Fat injection may be done under local anesthetic or asleep under intravenous sedation. If a small area is being treated, such as the lips and smile creases, this may be done awake. However, if other areas of the face are being treated, or if other procedures are done simultaneously, it is ideal to take advantage of the anesthetic so the patient is asleep for the needles.

Donor Site Selection

The abdomen is the most common donor site. On very thin women, there may not be enough abdominal fat, in which case the outer thighs are used instead. Local anesthetic is injected and fat is withdrawn ("aspirated") using a mini liposuction cannula. Presently, I use a fat collection system called "Lipivage™" that separates out the fat component as it is suctioned. Alternatively, I use a centrifuge to separate the fat component from the fluid that accompanies it. The "pure fat" component is prepared by the nurse in small syringes and then injected using a tiny cannula. The cannula is a narrow hollow metal tube, a little bigger than a needle, so that the fat globules can be injected with less chance of breaking up the cells. Also, the tip is rounded to avoid trauma to the tissues or possible injection into a blood vessel.

Typical areas for fat injection

How are the fat cells injected?

I prefer to use 5 or 10 cc syringes (60 cc for the buttocks) rather than 1 cc syringes that require numerous injections. The goal is to deliver more transplanted fat cells using fewer injections, causing less trauma, less swelling and an easier recovery. Also, the fat cells are more likely to "take" with less injury to the recipient tissues providing blood supply to the transplanted fat cells.

Using this approach, there are fewer alternative paths for the fat cells to take so they are likely to stay in position better.