[Duhan Plastic Surgery Fat Grafting] - [Types of Side Effects and Problems with Fat Grafting]

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What are the side effects of fat grafting?

Fat grafting should produce good results, but depending on the surgeon's skill and technique, unavoidable problems can sometimes occur.

Poor results due to low graft-take rates, awkward shapes, asymmetry, severe swelling, inflammation, fat necrosis, calcification, irregularity, sagging, and pigmentation can occur.

Types of side effects and problems with fat grafting

Inflammation	Bacteria enter during the procedure, and as the fat fails to take and melts during the graft-take process, inflammation occurs
Necrosis	During the graft-take process, the fat does not receive proper blood supply and fails to take; the rotten melted remnants remain
Calcification	During the graft-take process, the fat does not receive proper blood supply and hardens, with calcium deposition forming a firm mass
Irregularity	If the fat is not grafted evenly or is concentrated in only one area, a uniform shape cannot be achieved and the area becomes uneven
Sagging	If too much is grafted or if it is grafted in the wrong place, sagging of the face can occur.
Pigmentation	In cases of severe bruising or swelling, depending on the person's constitution, iron components left in the bruise may deposit in the skin and oxidize, turning brown. This can sometimes occur after under-eye procedures depending on constitution.
Asymmetry	When left and right graft-take rates differ, or the amount is not properly adjusted during the initial procedure, causing left-right imbalance
High absorption rate	A condition in which enough fat does not take to create the desired contour, and much of it is absorbed, so the shape before and after the procedure does not change much
Awkward shape	A condition in which too much fat takes or fat is grafted into an inappropriate area, disrupting the overall facial balance

Candidates for fat grafting side effect correction

Our clinic has specialized in fat grafting since 2001, but we do not perform breast fat grafting.

The breasts are an area where fat must be injected in large quantities to see any effect, so it is difficult to graft enough fat. Also, when a large amount of fat is injected, fat necrosis or fat calcification can cause the breasts to become hard and lumps may be felt.

In severe cases, a large abscess may also develop due to inflammation.

In future breast cancer screenings, cancer may not be diagnosed because of these calcifications, so it is better not to perform breast fat grafting.

There are principles in plastic surgery.

Because both good and bad results must be considered, if the probability of an undesirable outcome after surgery is even 1 in 10,000, that procedure should not be performed.

Misconceptions and problems about fat grafting among the general public

​You may think that fat grafting always produces good results, but that is absolutely not the case.

People tend to think of fat grafting as easy, but it is by no means a simple or easy procedure.

As with all surgeries, results vary depending on the surgeon's experience and expertise.

Fat grafting is a more demanding procedure than any other type of plastic surgery, and in addition to a very complex process, it requires experience, know-how, and highly refined manual skill.

Although many hospitals perform fat grafting, only a small number can produce proper results.

If fat grafting is not done properly, the result may be worse than not doing it at all.

In principle, fat grafting can produce good results only when performed precisely.

The technique varies by hospital, and there can be major differences depending on experience.

You may develop a negative impression after seeing or hearing about poor fat grafting, but if you receive proper fat grafting, you can be satisfied even after a single procedure.​

Micro liposuction for correcting fat grafting side effects

1. The skin is marked with a design to indicate the liposuction area.

2. Painless sedation is used to eliminate pain during local anesthesia.

3. Local anesthesia is administered at the liposuction site.

4. Fat is melted using an ultrasonic liposuction device.

5. Necrotic tissue or melted fat is suctioned out using a micro suction cannula.

6. After liposuction, the face is effectively compressed with a facial band.

The area of the skin to be suctioned is designed and marked.

The shape of the design varies from person to person, and the areas are marked according to where side effects have occurred, such as the cheeks, jawline, or under the eyes.

A plan is made for which area will undergo how much liposuction.

An IV sedation is used through a vein in the arm.

Because local anesthesia can be painful, local anesthesia is administered while the patient is under sedation so it can be done without pain.

After local anesthesia is finished, the patient wakes up.

It usually takes about 5 minutes to fall asleep under sedation.

Sedation is different from general anesthesia. It is a safe anesthetic method and is used as an adjunct to local anesthesia.

A cannula is inserted from the edge of the area to be suctioned, and suction is performed delicately and gently.

When the suction amount is large, the fat may first be melted with ultrasound and then suctioned with a fine cannula. If the amount is not large and more delicate suction is needed, suction may be performed only with a fine suction cannula equipped with a viewing instrument.

The main point of suction is to remove fat evenly and without irregularities throughout the designed area.

