can be easily performed using the frozen stored fat. If you come for a second procedure after 10 months, the fat has already been discarded, so fat must be harvested again for the second procedure.

Is there a difference in results between using stored frozen fat and using freshly harvested fat?

If frozen fat is properly stored, the characteristics of the fat cells change very little.

Therefore, frozen stored fat shows almost no difference in result compared with freshly harvested fat.

Knowing how to store fat well is also one of the techniques in fat grafting.

Without fat storage technology, it is difficult to store it even for one month.

In addition, harvesting is required every time the procedure is performed, which creates inconvenience and extra effort.

The storage method requires sterile, low-temperature freezing, and impurities must be removed before storage so that the fat does not deteriorate, which helps extend the frozen storage period.

In general, fat cells can be stored sufficiently for about 10 months without deterioration.

If a clinic says that frozen fat quickly deteriorates and therefore must be harvested again each time the procedure is performed, that clinic likely has somewhat inferior storage facilities or technique.

In foreign countries, frozen fat is sometimes used for up to 3 years.

Misconceptions about fat grafting

The effect of fat grafting in the buttocks or breasts

Fat grafting is sometimes performed to address buttock hollowness or to enlarge the breasts.

However, there are problems with this.

In the case of the buttocks, because it is an area that must keep moving, the survival rate of fat is extremely low, and if it is grafted incorrectly, side effects such as pigmentation can occur.

Fat grafting to increase the volume of the buttocks is inevitably difficult.

For breast augmentation using fat grafting, at least about 1000 cc of fat must be harvested, and it is difficult to harvest that much fat.

The reason is that people with underdeveloped breasts are usually people who do not weigh much, and therefore there is often not enough fat in the lower abdomen, waist, or thighs to harvest, making it difficult to harvest or graft as much as desired.

Also, and most importantly, if a large amount of fat is grafted into the breast area, some of the fat may necrose, leading to abscesses or calcification that can harden the tissue.

If an abscess forms with pus, it is quite difficult to heal and may leave significant aftereffects even after recovery.

In addition, calcification can become a critical problem because it may interfere with future breast cancer screening and prevent cancer from being detected. For that reason, breast fat grafting is, in principle, a procedure that should not be performed.

There are principles in plastic surgery.

Because both good and bad outcomes must be considered, if there is even a 1 in 100,000 chance of a bad result after surgery, that is a procedure that should not be done.

Breast fat grafting falls into the category above, so breast augmentation with fat should be decided very carefully.

The theory that fat harvested from the thighs survives well

The site for fat harvesting is not fixed.

If anything, the thighs are not a preferred donor site.

The problem is that fat contains a lot of oil.

Oil is an impurity, so it does not help survival.

After the procedure, there may be a lot of bruising and swelling, and until the bruising subsides, you should not walk more than necessary, which can make daily life inconvenient. If too much is harvested, problems such as changes in thigh shape or pigmentation may occur.

The choice of donor site should not be based only on survival rate.

It must also take into account whether there is enough fat, the convenience of harvesting, the amount of swelling, pain, and bruising after the procedure, how easy it is to return to daily life after harvesting, and the survival rate of the harvested fat. It should also consider the shape of the donor site and any future aftereffects.

For fat grafting, fat must first be harvested from an appropriate area.

The donor site is chosen by considering the amount of fat that needs to be suctioned. When only a small amount is needed, such as for the under-eye area, nose, or nasolabial folds, it is usually harvested from the lower abdomen.

The reason the lower abdomen is preferred is that it is easy to harvest, swelling and pain after the procedure are mild, and it is convenient for daily life.

If a large amount is needed, such as for the cheeks or forehead, you should check whether enough fat can be harvested from the donor area.

If there is excess fat in the lower abdomen, it is harvested there. If there is no fat in the lower abdomen, or if abdominal elasticity has decreased significantly due to aging or childbirth, then it cannot be harvested there even if there is fat elsewhere.

This is because the lower abdomen may sag after fat harvesting.

