Liposuction combined with fat grafting is a procedure where fat is taken from unwanted areas to improve figure, shape and form and then transplanting that same fat to other areas where volume, shape and fat contouring is desired and/or required.
The most common areas for modern energy-assisted liposuction in women include the abdomen, hips, bra line, arms, outer and inner thighs, inner knees, neck, and jawline. This fat can then be transplanted to the breasts, buttocks, or face to provide volume and fullness.
Plastic Surgery Talk
Overview & Frequently Asked Questions
What is a fat transplantation and liposuction combination procedure?
It is very common in Dr. Mulholland’s liposuction practice to take fat from unwanted areas and contours—improving figure, shape and form—and then transplanting that same fat to other areas where volume, shape and fat contouring is desired and/or required. The most common areas for modern energy-assisted liposuction in women include the abdomen, hips, bra line, arms, outer and inner thighs, inner knees, neck, jawline, and (rarely) the calf and ankle. Dr. Mulholland deploys energy-assisted devices, such as VASERLipo, SmartLipo and BodyTite to perform the liquefication and coagulation of the fat and blood vessels. This liquefication, turning it into a “mango milkshake” of fat, makes it easier to extract, resulting in less bruising, pain, and swelling.
The gentle ultrasound waves that separate and remove the fat tissue also preserve the fat cells’ integrity and cellular structure, facilitating transplantation and giving VASERLipo the advantage over other energy assisted devices.
Figure 1. The tip of the VASERLipo probe emitting gentle ultrasound waves that gently separate fat cells for easy removal. However, this process does not destroy adipocyte fat cells, so they can be transplanted successfully after VASERLipo.
When using other energy-assisted liposuction devices, such as SmartLipo and BodyTite, there is significant area soft tissue contraction and dermal enhancement and this is important to optimize contraction and control of shape and skin. However, fatty tissue that has been treated with the SmartLipo laser or the BodyTite radiofrequency devices is no longer viable and cannot be transplanted elsewhere as it will not survive. The use of VASERLipo allows preservation of the fat cells so they can then be transplanted. The most common areas for fat transplantation following liposuction in females include the face, the breast and buttock. In males, often the fat is transplanted into muscle tissue to build up the appearance of that muscle tissue or used in the face.
How is a fat transplantation and liposuction combination procedure performed?
VASERLipo radiofrequency-assisted liposuction is performed under local anesthesia with oral sedation or sometimes with local anesthesia and IV or general sedation. Modern liposuction will generally be performed under local anesthesia and oral sedation for patients who are not given to anxiety. Local anesthesia is administered to the zones of undesired fat. The fat is then totally numb and Dr. Mulholland can perform the extraction.
Figure 2. Local anesthesia (called tumescent infiltration) is being slowly inserted into the fatty tissue to be treated; rendering the fat completely without sensation and allowing the liposuction and transplantation to be performed.
This local anesthesia is also called tumescent anesthesia. One it has been administered, Dr. Mulholland will deploy the VASERLipo to liquefy and coagulate the fat. This liquefied, coagulated fat is then promptly and carefully aspirated with a small needle (microcannula).
Figure 3. This shows the small size of the blunt-nose tipped microcannulas that are used to gently extract the fat cells after VASERLipo to be used for transplantation.
Who is a candidate for a fat transplantation and liposuction combination procedure?
Individuals who have unwanted areas of fat that detract from their ideal silhouette are best candidates for liposuction with fat transplantation. These patients have already tried diet and exercise to reshape their contour and figure and in addition to the removal of fat would like that volume to be moved to other, more deficient areas of their face or body. Good candidates are also medically well with no uncontrolled illnesses such as hypertension, heart disease, or diabetes. Patients who would be considered unsuitable for VASERLipo with fat transplantation are those who are excessively overweight, unreasonable about the silhouette they can achieve, or are medically unwell.
What kind of anesthetic is used during a fat transplantation and liposuction combination procedure?
Tumescent local anesthesia is used for VASERLipo with fat transplantation. This is a highly diluted local anesthetic. It is inserted gently into the fat – simultaneously distending and expanding the fat cells, exposing it to the ultarsound energy while providing a loss of feeling during the procedure. The VASERLipo procedure gently separates the fat cells for less traumatic aspiration and preserves their viability for transplantation.
Figure 4. VASERLipo fat being removed by blunt cannula to be used for fat transplantation.
Is a fat transplantation and liposuction combination procedure painful?