In cases of necrotic abscesses in the breast, wide-ranging necrosis often occurs, so if suction alone cannot correct it, an incision may be necessary.

The suction procedure takes as little as 10 minutes or as long as 30 minutes depending on the area, and after suction is complete, a facial band is worn.

The facial band helps improve the effect of liposuction, reduce swelling and bruising, and prevent skin sagging.

It is worn for about 4 to 7 days, and for areas such as under the eyes, a band is not worn; only a small piece of tape is applied.

Micro fat grafting for correcting side effects

1. Fat is collected from areas where fat is abundant, such as the lower abdomen, waist, or thighs.

• Since anesthesia is local anesthesia (painless sedation), there is no pain at all.

• A fine liposuction cannula is used to collect fat into a syringe.

2. The collected fat is placed in a centrifuge to remove impurities (local anesthetic, serum, red blood cells).

The purpose of centrifugation is to remove impurities in the fat, increase its concentration, and improve the fat graft-take rate.

3. The fat that has been centrifuged undergoes a second concentration process to remove water and oil.

By removing water and oil, nearly 100% concentrated fat is obtained.

4. The fat is grafted into the area that has been locally anesthetized.

Fat grafting is performed after the tunneling process has created space for the fat to be placed.

Our clinic uses a micro needle (micro graft cannula) developed in-house.

The micro needle is a special grafting cannula used only by our clinic, allowing ultra-precise grafting.

The principle of fat grafting is to distribute the fat evenly across the grafted area so that it does not clump, while also maximizing the graft-take rate.

Before-and-after photos of fat grafting side effect correction

1. Irregularity that occurred after fat grafting

If the grafting is not performed precisely without tunneling, the fat may not be evenly distributed and the graft-take may also be uneven.

After it has fully settled, the depressed areas must be corrected by filling them very precisely using a micro graft cannula.

This is a highly advanced, delicate procedure that requires great skill.

2. Facial shape caused by overinjection or excessive graft-take after fat grafting

If too much fat is injected beyond what is needed, or if more fat takes than expected, the fat is removed by suction again.

Procedures such as fat-dissolving injections or AcuSculpt should not be expected to work well and may cause additional side effects, so caution is needed.

To restore a natural contour without irregularity, suction must be performed precisely with a fine suction cannula or an even finer micro suction cannula.

A moment here~

Other procedures for removing overinjected fat

AcuSculpt laser procedure	Similar to SmartLipo laser procedures, this device was introduced later after demand declined due to the insufficient effects of SmartLipo laser procedures. However, as with SmartLipo laser procedures, the results are often below expectations or nearly ineffective. In addition, severe swelling may occur, and heat damage to the skin can also be a side effect. New procedures are often marketed with indiscriminate false and exaggerated advertising, even though their effectiveness and side effects have not been verified, so caution is needed. Also, necrotic tissue or inflamed tissue cannot produce good results unless it is directly removed by inserting a suction cannula.
SmartLipo laser procedure	A method that uses a laser to melt and remove subcutaneous fat. The treatment effect is weak, and volume reduction is barely noticeable. Fat must be removed precisely from the desired location by the desired amount, so there is no procedure as accurate as directly removing it with a suction cannula. The degree to which externally applied laser passes through the skin and melts the subcutaneous fat below is very weak or almost ineffective, so desired results cannot be achieved with this method.
Fat-dissolving treatment (PPC injection)	This is a method of dissolving fat using injections, but depending on the drug, the effect is often negligible, or if a strong drug is used, side effects such as uneven skin may occur. Once the drug enters the body, it spreads to surrounding areas. It is impossible to know which area or depth the medication will spread to, and caution is needed because unintended areas may sink or develop pitted depressions like small pools. No matter what procedure is performed, desired results can only be achieved when the appropriate amount of fat is removed from the desired location under accurate design. Contouring with fat-dissolving injections is a method that is almost impossible to expect much from.

3. Asymmetrical shape that occurs after fat grafting

There are cases where both sides do not take evenly because the injection amount differs or because the graft-take conditions differ for some reason.

In such cases, the deficient area is corrected with additional treatment.

4. Hard calcification that occurs after fat grafting

This can occur when fat is injected too much in one place, or when fat that has deteriorated due to poor storage during a second procedure is grafted.

The hardened, calcified area is crushed and suctioned with a micro suction cannula for correction.

5. Pigmentation that occurs after fat grafting

This can sometimes occur constitutionally after under-eye fat grafting.

It occurs when bruising develops after the under-eye procedure, and after the bruising disappears, iron components left in the bruise deposit in the skin. Over time, it usually disappears on its own.

