Fat Processing for Fat Grafting: Does It Matter?

One of the most common questions that I get on the forum is “How do you process your fat?” This question pertains to how fat, once harvested from the body, is treated before injection into the face and/or hands. I know the intent of the question is in essence how do you process your fat in order for it to survive and thrive. I have come to realize that in the world of fat grafting, the processing part of the procedure has achieved a cult-like voodoo status that is unwarranted. I have trained with a Japanese surgeon in Tokyo who has been doing it for 20 years and he strains and filters the fat with excellent results and longevity. I have trained with a U.S. surgeon who centrifuges the fat and then decants it (my method) who also gets similarly long-lasting results.

Centrifuged fat before decanting the supra- and infranatant

I have heard such silly notions as you cannot let the fat touch the air for more than a few seconds.  Or, you must wick out every bit of oil so that the fat will survive.  Or, you cannot have any toxic lidocaine near the fat or it will not survive.  Or, you must get the stem-cell rich component so that the fat will have stem cells.  The only thing I have not heard so far is for the surgeon and maybe team to do a rain dance around the fat and chant a Hallelujah chorus.  To me, that would be as legitimate as everything else I described.

As you can probably note, I think the processing part is way overvalued.  A large reason I believe this is that the surgeons that I have trained with have used so many methods to take care of the fat and they have still demonstrated great longevity despite the technique.  I like to inform my prospective patients and the surgeons who train with me to forget for a moment the crazy attention paid to how to process the fat.  Instead follow the method that has worked well for someone who has done it for many years and who has shown unequivocal longevity and follow that surgeon’s method.  That is what I did, and it has worked well for me.

I think what is so much more important than how to process the fat is how to inject it.  That is what differentiates a great fat-grafting surgeon, a mediocre one, and a dangerous one.  For me, artistry defines what differentiates my fat-grafting results from those of my colleagues.  In short, I believe my results look nothing like anyone else’s.  As anything in life that requires handiwork, one’s hands on the subject truly can be the stamp of uniqueness:  a Picasso simply does not look like a Matisse, even though both are great artists.  You have to find the surgeon that creates the most artistic work that appeals to you.  That is what counts in my opinion.

Samuel M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas. To learn more about Dr Lam’s fat transfer procedures please visit our website www.LamFacialPlastics.com or call 972.312.8188 to schedule a consultation.