Modern energy-assisted liposuction devices pre-coagulate and liquefy the fat. This fat, “mango milkshake” is much easier to aspirate making it a gentler procedure. Energy-assisted liposuction techniques, like VASERLipo, are significantly less painful and less uncomfortable, and result in less bruising and swelling than old-fashioned liposuction techniques, as evidenced in peer-reviewed medical studies. This results in a much faster return to work and activities. The actual fat grafting procedure is performed with a very tiny, blunt tipped microcannula also minimizing risk of excessive bruising and pain.
Figure 5. A small blunt tipped microcannula, millimeters in size, is used to insert the fat grafts during the transplantation phase.
How are the Fat Grafted cells inserted into the area to be transplanted and augmented and how do they survive?
The fat graft cells are placed gently throughout the tissue to be augmented, using a microcannula. The transplanted fat cells, once evenly injected through the body part(s) to be augmented, survive for the first 96 hours on the passive diffusion of nutrients across the cell wall. Thus, the fat grafts need to be placed in multiple thin “tooth pick” sized columns through the host tissue to ensure they are thin enough to absorb nutrients and then the fat cells pick up a blood supply.
Figure 6. The fat cells in yellow are deposited gently, using the blunt micro cannula in structural columns through the host tissue to be augmented. This delicate and methodical technique ensures a high percentage of fat graft transplant survival.
Figure 7. Multiple columns of fat cells deposited in the tissue providing the augmentation and leaving enough space for nutrients to flow and blood vessels to grow in and provide long term survival.
How long does a fat transplantation and liposuction combination procedure take?
The fat extraction takes approximately 30 to 45 minutes per area (and multiple areas are often preformed). The amount of time required will depend on the thickness of the localized areas of fat to be contoured. The actual fat grafting itself, where the fat cells are delicately placed in the tissue to be transplanted and augmented, may take another 30 minutes.
How do transplanted fat cells survive?
The fat cells that are transplanted are your own cells, therefore they are not recognized as being foreign by your body and are not rejected. However, a very delicate fat transplantation technique must be executed by an experienced fat graft and fat transplant surgeon to ensure that the structure and shape to be achieved is created properly, and then that the transplanted fat cells pick up a blood supply (call neo-angiogenesis) and survive. In Dr. Mulholland’s experienced hands, most commonly well over 50% of the fat cells survive and flourish, providing augmentation, support, and contour.
Figure 8. Transplanted fat cells are picking up a blood supply for long term survival.
How long is the recovery following a fat transplantation and liposuction combination procedure?
Because VASERLipo is one of the modern, energy-assisted devices, patients experience quite a speedy recovery. Undergoing multiple-area liposuction and fat grafting (particularly fat transplanting to the breast, buttock, and body areas) and returning to very light, sedentary activities the following day is quite common. The transplanted zones are not visible and can be hidden with clothing. However, Dr. Mulholland recommends that you allow yourself two to three days off after your VASERLipo procedure to focus on recovery. Additionally, facial fat transplantation and grafting often requires several days off as there is usually significant swelling.
During the recovery process the patient will also need to wear a post-liposuction garment over the areas where fat transplant cells were harvested. This post-liposuction garment looks similar to a Spanx or Lycra-type compression garment and it will form the overlying soft tissue while it heals into the ideal silhouette. Liposuction garments are not worn in the areas where fat transplantation was performed, only on the areas where the fat was taken. These post-liposuction compression garments are meant to be worn under any clothing and provide comfortable support during your recovery. For the first three weeks your compression garment needs to be worn 22 hours a day. After the three weeks, the garments can be worn for support during the day but left off in the evening and overnight.
Patients will be able to return to low-impact activities such as walking, elliptical machines, or stair climbers within the two weeks. Patients wishing to return to high-impact activities like jogging, running, hot yoga or weight training are advised to wait until the fourth to sixth weeks. The areas that have received fat transplantation will be swollen and bruised. For fat grafting performed on the breast, buttock, or body areas, the modest swelling and bruising can easily be hidden with clothing immediately. Fat grafting and transplantation to the face does require 5-7 days for the swelling and bruising to look acceptable.
What will I look like immediately after a fat transplantation and liposuction combination procedure?
There will be swelling at the donor site immediately after the procedure, which will be contained by your compression garment. Generally, modern liposuction does not result in significant bruising. Avoiding aspirin (if possible) three weeks prior to your VASERLipo procedure will minimize your risk of bruising. There is often more bruising and swelling at the fat transplantation site (where the fat grafts were placed) than there is where the fat cells were harvested.