In such cases, fat is harvested from the thighs. The thighs are divided into the inner, outer, and back areas when determining the harvest site, and the area with the most excess fat is selected.

Fat is harvested carefully so that no distortion or indentations occur at the donor site.

In some cases, if the patient has a particular area they specifically want, fat may be harvested from that area whenever possible.

Because each person has different areas with excess fat and different body types, the most suitable fat harvesting site must be chosen according to the person's physical characteristics and constitution.

The area from which the fat is harvested does not determine the survival rate.

To achieve good results with fat grafting, it is necessary to have careful harvesting, proper purification such as oil removal, preparation of the treatment area, grafting an appropriate amount of fat evenly into the area, and grafting in a way that the final shape looks natural.

In other words, good results can only be achieved when the entire series of procedures, from start to finish, is done properly.

The misconception that grafted fat flows downward or moves

Fat grafting means transplanting solid cells.

The fate of grafted fat cells is one of two things.

They either survive and remain completely as your own cells, or they dissolve and disappear.

Solid cells never move or flow downward.

In unauthorized procedures, industrial silicone or paraffin is sometimes carelessly injected into the face, and because these are liquid substances, they often flow downward due to gravity.

Liquids can move by seeping between cells.

Some people see or hear about the side effects of unauthorized procedures and develop a bias, mistakenly thinking that fat grafting may also have problems. However, solid fat cells remain where they were grafted and can never move to another area.

Sometimes, in other clinics, fat is grafted excessively or into the wrong area, causing an unnatural look or making the area appear saggy. Looking at that, some may think the fat moved, but it is not that the fat flowed or moved; it is the result of incorrect grafting, or of grafting too much more than necessary, which makes it appear saggy under the weight of the fat.

In conclusion, fat cells are solid autologous tissue cells, so they either survive in place or disappear; they can never flow downward or move.

The theory that air exposure must be blocked during the purification process of fat

No step in fat grafting can be neglected, and purification is no exception.

The purpose of fat purification is to remove all unnecessary impurities other than fat cells.

The impurities removed during centrifugation are moisture, anesthetic, serum, red blood cells, and more.

What cannot be purified away during centrifugation is the oil component within the fat cells themselves.

Oil is one of the impurities that must be removed from fat cells and makes up a significant proportion.

It is distributed both inside and outside the fat cells, and the fat cells can be thought of as being entangled with oil.

The only way to remove the oil is to wrap the fat that has been centrifuged in sterilized gauze and remove it naturally by absorption. At this point, the fat is exposed to the outside.

Some argue that exposing fat to air increases the risk of infection or damages the fat through oxidation, but in reality, such effects are almost nonexistent.

When viewed under a microscope, fat cells are surrounded on both the inside and outside by a thick oil film, so the fat cells themselves cannot come into direct contact with air.

In addition, because diluted antibiotics are applied to the fat during the gauze purification process, bacterial infection can actually be prevented more effectively.

For these reasons, brief exposure of fat to air is not a problem at all, and exposure is unavoidable if the oil in the fat cells is to be removed, which improves the effectiveness of fat grafting.

Misconceptions and truths about the lasting effect of fat grafting

The reality is that in many cases, people say they got fat grafting at another clinic and saw almost no effect.

Even though there are many clinics that perform fat grafting, only a few can produce proper results.

If fat grafting is not done correctly, the result can actually be worse than not doing it at all.

In principle, fat grafting can only achieve good results when it is performed accurately.

The fat grafting method differs by clinic, and there are large differences depending on experience.

You may develop a negative impression after experiencing or hearing about incorrect fat grafting, but if fat grafting is done properly, good results can be obtained even with a single procedure.

The fat survival period is about 3 months.

Fat that survives beyond that time remains permanently as your own fat cells.

It is often misunderstood that the grafted fat disappears after 1 to 2 years and returns to the original state, but once fat has survived, it does not disappear for no reason.

That is medically and logically impossible.

