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What are the side effects of fat grafting?

Of course, the goal is to achieve good results, but depending on the practitioner’s skill and technique, sometimes uncontrollable problems can occur.

Poor results due to a low graft survival rate, awkward shape, asymmetry, severe swelling, inflammation, fat necrosis, calcification, contour irregularity, sagging, and pigmentation can occur.

Types and problems of fat grafting side effects

Because fat grafting uses autologous fat, unlike commercial filler materials, it has very few side effects.

Except for slight swelling and bruising after the procedure, there are essentially no side effects.

Therefore, it can be considered a safer procedure than any other plastic surgery.

However, this is based on the assumption that the fat grafting is done properly. If the procedure is performed against the principles, side effects can sometimes occur, such as an uneven surface, fat necrosis and hardening, inflammation, or an awkward shape due to excessive injection.

These are issues determined by the practitioner’s experience and skill, and are absolutely not an overall problem with fat grafting itself.

Therefore, if the procedure is performed according to the proper principles, such side effects are rare.

Inflammation	Occurs when bacteria invade during the procedure, or when the fat fails to survive during the grafting process and melts away
Necrosis	A condition in which fat that did not survive the grafting process due to inadequate blood supply decays and leaves behind remnants that have melted away
Calcification	A phenomenon in which fat that did not receive adequate blood supply during the grafting process hardens and calcium deposits, forming a hard lump
Contour irregularity	A phenomenon in which the fat is not grafted evenly, or is concentrated in only one area, resulting in an uneven, lumpy appearance
Sagging	If too much is grafted or it is not grafted in the proper location, facial sagging can occur.
Pigmentation	In cases of severe bruising or swelling, depending on the individual’s constitution, iron components left in the bruise may deposit in the skin and oxidize, turning brown; depending on the constitution, this can sometimes occur after under-eye procedures.
Asymmetry	When the left and right graft survival rates differ, or the amount is not properly adjusted during the initial procedure, causing left-right imbalance
High absorption rate	A condition in which the fat does not survive sufficiently to achieve the desired contour, and much of it is absorbed, so the shape before and after the procedure does not change much
Awkward shape	A phenomenon in which fat survives excessively or is grafted into the wrong area instead of the appropriate area, disrupting the overall facial balance

Candidates for treatment of fat grafting side effects

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

The breast is an area where a large amount of fat must be injected to achieve some effect, so it is difficult to graft enough fat, and if too much fat is injected, fat necrosis or calcification can make the breast hard and cause lumps.

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

In future breast cancer screenings, calcification may prevent cancer from being diagnosed, so breast fat grafting is not recommended.

There are principles in plastic surgery.

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

Common misconceptions and problems ordinary people have about fat grafting

People who do not know much about fat grafting may think that if it is done at any clinic, the results will all be good, but that is absolutely not the case.

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

As with all surgeries, the result depends on the surgeon’s experience and know-how.

Fat grafting is a more demanding procedure than any other plastic surgery, and it requires a very complex process along with extensive experience, know-how, and highly precise manual skill.

There are many clinics that perform fat grafting, but only a handful do it properly.

Fat grafting is easy to perform, but difficult to produce proper results with.

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

Methods differ by clinic, and results vary greatly depending on experience.

Sometimes, after seeing or hearing about incorrect fat grafting, people may develop a negative bias, but if you receive proper fat grafting, you can be satisfied even after a single procedure.

Micro liposuction for correcting side effects

① A design is drawn on the skin to mark the liposuction area.

② To eliminate pain during local anesthesia, sedation anesthesia is administered.

③ Local anesthesia is performed in the liposuction area.

④ The fat is dissolved using an ultrasound liposuction device.

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

⑥ After liposuction, the facial band effectively compresses the liposuction area.

A treatment area for fat suction is designed on the skin.

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

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

Anesthesia is administered as intravenous sedation through a vein in the arm.

Because local anesthesia is painful, local anesthesia is performed after the patient has already been placed under sedation, allowing it to be done without pain.

After the local anesthesia is finished, the patient wakes up.

It usually takes about 5 minutes to fall asleep with sedation anesthesia.

Sedation anesthesia is different from general anesthesia; it is a safe method of anesthesia used as an adjunct to local anesthesia.

A cannula is inserted from the edge of the area to be suctioned, and the fat is carefully and gently removed.

