Fat Grafting Using a Hair Transplant Model for Understanding Part 2: The Dip

The early swelling of fat grafting that dominates the first 1 to 3 weeks after a procedure can be misconstrued as a result when it in fact is a mixture of engorged fat cells and postoperative swelling. Sometimes the stretched out appearance at 1 month looks overly ideal because the fat result is settling down but the skin is still stretched free of pores and wrinkles. I always try to caution my patients of either liking or disliking an early result too much because either way it is inaccurate and not representative of the ultimate outcome.

As discussed in the first article of this series, a fat graft can be conceptualized like a hair graft in which new blood supply takes place over a period of a year and gradually improves. The only big difference is that a hair graft never goes through a period of swelling that could be misinterpreted as a result. Fat grafts however go through a period of too much, then just right, then as the fat cells shrink and all the swelling goes away can recede to almost a disappointing result, which I have termed “The Dip”. As the blood supply is gained to each fat cell over 6 months to a year, the fat graft itself gets better and better and better.

In the past I was very strict in thinking about the dip, structuring the time period to about 3 months in time. Many of my patients however became confused when either they did not experience a dip or when they experienced it later or sooner than the anointed 3-month period of time. Why would this dip period either not occur or occur at variable points? That is something that I have truly refined in my thinking over the period of 2010 into 2011.

Let’s start back with the hair transplant model which in my opinion is more visible because I can clearly see when hairs are growing on a bald scalp and when they are not. When I have my hair transplant patients come back to see me sometimes I see that they are growing hair like wildfire at 4 months and other times I see that there is no significant change until 9 months. However in general I see that the majority of patients start seeing noticeable improvements about 6 months after a procedure. Some even do not have all their grafts fall out but the grafts stay in the scalp and start growing earlier than normal. With the degree of variability that I see in my hair transplant results, I started to understand that a fat graft is very similar to a hair graft in the variable nature of its growth cycle. Accordingly, I have witnessed in my fat graft patients “dips” at 6 weeks, 3 months, 6 months, 9 months, and even at 1 year.

It always shocks me when I see a patient (two this last week) from out of town and I thought they had decent results at 1 year but at 2 years I was blown away. They swear they did not gain weight and their faces did not look fat: they just looked magnificently radiant and beautiful. Could this be the touted stem-cell effect? Well, that is something that I will be discussing in the third and final installment in this series (and will be investigating more in-depth in future articles.) I personally think it is the end of the maturation process for a fat transfer result.

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