Dr. Sam Lam Plastic Surgery Forum

HI Dr Lam,

Could you be so kind as to briefly walk us through and actual fat grafting procedure?? What I mean is, could you briefly comment a bit on things like what actually is done during the procedure and how long does the actual procedure take. In terms of time, let's take for example a simple fat graft to cheeks.

I've seen your videos and I know that, in a nutshell, you harvest fat from one part of the body and inject it back where needed, but what actually goes on during the procedure is a mystery to me.

Also, what kind of anesthesia, if any, is used??

Hi Lulu,
Here's the rundown. The procedure is divided essentially into three parts: harvesting the fat, processing the fat, and injecting the fat. The total operative time is less than 2 hours. I can do this procedure under light iv sedation or general anesthesia. My anesthesia staff is equipped to perform any level of anesthesia.

HARVESTING THE FAT: After the thighs or legs are numbed, I harvest the fat by using a syringe equipped with a small harvesting cannula. I hand harvest everything, in other words no machine suction just gentle hand suctioning with the syringe. Once I have harvested between 6 to 8 syringes, I give these syringes (sterilely of course) over to my assistant who processes the syringes.

PROCESSING THE FAT: The fat is then placed into a centrifuge for a few minutes to separate any blood, lidocaine (numbing medicine) and lysed (broken) fat cells. After a few minutes, the processed fat is placed into a test tube rack (all sterilely or cleanly done) with all of the impurities poured off so you have a clean column of fat. The fat column is also wicked of any further impurities with a cottonoid sponge. The fat is then placed into tiny 1 cc syringes with a blunt infiltration cannula.

INJECTING THE FAT: Once the face has been numbed during the processing time, I inject the fat through typically 6 facial ports, 3 on each side. I rarely just do the cheeks as aging is panfacial (the entire face) so I will infiltrate fat into, for example, the temple, brow, upper eyelid, lower eyelid, tear trough, anterior cheek, lateral cheek, buccal, precanine fossa, smile line, mental crease, prejowl sulcus, and anterior chin. I am trying to achieve a balanced and global rejuvenation.

Once I have finished placing the fat, you are awakened from sedation and brought to the recovery room where you will be observed for 1 to 2 hours and then discharged home with a companion (or an assigned companion). Of note, I use no sutures of any kind, no surgical knives, and you have no bandages following the procedure.

Hope that helps,
SML

Hi Dr. Lam,

In this thread you indicate that you perform fat grafting under light IV sedation or general anesthesia. A surgeon in my area gave me the choice of having facial fat grafting (to the lower eyelids and cheeks) under local anesthesia only or twilight sedation. Why don't you perform this fat grafting under just local anesthesia? Does it affect the outcome of the procedure or just patient comfort?

Thanks.

I have done it under local anesthesia and it was uncomfortable for my patient. I will not repeat that mistake more than one time. Since I own and operate a surgery center, why don't I just make your experience comfortable? Do people do hair restoration under local anesthesia? All the time. That is very uncomfortable. Do you want to have your face lift done under local anesthesia. There is a major chain of face lift operators (I won't mention any names here) that does it under strict local because it is done to save money in an office. Besides horrific results I see every single week, the patients go through hell. Lastly remember, most people only see the hollow under the eye. I create a well-balanced and proportionate face. That's why my results look so good. I rarely if ever do the lower eyelid alone because it simply still makes someone look totally exhausted. Try it. You will see. When I do fat grafting, the cheek as a support to the lower eyelid is critical to finish the picture so is the brow and buccal transition as well as the chin. Now, why did I mention all of that? Because, with extensive fat grafting and harvesting it is much more comfortable to do this with some sedation. However, many surgeons do not have a surgery center so it costs them a fortune to go elsewhere to have the procedure done. Patient comfort is a priority for me.

I was watching a didactic series for hair restoration and one of the lecturers said a patient may forget in 10 years what their experience was, how they used to look like, etc., but one thing they will NEVER forget is the pain they went through.
best,
sml