If it does not go away easily, the color can be lightened with micro fat grafting.

6. Necrosis that occurs after fat grafting

This is when fat is injected too much in one place, fails to take, melts into liquid, and accumulates; in some cases, it suppurates and turns into pus.

It is removed by suction with a micro suction cannula.

7. Bacterial infection that occurs after fat grafting

This is a case in which bacteria invade for some reason after fat grafting and cause inflammation.

It can occur if the patient's constitution has low immunity or if surgical instruments and materials are not sterilized before the procedure.

All inflammatory tissue must be removed using a micro suction cannula.

A moment here~

How to perform fat grafting without side effects

Procedure in a sterile state	As with all surgeries, fat grafting must also be performed with completely sterilized instruments and materials. After the procedure, the inside of the suction cannula should be thoroughly cleaned with a brush and sterilized with a high-pressure steam sterilizer so that no fat residue remains inside the used suction or grafting cannula. Anesthetics, saline, and the like must also be carefully managed so that they are not contaminated. Thorough disinfection and material management can prevent bacterial infection and inflammation.
Several stages of fat purification	Fat purification must remove impurities completely through several stages to maximize the effect. Harvested fat usually contains about 80% impurities, and only about 20% is actually usable. If the remaining impurities (blood, serum, anesthetic, oil, water, etc.) are not removed, the results will be poor no matter how well the graft is performed.
Pre-conditioning before fat grafting	A high graft-take rate should ideally allow a satisfactory result in a single procedure. Fine fat must be placed evenly in multiple layers, and before that, space must be secured at the graft site so that previously grafted fat is not compressed by surrounding tissue, allowing it to take well without pressure.
Precise and even grafting across multiple tissue layers	Expression of a soft and natural contour is the key to fat grafting. To create a soft contour, it is preferable to graft in a three-dimensional way, evenly across multiple layers. The grafted locations include the subcutaneous layer, muscle layer, and fascia layer, and the fat must be spread throughout the tissue as if sowing seeds evenly to achieve a soft contour without irregularity.

Precautions after micro liposuction

After liposuction of the cheeks, wear a facial band for about 4 to 7 days to prevent sagging of the face and reduce swelling and bruising.

For other small areas such as under the eyes, a facial band is not specially worn; only a small bandage with gauze is applied for 1 to 2 days and then removed.

There is no special care after that.

If there was any infection or inflammation before the procedure, antibiotics and anti-inflammatory medication are prescribed.​

Precautions after micro fat grafting

1. Fat grafting requires skilled technique and experience.

There can be a large difference in results depending on the operator's skill, so poor fat grafting can actually make the impression worse, so caution is needed.

2. After fat grafting, do not use cold packs, warm packs, or any other measures.

Cold packs can interfere with blood circulation and reduce fat graft-take, and warm packs carry the risk of burns, so no compresses should be used after fat grafting.

3. After facial fat grafting, do not apply any bandages or tape.

Except for some swelling and slight bruising, you can wear makeup and return to daily life immediately, but for 1 to 2 weeks the swelling may make things look a little awkward.

4. After fat grafting, running exercise should be avoided for about a month, and no alcohol or smoking for about a week.

Except when fat was harvested from the leg, walking, weight training, and stretching may begin after one week.

5. Since fat grafting takes about 3 months to settle, it helps fat take if you avoid rubbing or pressing hard on the treated area while it is settling.​

Number of fat grafting procedures

If performed according to principles with skilled technique, fat grafting usually produces satisfactory results even with just one procedure.

In some cases, a second procedure may be performed.

The interval between procedures is from 3 months to as long as within 10 months, and treatment can be done with the remaining frozen fat.

When a repeat procedure is performed, the fat that was collected at the time of the initial fat grafting is thawed and used.

Frozen fat requires good storage technology and technique; otherwise, the storage period becomes very short and the fat may deteriorate.

Our clinic has facilities and technology to preserve fat almost in its original state until October, and if a second procedure is performed after one year has passed, fat is harvested again for treatment.​

Long-term effects of fat grafting

Some people say fat grafting has no effect because much of it is absorbed, but that applies to cases where the procedure was done poorly.

Fat grafting is a procedure that can produce good results when performed based on skilled technique and experience.

If done correctly, satisfactory results can be achieved, and once the grafted fat takes, it is no longer absorbed and remains your own fat tissue for life, making it one of the safe and effective methods.

On average, receiving fat grafting once, or in rare cases twice, can provide permanent facial contour correction effects.

How to prevent side effects of fat grafting

Because fat grafting uses autologous fat, it has almost no side effects unlike commercial filling materials (fillers).

