Additional procedures / Fat grafting
Fat Grafting
Your own fat, taken by liposuction and transferred to where volume is wanted: the cheeks and other areas of the face, the breast, or the hips and buttocks. On its own or as part of facial feminization, breast reconstruction, or body feminization surgery, with Dr. Steven Ovadia.
Overview
Volume from your own tissue
Fat grafting moves fat from where you have it to where you want it. It is taken by liposuction, prepared, and placed in fine threads, and the fat that takes becomes a living part of the area it was placed in. There is no implant and nothing to absorb or repeat.
Dr. Ovadia uses it in three places. In the face, to round the cheeks and soften the midface, on its own or as part of facial feminization surgery. In the breast, most often to refine a reconstruction. And in the hips and buttocks, as the Brazilian butt lift and as part of body feminization surgery.
The face
Fat grafting to the face
Facial feminization surgery changes the skeleton: the brow bone, the nose, the jaw and chin. The soft tissue over that skeleton matters too. Full, rounded cheeks, soft temples, and a midface that curves rather than angles are features that read as feminine, and they are features of volume, not bone. Fat grafting adds that volume, on its own or in the same operation as the bone work.
Cheeks
Soft, rounded fullness over the cheekbones is the most common goal. Fat is placed over the cheekbone and in the area just below it to round the midface and lift the apparent position of the cheeks.
Temples
Hollow temples make the upper face look narrow and the brow bone more prominent. Filling them softens the transition from the forehead to the cheeks.
Under the eyes
The hollow between the lower eyelid and the cheek, the tear trough, can be softened with small amounts of fat so the eye and cheek blend into one surface.
Lips and around the mouth
Fat can add volume to the lips and soften the lines from the nose to the corners of the mouth. For lip shape, see the lip lift, which changes the proportion of the lip rather than its volume.
Jawline and chin
Small amounts of fat can smooth the contour along the jaw and chin after bone work, filling any irregularities so the new shape reads as one smooth line.
The breast
Fat grafting to the breast
In the breast, fat grafting is mostly a finishing tool. It is one of the ways Dr. Ovadia refines a breast reconstruction, and it can add a modest amount of volume on its own. See the implant-based reconstruction and implant exchange pages for where it fits.
After breast reconstruction
Fat grafting is a common second step after implant or flap reconstruction. It fills hollows along the upper edge of the breast or beside the breastbone, smooths a visible implant edge or rippling, and evens out the two sides. It is often done at the time of nipple reconstruction or implant exchange.
With or instead of an implant
Fat can add a modest amount of volume to the breast on its own, usually less than a cup size, with no implant. For a larger change an implant is still the right tool, and fat can be added around it to soften the result. Fat grafting is also an option when implants are removed and some fullness is wanted back.
Where the fat comes from
The fat is taken by liposuction from the abdomen, flanks, or thighs. For the breast the amounts are larger than for the face, so the donor site is contoured at the same time.
Hips and buttocks
The Brazilian butt lift and body feminization
Fat grafting to the hips and buttocks is paired with liposuction of the waist, so the change is to the whole proportion. For transfeminine patients it is one of the main steps of body feminization surgery.
The Brazilian butt lift (BBL)
Fat is taken by liposuction from the waist, back, abdomen, or thighs and transferred to the buttocks and hips. The shape change comes from both halves: the waist is narrowed and the buttocks and hips are filled, which is what gives the curve.
Hips, for body feminization
For transfeminine patients, fat grafting to the hips and buttocks is one of the main steps of body feminization surgery, done with liposuction of the waist and flanks to move the proportion from the shoulders and waist toward the hips.
Placed above the muscle
For safety, the fat is placed only in the fatty layer under the skin, never into or below the buttock muscle. Dr. Ovadia follows current safety guidance for this operation, and the amount transferred is planned around what that layer can hold.
Sitting and sleeping afterward
Pressure on the grafted fat in the first weeks lowers how much survives. For about two weeks you sleep on your stomach or side and avoid sitting directly on the buttocks, using a cushion that shifts weight to the thighs when you do sit.
How it works
What happens in surgery
Fat is taken by liposuction
A small amount of fat is removed with a thin cannula through a tiny incision, most often from the abdomen, flanks, or thighs. For the face the amount is small; for the breast or the hips and buttocks it is larger, and the donor site is contoured at the same time.
The fat is prepared
The fat is processed to separate the fat cells from fluid, oil and blood, so that what is injected is concentrated, living fat.
The fat is placed in thin threads
Using fine cannulas, the fat is placed in many small threads at different depths across the area being treated. Spreading it this way is what lets the fat pick up a blood supply and survive.
Slightly more is placed than the final result
Not all of the transferred fat survives, so a little more is placed than the goal. The fat that takes, in roughly the first few months, is there to stay.
