Dr. Sam Lam Plastic Surgery Forum

Hi Dr. Lam -

Why is it that there is so much swelling with the fat transfer procedure? What causing so much swelling?

first, i hope you mean my swelling not someone else's because mine is a lot less than most. however, let's figure this out: most surgeries take away tissue (browlift, facelift, etc.), then you swell on top of it. one step back and one step forward so to speak. not exactly. now, let's take fat transfer: i am adding volume then you are swelling on top of it. two steps in the same direction, both additive. i hope that was already obvious to you. if not, that is the reason.

Just swelling in general following a fat transfer.

Your patient diaries are helpful and I was curious why the fat transfer ones stop at 1 week because it seems that the swelling continues for a least another week or two. There doesn't seem to be a big dip in swelling in that first week from what I can tell so it would be nice to see that in the diaries.

Thanks for your explanation. It was helpful.

that is actually a great idea. the reason for the one week thing is i think most people are tired of filming at 1 week. also, that is when i see them back in the office. i typically don't see them back again for a month. i will try to make some 2 week videos coming up. only a handful of patients want to shoot these videos though. i think i have a few 2 week shots in my "journeys" section. this is a section that i created before the diaries of people coming back to me in the office and i filmed them. that preceded the idea of the daily diary.
best,
sml

Also just a follow up question on swelling. This may seem dumb but to a layperson what exactly is swelling? Is it just fluid retention? Why exactly does that result from surgery? I know what you said earlier about the adding fat and then swelling but I just want to understand why it is that the body or face swells and what is swelling exactly.

Thanks.

swelling represents fluid accumulation in the area due to several things: blood in the area (usually very minor), fluid accumulating from damaged cells, fluid leaking out in the area due to "swelling factors" that are released, some lidocaine left over, etc. it is our body's response to injury in short. the time for swelling to go away depends on how much swelling is caused (how rough the surgeon is versus how gentle including how long the procedure is and obviously how much fat was placed which the fat volumes alone can cause "swelling") as well as how our lymphatics (cleaning system of the body) clears the swelling. that takes a few weeks to entirely have functional cleared lymphatics. the lymphatics can be further slightly compressed during the first week or two that may lead to the recovery being what it is. hope that is clearer.
best,
sml

I had fat transfer with Dr. Lam last May (last weekend). By mid June (two weeks later), I went on a cruise with a bunch of people who only see me so often. Nobdody noticed (including my father who lives in another state). So it takes about 2 weeks to de-swell from the fat transfer. One week wasn't enough. I still looked a little odd (not enough to keep me inside but nevertheless a little odd). See my other post on the rhinoplasty concern by the Asian fellow... Profwho from Austin

thanks. that is generally very accurate. i always just want to be careful. i had one patient want to kill me at a month because of "swelling". i thought she looked good but her mind she looked terrible. she sent me an apology at 6 weeks. she was the only patient out of several hundred who thought that at such a late date btw. i had one patient at 1 week that looked so good that i couldn't even remember i did her fat transfer the week before (that is the only patient too). she still looks great a year out. swelling and perception of swelling are variable. my "conservative" response is you and no one else will like it at a week; you probably still might not like it at 2 weeks but other people will probably begin to like it at 2 weeks; and you and others will probably like it at 3 weeks. those are obviously some vague guidelines.
best,
sml

I had one patient at 1 week that looked so good that i couldn't even remember i did her fat transfer the week before (that is the only patient too). she still looks great a year out.

See I would assume that if a patient loves the result at less than 2 weeks they would be disappointed in the end because what they really love is the swelling, yes? So when the swelling goes away there is less augmentation than what they've grown to love. That's not to say that they don't retain, rather that what they retain will inevitably be less than what they see with swelling. What would cause this in the first place? Less fat in or like what you said about good lymphatics or a combination? Did this patient want a touch-up once the swelling went down completely or was she happy enough with it? Do you ever think a patient could benefit from a touch-up when they don't want one or vice versa?

Thanks Dr. Lam and a Happy New Year to you

yes, i was surprised at how good she looked long-term too. generally, i don't like it when someone loves it at a week. but really the reason why someone undergoes less swelling than someone else is due to a myriad of factors. however, one reason simply is age. oftentimes, younger patients require less fat to achieve a great result so they have less swelling. so they have a shorter interval between swelling (hate it) to not so impressed (typically 3 months but in their case maybe a month or so) to a longer time to love it (since the interval has now increased from 2 to 6 months versus 3 to 6 months of dipping).

interestingly, all my touchups this year have been my call of wanting to make my results better. i had a lady yesterday that wanted a touchup under her eyes but showing her the photographs i couldn't even see what she was talking about. therefore, safety always dictates care. many times people forget what they used to look like. we tend to stare too closely at the mirror at minute flaws that cannot be helped. as i always say, you will never be perfect, just improved and typically a lot. actually, here is the photo of the woman who wanted a touchup at a year. see attached. i have consents to show her photos. it is a great comparison because she has no makeup on either photo, and she wanted a touchup under her eyes (??) i think you can see that i have corrected her browlift and bleph look by a large degree (not perfect but better). what is fascinating is that i have the link here to her one week result where she is swollen (but really not bad including her video): lamfacialplastics.com/plastic_surgery/dallas/content/view/1409/9/

i will help guide you to safe results always. we tend to have complete amnesia of what we used to look like. my job is to use a standardized photograph to remind you of how far you have come. i think this case shows you the degree of variability. what is also interesting is that the pictured woman is only just over a year (actually 1 year and 2 weeks). she will actually continue to improve over the next 8 months as i typically see so the result is definitely moving in the right direction.

best,
sml

btw, i found her 3.5 month "dip" photo, again without makeup. she still looks awesome even through the dip. but she looks a lot better now.

oftentimes, younger patients require less fat to achieve a great result so they have less swelling. so they have a shorter interval between swelling (hate it) to not so impressed (typically 3 months but in their case maybe a month or so) to a longer time to love it (since the interval has now increased from 2 to 6 months versus 3 to 6 months of dipping).

Can you clarify this a bit. I'm a little confused. So taking this lady as an example she had a dip at 1 month and it lasted for 2 months or 6 months? I'm not sure I follow completely. Also, do you always wait a minimum of 6 months before a touch up if you did one even if the patient wanted it sooner? It just seems a long time to wait if you've dipped to almost pre fat transfer levels.

i'm seeing patients now, but read this blog first:

lamfacialplastics.com/lfp-blog/questions/lam-facial-plastics/understanding-the-nature-of-a-transplant-part-iii/533

then understand that 6 months is too early. you will have an overinflated face if you go back that early to retouch even 6 months.

best,
sml

i have a few more minutes. not everyone dips. only 20 or so percent dip to the point that it looks not so impressive. even those that do not dip significantly still look much better a year or two down the road. you must not rush to do a touch up that early. it will lead to an overfilled look 2 years down the road. that is not worth it. i hope that is clearer. if i can do anything to make this clearer let me know. just more of my videos. they help a lot. or should.
best,
sml

So you think 6 months is too soon for a touch-up? If you did a touch-up then when is the "right" time? After 8 months? Also, does everyone have this blending effect that comes into play 6 months or 8 months after the procedure?

p.s. Sometimes it's difficult to see the level of augmentation from the frontal view in these pictures and in some of the others on the site. The 3/4 views are what really lets me personally see how much of an improvement is there. The one that comes to mind is the asian woman where you included her 3/4 view.