In plastic surgery, fat injections are used for many different purposes (increasing volume, dimming scars, treatment of wrinkles..). The most intensive area is undoubtedly aesthetic use for volume increase. Butt lift with fat injection, penile thickening, filling the collapsed areas on the face, and highlighting the jaw contour are some of these applications. The most common question our patients ask in this regard is how long the fat will stay where it is injected and how long it will last. Usually, this question is answered as "% of amount". Everyone says 40%, 60%, with a high hand. I inject fat almost every day as part of my clinical practice, and I know a great deal about it. My opinion is that these ratios are all just a make up. The truth is very different. What I'm going to talk about here is my clinical experience, the biopsies we take from the patients, our personal inferences from the follow-up results of our patients. So I didn't get what I'm writing here from a book or a scientific article. What I write is entirely my personal experience and opinion.

The writing will be a bit long, I should warn you from the beginning (the writing will be a few parts). But it's worth it. Read..

I perform fat injection quite intensively in facial and penile thickening. We record the operations of these patients (actually all of our operations) with video. We received biopsies from some of our patients (1 year after the surgery) and examined the result of the fat we injected. We've followed our patients for many years. In particular, we followed the patients we treated in the facial region for many years (some more than 10 years). We've had some very interesting patients sometimes, and they've made a very important contribution to our experience. Let me write down the ideas I have gained as a result of my experience item by item so that it is easy to read.

- You can't give a certain rate about the fat retention rate. This rate is different for everyone. There are some factors affecting the fat retention rate. We extract fat from the area around the abdomen and waist, prepare it in the same way and inject it with the same technique, but the retention rate of the fat varies greatly from person to person. Some have 90% dissolvance at the end of 1 year (I say eyeball estimate), some patients come to us for check up 6 years later and we see that there is no dissolvance in the fat we inject. This certainly indicates that there are other factors involved besides the way we apply it. What are these?

- There are 3 factors affecting fat retention: the "quality" of fat, whether the injection site is a moving area and the patient's metabolic rate. Let me explain these factors separately.

- 1) "Fat quality": Since I am intensely engaged in penile enlargement surgery (fat injection is performed in this surgery), I have very detailed and clear ideas on this issue. First of all, you should know that not everyone gets fat from their bellies the same way. In some patients, when we extract fat directly from the abdomen with a vacuum injector, fat that resembles a dry, mashed potato or crushed banana comes out. There is no liquid in the contents; when you filter, nothing is filtered. We call this fat "very good quality." This type of fatty tissue does not lose volume where injected and stays for many years. In some patients, when we extract fat directly from the abdomen with a vacuum injector, fat tissue comes with plenty of fluid. You see fatty tissue floating in the fluid in the injector. When filtered, plenty of liquid is filtered. This fat is a "poor quality" fat, and no matter how much you filter it, it loses a lot of volume in a few months when you inject the remaining solid part. Why? What's the difference? I'm telling you.. Lets continue..

- Well, without talk around, I'll tell you why, it has something to do with the diet. In people who come from abroad and are not very selective in nutrition (okay, let me just write: people who eat pork and fat), the abdomen fat is usually very dry and solid (i.e. of good quality). If the fat tissue extracted from the abdomen is "quality", only the required amount of fat should be injected into the injection site because it will not dissolve, no dissolvance share is required. I've seen cases like this five or six years later, and there's never been a loss of fat. When I see these patients six years after surgery, I'm not trying to remember what the fat we extracted from the abdomen was like six years ago. I wrote it down above, we record all surgeries. When I look at the surgery record of the patient 6 years ago, we see that the fat we extracted from the abdomen is dry and "quality". If the fat is "poor quality", it would be appropriate to inject a little more fat than necessary, considering that it will dissolve in a few months (taking into account the dissolvance share). In the second part of the article, which will be published later, I will talk about a few of my cases. You'll find that my inferences are correct.

