Question: I’ve seen some results of fat transfer that look great but other times the person looks too puffy or bloated. How do you avoid a puffy look?

Answer: The simplest way to avoid a puffy or bloated look with fat grafting is to simply not put in too much fat.  My personal opinion is that there is a "happy place" for fat grafting where we get to add a small amount of volume and make somebody look refreshed, and yet we do not need to add so much volume that they look puffy or swollen.  I will most commonly perform fat grafting in association with other surgical procedures, such as lower lid blepharoplasties and facelifts, and I, therefore, typically place relatively small amounts of fat compared with surgeons that try to rejuvenate the entire face simply by adding volume with fat grafting.  I have found that this combination approach allows me to create extreme rejuvenation while maintaining a very natural and healthy appearance. 

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Question: I’ve heard that when performing a fat graft, if the stem cells are used, the results are amazing. Do you perform this?

Answer: With every fat grafting procedure that has ever been performed, cell stems are included in that fat.  Newer technology theoretically allows us to isolate a higher concentration of these stem cells for transfer and there is theoretical improvement in the results, though I have personally not seen any good head-to-head comparisons clinically.  In essence, when we harvest fat from any part of the body there are stem cells included in this tissue and I think that most people that have done a fair amount of fat grafting will agree that there seems to be some rejuvenation of the overlying skin after placement of fat through a fat grafting procedure.  We feel that this may be due to stem cell activity from the fat grafting, but maybe it is just part of the healing process from placing fat, and I think that there is a lot of scientific experimentation that needs to occur before we can really firmly say whether or not the stem cells are truly beneficial with this procedure.

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Question: I am having fat transplanted from my buttocks to my cheeks to smooth my facial contours. My doctor mentioned the use of plasma reclaimed from my own reserves as a means of enhancing my procedure. In your opinion, does PRP in fact increase the success of lipid transfer?

Answer: I really do not have enough scientific information to be able to answer your question definitely as I have really not seen a good study that compares standard fat transfer to the plasma-reclaimed fat transfer to determine whether in the human body you get a better success of fat survival. There are obviously a lot of different physicians performing experiments on fat transfer so, hopefully, in the future we will get a better idea of whether this is really something that is beneficial.

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