Except for slight swelling and bruising after the procedure, it can be said that there are virtually no side effects.

Therefore, it can be considered safer than any other type of plastic surgery.

However, this is based on the case where fat grafting is performed properly. If the procedure is done against principle, side effects may occasionally occur, including uneven, bumpy shape, fat necrosis and hardening, inflammation, or awkward appearance due to excessive injection.

The entire process from fat harvesting to purification and grafting must be carried out very delicately, carefully, and according to principle in order to achieve good results.

This is determined by the operator's experience and skill, and is not an inherent problem with fat grafting as a whole.

Therefore, if the procedure is performed according to principle, these side effects rarely occur.

As a rule, it is best not to receive treatment from a non-specialist with limited experience or someone who does not hold a board certification in plastic surgery.​

Misconceptions and problems about fat grafting

You may think that fat grafting always produces good results, but that is absolutely not the case.

People tend to think of fat grafting as easy, but it is by no means a simple or easy procedure.

As with all surgeries, results vary depending on the surgeon's experience and expertise.

Fat grafting is a more demanding procedure than any other type of plastic surgery, and in addition to a very complex process, it requires experience, know-how, and highly refined manual skill.

Only a handful of hospitals perform fat grafting properly.

Fat grafting is a procedure that is easy to perform but difficult to produce proper results with.

Procedures and post-procedure care for fat grafting

This is the procedure before and after undergoing fat grafting surgery.

1. Make a consultation appointment by phone or online.

2. Visit at the scheduled consultation time and receive counseling.

3. If you want the procedure, make a surgery appointment immediately after the consultation and leave. You can also make a surgery appointment later by phone or online.

4. Arrive 30 minutes before the surgery appointment time to hear an explanation of the fat grafting procedure and receive the design.

5. After the design is completed, change clothes and receive an IV injection for painless sedation.

6. Fat grafting times vary by area, and if multiple areas are done at the same time, the procedure may take longer. On average, it takes from 30 minutes up to 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 instructions and the date of your next visit will be scheduled.

9. Visit two days after the procedure to check the progress of the fat grafting area and disinfect the fat-harvest site. Showering is possible starting two days after the procedure. Visit on the 7th day after the procedure to check the progress and remove the stitches from the fat-harvest site (navel). If your home is too far and it is difficult to visit, you do not have to come in.

10. If a second procedure is needed, you will return and receive it between 3 months and 1 year later.

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Question) I heard that if you get fat grafting, most of it is absorbed and there are many cases where it has no effect. Is that true?

Answer) Fat grafting methods differ by hospital, and results vary greatly depending on technique.

If fat grafting is done carelessly and against principle, most of the grafted fat may be absorbed, to the point that there is almost no difference from not having had the procedure.

Only when the entire process from fat harvesting to purification and grafting is performed accurately and according to principle can a high graft-take rate and the effect of a uniform, soft contour be achieved.

Question) I heard that the face can become bumpy after fat grafting. Is that true?

Answer) The principle of fat grafting is to achieve a uniform and soft contour.

If an uneven, bumpy side effect occurs, it is the result of incorrect fat grafting that goes against principle.

There are many causes of unevenness.

Examples include grafting fat irregularly just under the skin, grafting too much fat in one area, grafting unevenly by concentrating fat in certain areas rather than distributing it evenly, and failing to perform proper molding after the fat grafting.

Therefore, to achieve a uniform and soft contour, fat should not be grafted too superficially, and micro fat grafting should be performed evenly and uniformly, with molding completed at the end to achieve the effect of soft facial contour correction.

Question) What side effects can occur after fat grafting?

Answer) Because fat grafting uses autologous fat, it has almost no side effects unlike commercial filling materials (fillers).

Except for slight swelling and bruising after the procedure, it can be said that there are virtually no side effects.

Therefore, it can be considered one of the safest procedures of all plastic surgeries.

However, this applies only when fat grafting is performed properly. If the procedure is done against principle, side effects may occasionally occur, including uneven, bumpy shape, fat necrosis and hardening, inflammation, or awkward appearance due to excessive injection.

Duhan Plastic Surgery

Features of the autologous fat grafting clinic

All anesthesia is performed with local anesthesia (sedation).

All fat grafting procedures are performed under local anesthesia, regardless of the area treated.

Local anesthesia is performed together with sedation, and the procedure can be done without any pain even during anesthesia and after the anesthesia is finished.

Depending on the area, hyaluronidase, an anti-swelling agent, is mixed with the local anesthetic and administered.