What kind of results can I expect after a fat transplantation and liposuction combination procedure?
Toronto liposuction and fat transplantation patients can expect very elegant results in the hands of Dr. Mulholland. Dr. Mulholland is well-known for his advanced liposuction and body contouring of all areas. Improvements in figure, shape, and contour are virtually assured, as fat is removed in the areas of contour concern and then transplanted to regions of the body that would benefit from more fat, contour, and shape. The “take from Peter to pay Paul” is a very popular strategy for many body contouring patients and they can expect excellent aesthetic contour enhancements.
Figure 9. VASERLipo liposuction of the love handles and flanks (for improvement in the waist) with fat transplantation to the Buttock
Figure 10. Patient who underwent a Neck and Jowl lift, along with a eye lid blepharoplasty and fat transplantation from her tummy to the cheeks, smile lines, and marionette lines.
What are the patients saying about their fat transplantation and liposuction combination procedure?
Dr. Mulholland has performed VASERLipo with fat transplantation techniques on various television programs and has appeared in top Canadian newspapers and magazines. Patients who come to see Dr. Mulholland understand that no diet or exercise plan can specifically target localized zones of the body to reduce unwanted pockets of fat like liposuction. They are extremely happy with the results achieved on their bulges and contours; tummy, bra lines, love handles, saddlebags, bat wings and inner thigh/inner knee fat.
Dr. Mulholland’s patients are particularly satisfied because of his blend of artistry and technical skill. His ability to understand the optimal countering for each individual patient and to d results that are unique to each patient’s body and particular concerns.
Figure 11. Patient underwent VASERLipo to the abdomen and hip and used the fat for fat transplantation to the breast for a 1/2 cup size improvement.
How long will the results last after a fat transplantation and liposuction combination procedure?
The results will be lifelong and the removed fat cannot not return. It is also crucial to maintain your weight after liposuction and stay within five to ten pounds of your post operative weight to maintain the permanent contouring and enhancements. Excessive weight gain will result in fat accumulating in areas where traditionally you might not have collected fat and this can compromise your new silhouette.
Is there any maintenance required after a fat transplantation and liposuction combination procedure?
There is no specific maintenance needed for areas where the fat has been removed. For the area where the fat transplantation was performed, the grafted fat may dissipate over time. Typically in high animation areas (like the face) fat transplantation may last 1-3 years. In low movement body zones (like the breast and buttock) the fat transplantation will quite often last several years. However, with age all fat is broken down and lost, so repeat volumization procedures, (either fat grafting again or off the shelf fillers such long-lasting Juvederm Voluma) may be required.
Dr. Mulholland recommends maintenance of the skin-tightening effect. On the areas where fat was removed, body heating treatments are usually required to keep the skin looking tight. Dr. Mulholland may utilize a combination of bulk heating radiofrequency devices to ensure the best possible skin contraction, such as Venus Freeze, Accent®, Exilis®, the VASERShape™, the Forma™ or Thermage® Body. Upon completion of your series of post-operative treatments, SpaMedica recommends a single treatment every three months to maintain skin tautness, elasticity and contour.
How much will a fat transplantation and liposuction combination procedure cost?
Pricing is dependent on size, amount of fat, and number of areas to be treated. In general, patients will find single-zone VASERLipo will start at between $3,999.00 to $6,999.00 for the first zone. Subsequent zone discounting for the second, third or fourth zones will be applied. Generally, depending on the size of the patient and their Body Mass Index (BMI), you can have liposuction on three to four zones for $9,999.00. The fat transplantation component of the procedure is usually $3999 for one large zone (for example, an entire face, breasts or buttocks).
Why choose SpaMedica and Dr. Mulholland for my a fat transplantation and liposuction combination procedure?
All cosmetic procedures are an art. At SpaMedica, art meets science with the application of energy-assisted liposuction devices. Their use is a highly-specialized skill; one for which Dr. Mulholland has been an innovator and a pioneer. He helped develop the radiofrequency VASERLipo and has taught thousand of other surgeons from around the world. SpaMedica has the most combined energy-assisted devices in Canada and Dr. Mulholland receives requests from patients around the globe for his liposuction and contouring skill as he is considered one of the foremost experts in the world in advanced modern liposuction. The SpaMedica team is well-known for their service, experience, care, and attention to your preoperative and postoperative needs.