If the amount to be removed is large, the fat may first be dissolved with ultrasound and then suctioned with a micro cannula. If the amount is not large and more delicate suction is needed, suction may be performed only with a micro cannula fitted with a syringe.

The key point of suction is to remove fat evenly within the designed area without creating irregularities.

In cases of necrotic abscess in the breast, necrosis often occurs extensively, so if it cannot be corrected by suction alone, an incision may be necessary.

The suction procedure takes about 10 to 30 minutes depending on the area, and after suction is finished, a facial band is worn.

The facial band enhances the effect of liposuction while reducing swelling and bruising and preventing skin sagging.

It is worn for about 4 to 7 days, and for small areas such as under the eyes, no band is worn; only a small piece of tape is applied.

Micro fat grafting for correcting side effects

1. Fat is harvested from areas where it is abundantly stored, such as the lower abdomen, waist, or thighs.

• Because local anesthesia (sedation anesthesia) is used, there is no pain at all.

• Fat is harvested into a syringe using a fine liposuction cannula.

2. The harvested fat is placed in a centrifuge to obtain pure concentrated fat.

The purpose of centrifugation is to remove unnecessary fat, reduce side effects of fat grafting, and increase graft survival.

3. After centrifugation, the fat undergoes a second concentration process to remove water and oil.

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

• The required amount of fat is measured into 1cc syringes. For facial contour correction, about 10 to 20cc of concentrated fat is usually needed.

4. The fat is grafted into the area where local anesthesia has already been administered. The refined fat is transferred into a fine 1cc syringe and grafted into the desired area.

Fat grafting is performed after the tunneling process is complete and space has been secured for the fat to be grafted.

At our clinic, we use a self-developed microneedle (micro graft cannula).

The microneedle is a special graft cannula used only at our clinic that allows ultra-precise grafting.

The principle of fat grafting is to distribute the fat evenly across the entire area to be grafted so it does not clump, while maximizing graft survival as much as possible.

Before-and-after results of side effect correction

1. Contour irregularities that occurred after fat grafting

If grafting is performed without tunneling and with precision, the fat may not be evenly distributed and can become uneven.

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

This is a highly advanced and delicate procedure.

2. Facial shape after excessive fat injection or excessive graft survival

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

Procedures such as fat-dissolving injections or AccuSculpt may not produce the desired effect or may cause additional side effects, so caution is necessary.

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

Other procedures for removing over-injected fat

◆ AccuSculpt laser procedure

This is a device introduced later after SmartLipo laser procedures, which are similar to it, lost demand due to their limited effectiveness.

However, like SmartLipo laser procedures, in most cases the effect is below expectations or almost nonexistent.

It can also cause severe swelling and sometimes thermal damage to the skin.

New procedures often mislead consumers with indiscriminate false or exaggerated advertising even before their effectiveness or side effects have been verified, so caution is necessary.

Also, necrotic or inflamed tissue must be directly removed by inserting a suction cannula; otherwise, good results cannot be achieved.

◆ SmartLipo laser procedure

This is a method of dissolving and removing subcutaneous fat using a laser.

The treatment effect is weak, so it is a method in which little volume reduction can be seen.

Because fat must be removed in the desired amount from the desired location, there is no method more accurate than directly removing it with a suction cannula inserted into the area.

The extent to which externally applied laser passes through the skin and melts the subcutaneous fat underneath is very weak or nearly ineffective, so this method cannot achieve the desired result.

◆ Fat-dissolving procedure (PPC injection)

This is a method of dissolving fat using injections, but depending on the drug, the effect is often minimal, or if a strong drug is used, side effects such as lumpy skin can occur.

Once a drug is injected into the body, it spreads to surrounding areas.

It is impossible to know which area and at what depth the drug will spread, and unwanted areas may sink or develop hollow, pit-like depressions in spots, so caution is needed.

In any procedure, the desired result can be achieved only when the appropriate amount of fat is removed from the intended area under precise design.

Using fat-dissolving injections for contouring is a treatment method with very limited expectations.

Do not be misled by false or exaggerated advertising whose effectiveness has not even been verified.

3. Asymmetry that occurred after fat grafting

Sometimes the amount injected differs, or the conditions for graft survival differ for some reason, causing uneven survival on both sides.

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

4. Hard calcification that occurred after fat grafting

This can occur when too much fat is injected into one area, or when fat that has deteriorated due to poor storage conditions is grafted during a secondary procedure.

The hard, calcified area is broken up and suctioned with a micro cannula for correction.