Results
What to expect from the result
Some of the fat does not survive
Transferred fat needs to pick up a blood supply in its new position, and some of it does not. How much takes varies from patient to patient and area to area. Dr. Ovadia places slightly more than the goal to allow for this, and the fat that has survived by a few months is permanent.
Swelling hides the result at first
The treated areas look fuller than the final result in the first weeks, because of swelling on top of the extra fat placed. The shape settles as the swelling goes down and the fat that will not survive is absorbed.
A second session is sometimes planned
Because fat survival varies, some patients have a second, smaller session to add to areas that took less than expected. Whether this is likely for you is part of the planning conversation.
Fat changes with you
The fat that survives behaves like the fat it came from. It stays with you, and it will gain or lose some volume if your weight changes significantly.
Recovery
What to expect afterward
Recovery from fat grafting on its own is short: a week or two of soreness and bruising at the donor site and swelling where the fat was placed. When it is done with other procedures, the overall recovery follows theirs; for facial feminization, the full guide is on the recovery page.
Swelling and bruising
Swelling is normal and expected, and the treated areas are swollen and often bruised in the first one to two weeks. As a general guide, about half of the swelling settles by 6 weeks and the rest by 6 months.
The donor site
The area the fat was taken from is sore and bruised for a week or two, like a small liposuction. A compression garment over it helps.
Protecting the grafts
Pressure on the treated areas in the first weeks can affect how much fat survives. Dr. Ovadia's team will go over how to sleep, how to wear the compression garment around the grafted areas, and, after a BBL, how to sit, and what to avoid.
Numbness
Temporary numbness over the treated areas is common. It comes from nerves being stretched during the operation, and it improves over time.
Normal swelling comes on slowly. A rapid increase in swelling is something to watch for, and it should be brought to your physician's attention right away. When fat grafting is part of facial feminization surgery, see the recovery after FFS page for the complete guide.
Your surgeon
Placed where it will change the shape
In the face, fat grafting does its best work when the bone underneath is already in the right shape, so Dr. Ovadia plans the soft tissue with the skeletal work rather than using fat to hide a shape that bone surgery should correct. In the breast and the body, he plans it against the whole result: what the reconstruction or the liposuction has already done, and what the fat layer can safely hold.
Dr. Ovadia is fellowship-trained in craniofacial surgery and in gender-affirming surgery, is board certified by the American Board of Plastic Surgery, and sees patients in New York City and in Jersey City and Millburn, New Jersey. Read more on the facial feminization surgery, body feminization surgery, and breast reconstruction pages.
Questions
Common questions about fat grafting
What is fat grafting?
Fat grafting, or fat transfer, uses your own fat to add volume where it is wanted. Fat is taken by liposuction, prepared, and placed in fine threads into the face, the breast, or the hips and buttocks. The fat that survives is permanent.
Is fat grafting part of facial feminization surgery?
It can be. Rounder, fuller cheeks and a softer midface are among the features that read as feminine, and facial fat grafting is one of the procedures that can be part of a facial feminization surgical plan. It is also done on its own for patients who are not having facial feminization surgery.
How is fat grafting different from filler?
Filler is a manufactured gel that is absorbed over months and has to be repeated. Fat grafting uses your own tissue, and the fat that takes is permanent. Fat grafting is surgery, with a donor site and a longer recovery than filler; filler is an office treatment. Which is right depends on how much volume is wanted and for how long.
How much of the fat survives?
It varies from patient to patient and from area to area. Not all of the transferred fat picks up a blood supply, so Dr. Ovadia places slightly more than the goal, and some patients have a second, smaller session. The fat that has survived by a few months after surgery is there to stay.
Where is the fat taken from?
Most often from the abdomen or the inner thighs, through a tiny incision. The amount is small. The donor site is chosen with you.
Can fat grafting be used for the breast?
Yes. After breast reconstruction it is used to fill hollows, smooth the edge of an implant, and even out the two sides. On its own it can add a modest amount of volume, usually less than a cup size. For a larger change an implant is still the right tool.
Is a BBL the same as fat grafting?
A Brazilian butt lift is fat grafting to the buttocks and hips, combined with liposuction of the waist and surrounding areas. The fat is placed only in the fatty layer above the muscle, which is the current safety standard for this operation.
Can fat grafting be done with the rest of facial feminization surgery?
Yes. When it is part of the plan it is usually done in the same operation as the bone work, so that the soft tissue is shaped over the new skeleton. It can also be done as a procedure on its own.
Next step
Start with a consultation
Dr. Ovadia will look at where volume would change the shape, where the fat would come from, how it fits with any other surgery in your plan, and what to expect from the fat that takes.
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