Also, the reason the second procedure is performed after 3 months is so that the first grafted fat has fully survived and settled, and the shape can then be evaluated before proceeding.

Up to about 3 months after grafting, some of it is absorbed, but fat that has survived beyond 3 months is no longer absorbed and remains permanently as your own tissue.

However, the shape of the grafted area does not last forever.

As you age, skin sagging, wrinkles, and skeletal changes occur, so the area that received fat grafting does not stop aging.

For that reason, the effect of fat grafting is also described as semi-permanent, but more precisely it can be called permanent.

Although the wording differs, the effect can be considered to last until significant aging occurs.

Frozen storage period for fat and the effect of frozen fat procedures

Any fat left over after grafting is stored in sterile frozen storage for 10 months, and after 10 months, the stored fat is discarded.

Because of storage capacity limits, this clinic does not store it for more than 10 months.

If you undergo a second fat grafting within 10 months, the procedure can be conveniently done using the frozen stored fat. If you come for a second procedure after more than 10 months, the fat has already been discarded, so fat must be harvested again for the second procedure.

If frozen fat is properly stored, the characteristics of the fat cells change very little.

Therefore, frozen stored fat shows almost no difference in result compared with freshly harvested fat.

Knowing how to store fat well is also one of the techniques in fat grafting.

Without fat storage technology, it is difficult to store it even for one month.

In addition, harvesting must be done every time the procedure is performed, which creates inconvenience and extra effort.

The storage method requires sterile, low-temperature frozen storage, and impurities must be removed before storage so that the fat does not deteriorate, which extends the frozen storage period.

Usually, fat cells can be stored sufficiently for about 10 months without deteriorating.

If a clinic says that frozen fat deteriorates easily and must be harvested again every time a procedure is performed, that clinic likely lacks storage facilities or technique.

In obstetrics and gynecology, even when frozen sperm or frozen eggs are stored for years and then thawed for procedures on infertile couples, it can be seen that frozen cells are no different from freshly harvested cells.

There are reports that frozen fat is used for up to 3 years in other countries, and based on this clinic’s many years of experience, stored fat shows no difference in terms of procedure effect compared with freshly harvested fat

The issue of side effects in fat grafting

Because fat grafting uses your own fat, unlike commercial filler materials, it has almost no side effects.

Except for some swelling and bruising after the procedure, you could say there are no side effects.

Therefore, it can be said to be a safer procedure than any other cosmetic surgery.

However, this refers to cases where fat grafting is done properly. If the procedure goes against the principles, side effects can sometimes occur, such as lumpiness, fat necrosis and hardening, inflammation, or an unnatural appearance due to excessive injection.

These are determined by the practitioner’s experience and technique, and are absolutely not a general problem with fat grafting.

Therefore, if the procedure is performed according to the principles, these side effects almost never occur.

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At this clinic, based on over 20 years of rich clinical experience and know-how, we perform multilayer fat grafting.

The key to fat grafting is to allow the fat cells, which are living cells, to achieve a high survival rate.

To improve the survival rate, a large amount is not injected into one place; instead, it is grafted evenly and uniformly across multiple layers.

Between the skin and bone, there are several tissue layers such as the fat layer and muscle layer, and fat must be injected in a multilayer structure so that it does not overlap between the periosteum above the bone and the layers above and below the muscles.

Multilayer fat grafting has a duration that is 3 to 4 times longer than the existing method, and fat survival is also higher.

This clinic’s fat grafting also includes a process called “tunneling,” which allows the grafted fat to contact surrounding abundant blood vessels as much as possible and continuously receive nutrients.

Tunneling means creating space for the fat using micro-needles just beneath the skin. In other words, space is created as if making a tunnel, and then the fat is injected, so even after all the fat has been placed, it does not sag downward due to gravity or become lumpy.

In addition, a delicate injection method allows for customized design.

After fat grafting, we provide thorough aftercare and closely monitor the progress until the fat fully survives.

During follow-up, if necessary, we try to minimize dissatisfaction by using swelling-reducing injections, shape correction, and molding.

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