- There is no need to eat pork to get lard with food. Patients living abroad can get pork fat even with cake, pastries, bread. We have noticed that one exception is our patients who constantly get all their food from halal markets. From time to time, our conservative patients come from the France, Germany. To be clear, one can tell a little from one's clothing whether it's conservative or not. We ask such patients where they shop for food; if they do it from halal food markets, the fat we usually extract from the abdomen is "poor quality".

- The nutritional difference between our country and the European countries is just pork fat, I think. We sometimes go to European countries to rent houses for music festivals and stay for a week. Since we're staying at home, we want to cook at home and go to the grocery store for food shopping. The meat section is the most distressing. Almost all of the once-processed meat products (salami, sausage) have pork and fat. We need to ask the salesclerk which one doesn't have pork and fat. The guy looks at the section, then shows a package and says, "Not in this one, it's just beef." It is very difficult to avoid pork and fat if you live abroad. In fact, we later learned that they use lard on bread, cakes, pastries. Therefore, I think the most important difference between the diet abroad and the diet in our country is to feed on pork and lard. This affects the structure of the fat in the abdomen. The abdomen fat structure of the person who is fed with foods containing pork fat for a long time changes. We've seen some very obvious examples of this. In the second part of the article, which will be published later, I will talk about a case experience, you will understand.

- What does it matter if the fat we extract from the abdomen is "quality" or "poor quality"? Once the fat is "poor quality", it is absolutely necessary to inject a little more fat. You have to take into account the dissolvance rate. In addition, the patient should be told that another fat injection may be required within 1 year after the surgery. If the fat you extract from the abdomen is "quality", it will not dissolve for many years. In these patients, it is absolutely necessary not to inject too much fat. Since it will not dissolve, you should not take into account the dissolvance percentage. After the surgery, the patient should also be told that the fat is very good and that fat injection will not be needed again soon.

- At this point, I would like to draw attention to a point that seems very irrelevant but is actually very relevant. Most of the patients we enlarge the penis complain of bruising in the abdomen where we extracted fat from their abdomens after the surgery. That is correct. In fact, while liposuction is performed from the abdomen, some precautions are taken to prevent this bruising. Bleeding so cyanosis is being prevented by injecting some drugs into the fat extraction area. We don't take such precautions if we are going to extract fat from the abdomen and inject it elsewhere! Why? Because when we extract the fat, we need to see the natural state of the fat. If we inject drugs into that area, the fat we extract is mixed with the drug we inject and misleads us. We need to see if the fat is edematous in itself ("poor quality") or dry ("good quality"). Therefore, if we extract fat from the abdomen for fat injection, there will be some bruising in these areas, but this will pass in 2-3 weeks. That's the way it's supposed to be.

- I just want to say that I do not eat pork and lard when I was finishing this "the quality of fat and the relationship between lard and diet." Please don't rise up and say, "Does this man recommend pork?" Eating pork and lard has an undeniable effect on the abdomen fat structure. This does not mean that I recommend you pork. Please don't misunderstand. I'm just telling you this to answer the question, "Why does fat retent so well in some patients, while in others it dissolves too much?"

2) "Whether the injection site is a moving area": The second important factor affecting fat retention rate is whether the fat injection site is a mobile area. First, I have to tell you this. If you are injecting a large amount of fat into a area, you should know that this fat will not remain there as living fat tissue. To keep fat tissue alive, you must inject it into healthy tissue in columns up to 5 millimeters in diameter. It doesn't live otherwise. If you inject 60 cc's of fat tissue like a lake (as we do in penis thickening), this fat tissue will not stay alive, and over time it will die and become fibrous tissue (living cells die, remnants of cells become fibrous tissue). It's no different than planting seeds in the soil. How do farmers plant seeds? They take a handful of seeds and spread them over a wide area, because the seeds have to fall apart and each seed has to have its own soil area around it. If you pour all the seeds in one place, the seeds will not retent. Fat injection is usually performed to increase volume, so that fat tissue is injected into a region just to ponding. In Brazilian butt surgery, 1000-2000 cc fat is injected into the butt area, which is a very large volume and it is impossible for this fat to retain it as living tissue in that region. In penis thickening, we usually inject 60 cc fat subcutan of the penis. The amount of fat injected according to the amount of area is very high and therefore this fat does not live and transforms into fibrous tissue. We do not want fat to live here (in the penis). If you understand what I have said so far, let's continue below.