5. Pigmentation that occurred after fat grafting

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

It is caused by bruising after the under-eye procedure; after the bruise fades, iron components left in the bruise deposit in the skin, and over time it usually disappears on its own.

If it does not go away easily, micro fat grafting can be used to lighten the color.

6. Necrosis that occurred after fat grafting

This happens when fat is injected too much into one area, fails to survive, and melts into liquid that pools; in some cases it becomes suppurative and turns into pus.

It is removed by suction with a micro cannula.

6. Bacterial infection that occurred after fat grafting

This refers to cases where bacteria invade for some reason after fat grafting.

It can occur when the person’s constitution has reduced immunity, or when the procedure is performed without proper sterilization of the instruments.

All inflamed tissue must be removed using a micro cannula.

Procedure methods for fat grafting without side effects

◆ Perform the procedure in a sterile environment

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 to ensure no fat residue remains inside the used suction or graft cannulas, and then disinfected with a high-pressure steam sterilizer. Anesthetic agents and saline must also be carefully managed so they are not contaminated.

Thorough disinfection and material management can prevent bacterial infection and inflammation.

◆ Multiple stages of fat refinement

Fat refinement must completely remove impurities through several stages to maximize effectiveness.

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 grafting is done.

◆ Preliminary preparation before fat grafting

With a high graft survival rate, a satisfying effect should be achieved with a single procedure whenever possible.

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 the fat to survive well without pressure.

◆ Precise and even grafting into multiple tissue layers

The expression of a soft and natural contour is the essence of fat grafting.

To create a soft contour, it is better to graft using a three-dimensional method that distributes the fat evenly across multiple layers.

The grafting locations include the subcutaneous layer, muscle layer, and fascia layer, and the fat should be spread through the tissue like evenly sowing seeds to achieve a smooth contour without irregularities.

Precautions after micro liposuction

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

For smaller areas such as under the eyes, no facial band is used; instead, a small bandage with gauze is applied for only one or two days and then removed.

No special care is needed afterward.

If there was infection or inflammation before the procedure, antibiotics and anti-inflammatory medication will be prescribed.

Precautions after micro fat grafting

◆ Fat grafting requires skilled technique and experience.

Results vary greatly depending on the practitioner’s skill, so incomplete fat grafting can actually make the overall impression worse, so caution is needed.

◆ After fat grafting, do not apply cold packs, hot packs, or any other treatment.

Cold packs can hinder blood circulation and reduce fat graft survival, and hot packs carry a risk of burns, so no type of compress should be used after fat grafting.

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

Except for swelling and slight bruising, makeup can be applied and normal life resumed immediately, but for 1 to 2 weeks the swelling may make things look slightly awkward.

◆ After fat grafting, avoid running exercise for about one month, and refrain from drinking alcohol and smoking for about one week.

Except when fat is harvested from the legs, walking exercise, weight training, and stretching can begin after one week.

◆ Since fat grafting takes about 3 months to settle, it helps fat survival not to rub or press the treated area heavily while it is settling.

Number of fat grafting procedures

If the procedure is performed with skilled technique according to the proper principles, fat grafting usually produces satisfying results with just one session.

In some cases, a second session may be performed.

The interval between procedures is usually within 3 months, and at the latest within 10 months, and the procedure can be done using the remaining frozen fat.

When repeating the procedure, the fat that was harvested during the initial fat grafting is thawed and used.

Frozen fat requires proper storage technology and procedures; otherwise, the storage period becomes very short and there is a risk that the fat will deteriorate.

Our clinic has the facilities and technical capabilities to preserve fat in nearly its original state for up to 10 months, and in cases requiring a third procedure, fat is harvested again.

Lasting 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 can produce good effects only when performed based on skilled technique and experience.

If done accurately, fat grafting can provide satisfying results, and once the grafted fat survives, it is no longer absorbed and remains as the person’s own fat tissue for life, making it one of the safe and effective methods.

On average, one session, or rarely two sessions, can produce a permanent facial contour correction effect.

How to prevent fat grafting side effects

Because it involves grafting the body’s own tissue, it should not cause side effects in itself.

However, unsatisfactory results or side effects may occur due to the practitioner’s inexperience.

The entire process, from harvesting the fat to refining and grafting it, must be carried out very delicately, carefully, and according to the principles to achieve good results, so it is best not to receive treatment from a non-specialist who lacks experience or is not certified in plastic surgery.