Fat Grafting

I am very excited to discuss fat grafting — an innovative technique that my Beverly Hills, West Hollywood, and Marina Del Rey patients have been requesting more frequently, and that is revolutionizing the approach to certain problems in aesthetic breast surgery.

If you're interested in how fat grafting, also called fat transfer, can help you achieve your aesthetic goals, you can request a consultation to visit our Los Angeles County practice in person. You may also call us at (310) 576-3635 .

Fat Grafting Patient Photos

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Fat Grafting Case 506

This patient is a 39-year-old female who presented to my office with complaints of breasts which were larger than desired, particularly in the lower pole, which also demonstrated significant ptosis (drooping). The patient also had extra fat in the flanks, back, and lateral chest regions...

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Fat Grafting Case 504

This patient is a 52-year-old female who presented to my Los Angeles office with complaints of breast size smaller than desired as well as ptosis (drooping), laxity of the abdomen, and extra fat of the flanks and outer thighs. She preferred to avoid implants.I recommended a "Mommy Makeover&q...

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Fat Grafting Case 448

This patient is a female in her late 40's who presented to my  office with complaints of back, neck and shoulder pain due to large pendulous breasts. The patient was also noted to have severe asymmetry as well as significant ptosis. I felt a bilateral breast reduction would give the pati...

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Fat Grafting Case 432

This patient is a 58 year old female who presented to my office with widely spaced, unnatural appearing breasts.  She also had hardening of the breasts consistent with capsular contractures.  I felt this patient would need a complex breast revision with complete capsulectomies...

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Fat Grafting Case 405

This patient in her 50's presented to my office wanting fuller and perkier breasts.  Since she had naturally fuller breasts and did not want a huge size increase, I recommended fat grafting instead of implants for a natural and low-maintenance result.I performed a vertical...

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What Is Fat Grafting?

Fat grafting is a technique in which fat is removed from locations where it is not wanted (for example, the love handles and thighs) and reinserted into areas where more fat is needed, such as the breasts.

The key to successful fat grafting is related to the harvesting, processing, and reinsertion of the fat. I use power-assisted liposuction to take fat from areas where it is not needed, but instead of discarding the fat, I suction it into a device produced by LifeCell called the REVOLVE™ System.

LifeCell Revolve product
Photos courtesy of LifeCell

The REVOLVE System is a closed unit that the fat enters after being suctioned from the patient's body. The fat enters via the liposuction tube without ever being exposed to the outside environment, and is collected in a mesh container that holds the fat cells but allows fluids to pass through. The fat is washed multiple times with a fluid called Lactated Ringers solution (similar to saline solution), and a small, hand-turned "propeller" inside the mesh container is used to remove any fibrous tissue strands and other impurities.

Once the fat has been cleaned and purified, it can be drawn up into syringes for reinjection without ever being exposed to the outside environment.

After this, the fat is injected in multiple thin streams in the tissues of the recipient sites to add padding and volume where it is needed. The reason thin streams (or threads) of fat are used is that it maximizes blood supply to the fat grafts and improves the amount of the graft that "takes" (survives).

Traditionally, fat grafting was associated with a relatively high resorption rate, but I am finding almost 80% survival due to the quality and purity of the fat I harvest with the REVOLVE System. Additionally, the short time it takes to process and reinject the fat limits the time the fat cells are outside the body, further improving their survival rate.

Fat grafting risks can include resorption, oil cysts, and firm nodules, which can occur if the fat does not heal properly where it was injected. Fortunately, I have seen almost none of these issues due to the quality of the REVOLVE System and the precision of my techniques.

Syringes filled with fat

When Is Fat Grafting Appropriate?

Fat is great material: It's soft, natural, and doesn't require maintenance once it heals. I use fat grafting mostly for my breast surgery patients. I use fat grafting for 2 main reasons: to add volume and to cover irregularities.

With regard to volume, the ideal patients are those who need a breast lift and want to have more fullness in the upper breasts, but do not need or want implants. In these cases, I improve the breast shape and position with a traditional breast lift, and then layer the fat in the upper breasts to create a full, youthful appearance.

Without the fat, patients with naturally smaller breasts could potentially have a slightly "scooped out" appearance to the upper breast, which traditionally needed to be corrected with breast implants. Implants are great when they are necessary, but they do carry risks and maintenance, so when smaller volumes are needed (approximately 100- to 250-cc implants), fat is often a better option.

Real Patient Before & After Photos

This woman came to Dr. Cohen for a breast implant revision with fat grafting.

Complex Revision before Before
Complex Revision after After

Fat grafting is something I also use frequently to correct implant visibility. Some patients can see or feel implants through their skin due to a thinning of the tissues. In the past, I would exchange their implants to a more favorable size and material during a revision procedure, using products such as Strattice™ to add internal support.

While I still use those techniques, I now have the option of layering in fat above the areas of implant palpability or visibility to add padding. This adds thickness and smoothness to the breast, creating a more natural look and feel.

Who May Not Be a Good Candidate?

Almost anyone who has fat to give is a candidate for fat grafting. Occasionally, I will see patients who are so thin that they don't have enough fat to harvest. Fortunately, most patients do have a few pockets of fat available for donation to other areas of the body.

I always evaluate patients in person to make sure they are proper candidates for the technique. For those patients who are good candidates, fat grafting can improve very difficult problems that might otherwise be almost impossible to fix.


Dr. Robert Cohen

Certified by the American Board of Plastic Surgery

Dr. Cohen is a leader in the field of aesthetic plastic surgery whose expertise is highly regarded by both patients interested in improving their appearance, and plastic surgeons seeking to improve their techniques by attending his lectures. Dr. Cohen's goal is to understand your specific concerns, evaluate your anatomy in detail, and create a customized plan to help you achieve the best results possible based on the most modern techniques and materials available. Let him put his experience and aesthetic insight to work for you.

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