- It takes a process for the injected fat to "retain", that is, to transform into fibrous tissue. In this process, fat cells die and transform into fibrous tissue. At the beginning of this process, if the fat moves in the injected area, the fat cells are lost by mixing with the blood. To give an example, we prohibit our penis enlargement patients from having sexual intercourse for 3 weeks. If there is movement (sexual intercourse) on the penis shortly after the fat is injected, the injected fat is lost. Since fat cells die and transform into fibrous tissue at the end of three weeks, it cannot mix with the movement in that region and there will be no volume loss. In other words, fat cells need to pass the transformation process into fibrous tissue by staying as still as possible. After transforming into fibrous tissue, it no longer dissolves into blood like living fatty tissue.

- In the winter symposium in 2013, the topic of the symposium was genital aesthetics. After my presentation, a colleague of mine said: “I can't keep the fat I injected to stay this long. And I don't forbid an intercourse for three weeks after penile enlargement, where did that come from? " Isn't it obvious? It actually gives me the answer. Since the patients are not forbidden to have intercourse for 3 weeks, the injected fat is lost when the patient has intercourse before 3 weeks. However, if there is no movement on the penis for 3 weeks (intercourse should be prohibited for 3 weeks), injected fat tissue transforms into fibrous tissue during this period and there is no dissolution.

- What I'm saying is, what is important in retention of injected fat is whether injected fat area is moving. If possible, it is necessary to keep that area inactive for 2-3 weeks. This automatically means: fat injection is not a good option for lip thickening. The fat injected into the lip dissolves early. Even if the patient doesn't talk, sooner or later he'll eat. As his lips move, the injected fat (before it has a chance to remain motionless and transform into fibrous tissue) mixes with blood. In contrast, fat injection "retents" very well in some areas. For example, forehead.. For example, the jaw angle. Cheekbones .. These areas are relatively still areas and the injected fat "retains" very well here.

- 3) Patient's metabolic rate: Injected fat tissue usually transforms into fibrous tissue. Fibrous tissue also dissolves over time. There are cells in the body that "rasp" fibrous tissues over time. These transformations are proportional to the patient's metabolic rate. In people with rapid metabolism, such as athletes, these transformations are also rapid. Therefore, the volume of injected fat decreases more rapidly over the years compared to normal people.

- Examples of "rasping" of fibrous tissue include surgical scars. The remaining suture scars heal completely within 1-2 years after the surgeries, relieve the redness and soften; but over the years they begin to soften and fade further. So I don't think any fat injection is a lifetime, even if it "retent" very well and stays for years.

RESULT: Fat injection works better if performed in inactive areas. The fat extracted from the abdomen "retents" better as it is dry and free of edema. The "quality" of abdomen fat is related to nutrition (in my opinion, the taking of lard with foods makes the fat more solid and "retains" better). If the fat extracted from the abdomen is very edematous, the retention rate will be low. Due to these factors, we can not say that it is as much as % by generalizing in everyone. The retention / dissolution rate of the injected fat varies greatly from person to person. In section 2 of this article, I will talk about a few of my fat injection cases. I'll tell you the lessons I learned from each case. Don't miss it..

Dr. Oytun İdil (Plastic and recontructive surgeon)
www.idilpenissurgery.com
oytunmd@gmail.com
+90 533 5690649
+90 505 2965569

Op. Dr. Oytun İdil

(Plastic aesthetic and reconstructive surgeon)

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