Hyaluronidase is an expensive anti-swelling agent that has a tissue-fluid diffusion effect, helping prevent swelling almost entirely from immediately after the procedure.

We have a systematic and advanced fat grafting system.

The success of fat grafting depends on the graft-take rate.

To maximize the graft-take rate, the following are necessary.

□ Living fat cells must be harvested.

□ To increase fat purity, the fat is made as pure as possible through centrifugation, purification, and removal of unnecessary oil.

□ Before fat grafting, subcutaneous tunneling is performed at the graft site to secure space for the fat.

□ Using a micro fat grafting cannula, precise and detailed fat grafting is performed for each area.

□ By grafting micro amounts in multiple layers using a three-dimensional method, the graft-take rate is increased and a soft contour is created.

The fat is harvested from appropriate and varied donor sites.

The most commonly used harvesting site is the lower abdomen. The lower abdomen is the first choice because it causes less pain after the procedure, less swelling and bruising, and is a comfortable area for daily life.

If there is not enough fat in the lower abdomen or if the person prefers another area, fat is also harvested from other sites. The next most commonly selected area is the inner thigh, followed by the outer thigh.

If there is not enough fat in the thighs either, the lower buttocks or the flanks may also be used.

There is no fixed rule for which area is best for fat graft-take.

Results are similar regardless of the area harvested from, and although the area with the most excess fat on your body is ideal for fat harvesting, it is better to choose the harvest site while considering the amount of fat to be taken and your activities after the procedure.

A two-step purification process for harvested fat maximizes the graft-take rate.

Harvested fat undergoes a two-step purification process to completely remove impurities other than fat cells.

Among the impurities in harvested fat, the highest proportion is local anesthetic, followed by oil.

It also contains impurities such as serum and red blood cells.

In the first step, it undergoes centrifugation for about 3 to 4 minutes, and in the second step, the oil removal process begins.

The parts purified by centrifugation are local anesthetic, red blood cells, serum, and so on.

Oil is removed manually using a natural adsorption method.

Through the two-step purification process, nearly 100% concentrated fat is obtained, maximizing the effects of fat grafting and increasing the graft-take rate as much as possible.

Space for fat grafting is secured through subcutaneous tunneling.

Subcutaneous tunneling is a necessary process to secure space in advance at the area where fat will be grafted, for high graft-take and uniform grafting.

It is the process of using a fine probe to move repeatedly under the skin in a fan-like pattern to create space for fat grafting.

The effect of subcutaneous tunneling is to increase the graft-take rate and prevent fat from clumping, thereby creating a uniform and soft contour.

Three-dimensional micro fat grafting can achieve a soft and uniform facial contour.

Although there are exceptions depending on the area, the basic method of fat grafting is the three-dimensional approach.

By dividing the fat into multiple layers and grafting small amounts evenly in each area, the graft-take rate is increased and the fat takes evenly, helping create a soft contour.

A micro fat grafting cannula is used for precise fat grafting.

In the past, methods using fat injection machines pushed fat under the skin with high pressure, which caused various problems.

The absorption rate of fat was high, graft-take was inconsistent, the contour became bumpy, and grafting into delicate areas such as under the eyes was difficult.

To solve these problems, the fat is transferred again into a thin 1cc syringe during fat grafting and then grafted into the desired area.

Our clinic uses a micro needle (micro graft cannula) developed in-house.

The micro needle is a special grafting cannula used only by our clinic, allowing ultra-precise grafting.

Fat grafting can be performed on the upper eyelids, lower eyelids, forehead wrinkles, glabellar wrinkles, nasolabial folds, and the bridge of the nose, making fat grafting possible in almost all cases except for very fine wrinkles.

Molding immediately after fat grafting helps create a uniform and soft facial contour.

Immediately after fat grafting, delicate molding is performed so that the grafted fat spreads evenly and creates a soft shape.

Molding is the final stage of fat grafting and one of the most important steps.

Rapid freezing and sterile storage of the remaining fat simplifies the second procedure.​

If a second procedure is performed more than 3 months after fat grafting, the remaining fat from the first procedure is used instead of harvesting fat again.

The remaining fat after the first procedure is stored after rapid freezing and sterile processing.

For the second procedure, the stored fat is thawed, making the procedure more convenient.

The storage period for fat is up to 10 months, and if you visit within 10 months, treatment will be performed using the stored fat.

Thorough aftercare system

After fat grafting, we carefully monitor the progress until the fat has fully taken by providing thorough aftercare.

During follow-up observation, if necessary, we try to minimize customer dissatisfaction through swelling-reduction injections, shape correction, and molding.

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