LIPOFILLING (fat injections) is a surgical operation used to augment areas of the body. It is frequently used in the face and hands to add soft tissue bulk and create a younger/more youthful appearance. It is also being used to augment small breasts ( instead of implants ). The operation is divided into 3 parts: liposuction of some excess fat, treating the fat, and re-injection into the area where it is needed. The incisions are tiny and inconspicuous. The recovery is relatively quick and the complication rate low. Ensure that whomever you choose is properly qualified and trained to do this procedure. The main advantage of this operation is that the tissue used is one’s own - and therefore there is no possibility of allergic reactions to a foreign material. The fat takes as a graft. The amount of graft survival is however unpredictable, i.e. some of the fat can dissolve and repeated injections may be needed. Sometimes the area is overfilled a little to compensate for this re-absorption. The procedure is best suited to healthy individuals who are at, or close to their ideal weight for height, and who have good quality, elastic skin.

Prior to Surgery

If you are considering lipofilling, consider what you want and which areas you regard as problematic. Think of any questions you may have and write them down to ask me later. No patient is operated on without a formal face-to-face consultation. At this consultation, your suitability and fitness for the procedure will be assessed. You will be examined and routine pre-operative photographs will be taken. Surgical options are discussed, as well as the risks and complications, venue for surgery and type of anaesthesia to be used. If you are a smoker, you should try to stop smoking 1 week before surgery and avoid smoking till healing is complete. If you are on any medication, inform your surgeon (this includes the oral contraceptive pill). Avoid aspirin containing drugs before and after surgery. Arnica, a homeopathic remedy, may help to diminish bruising and swelling in the area, but it should only be started on the second post-operative day, as it can increase the risk of bleeding if taken early. It is available from health shops. No specific diet or exercise program is required prior to surgery. Prior to surgery, arrange to have plenty of clean linen and towels - some fluid tends to leak out post-operatively and you may need to change soiled linen. Also ensure that you arrange for someone to drive you home from the hospital and to look after you on your first post-operative night. Make sure that for a few days after the surgery you have as few commitments as possible so that you can recuperate in peace. Drink plenty of fluids the day before surgery, and in the post operative period. Hygiene is obviously important and you should shower on the morning of surgery and every day after the operation too. On the day of surgery you should be fit and healthy. You should not be suffering from a cold, flu or any other illness. If you think you might be anxious the night before surgery, or if you want something to help you sleep, ask for this beforehand and it will be prescribed.

The Surgery

Liposuction and lipofilling is usually done under general anaesthesia. Prior to surgery, oral sedation/pre-med may be given if desired and the area(s) to be treated will be marked. You will be taken through to the operating theatre, the area to be liposucked will be prepared with a sterilizing solution to clean the skin and then the area is draped with sterile towels. I use the tumescent technique: a large volume of dilute local anaesthesia is infused into the donor site to prevent intra and postoperative pain and to reduce bleeding. The actual liposuction is performed through small (about 5mm) incisions, usually made in well hidden areas such as the panty line or in natural creases, for example, the lower buttock crease. A tube, called a cannula, is inserted and the fat is sucked out. When enough fat has been collected suction is stopped. Each incision is closed with a single suture and dressed with a light dressing. The collected fat is treated using a modified Coleman technique, and then re-injected via small incisions into the needed areas. After surgery, a pressure garment is applied to the donor site and you are transferred to the post-op recovery area (usually for a cup of tea and a biscuit!)

Following Surgery – Recovery

Most patients have their procedure performed as day cases and will require a responsible adult to drive them home and look after them on the night of surgery. You should wake up almost pain-free and will be given painkillers to control any discomfort over the next few days. You should drink plenty of fluids and pass lots of urine for the first 24-48 hours following surgery. Also, although you should rest up, you should try to mobilize: in other words, sit in a chair or walk around a little. This not only helps to mobilize fluid and thus reduce discomfort in the areas treated, but also prevents the development of leg clots. Some bloodstained fluid may leak through your dressings. You should plan ahead and have some towels and spare linen. It is advisable for the elasticated dressing on the donor site to be worn continuously for 3 weeks, then just in the daytime for a further 3 weeks. Arnica, started on day 2 after surgery, will also help with the bruising and swelling. Do not expect to look or feel good immediately after surgery. The areas treated will be swollen, bruised and a little sore - a bit like if you have worked out too hard in the gym. It is not unusual to feel depressed in the days or weeks following surgery. Try to keep in mind that this is normal and will subside as you begin to look and feel better. The wounds take about 5-7 days to heal, although they will mature over the next year. The stitches placed are usually dissolvable. Bruising subsides quickly from day 2 or 3 following surgery and is usually mostly gone by 10-14 days after your op, although some degree can persist for 3 weeks after surgery. Healing is a gradual process, which varies from individual to individual. Time off work is usually 1- 2 weeks. Plan to keep things quiet during this time. Patients who come from abroad require at least 7-10 days before returning home. Stretching and bending exercises can be started at the end of the first week following surgery, but more strenuous activity should be avoided for two weeks after surgery. Again, people are different and when you resume activity depends on the extent of your procedure and how you feel.

Risks and complications

If performed by a Plastic Surgeon in a proper operating theatre under sterile conditions on a relatively fit and healthy patient, liposuction and fat injection is a safe procedure. Major problems such as kidney failure, leg clots which migrate to the lungs, fat emboli and damage to underlying structures are possible, but very rare. The commonest problem after fat injections is the need for top up injections at a later stage. Complications in the injected site are rare. Over or under filling are possibilities. Asymmetries, and damage to adjacent structures can occur. Donor site problems depend on how much fat was liposucked. If very little was needed then problems are again uncommon. If more fat is needed then contour irregularities, and patches of numbness can occur. Pigmentary problems can occur especially if you go in the sun while still bruised. Sun exposure can fix the pigment in the skin and is to be avoided. Most patients form inconspicuous scars. Red, raised, hypertrophic or keloid scars can occur, but rarely. In general complications are rare, especially the major complications. Liposuction and fat injection is one of the safest procedures performed by plastic surgeons.

Satisfaction

As long as the fat remains, the areas treated will have a fuller more youthful appearance. If larger volumes of fat are needed you will need to plan for 2 or 3 sessions. Up to 50% of the fat can re-absorb and repeated injections are often necessary. As this innovative technique becomes more widely used more and more patients are happy with their natural healthy looking younger look.

If you are worried post-operatively

• Telephone the ward of the hospital from which you have been discharged.

• Telephone my secretary during office hours – 07780 785186.

• In an emergency (and you have failed to contact me by the above two methods) then please telephone St George’s Hospital (020 8672 1255) and ask them to either bleep me or the Resident Plastic Surgery House Officer on call (Bleep 7050).