The major disadvantage of fat grafting – transfer is predictability of the end result. If I employ dermal fillers my usual correction is 1:1, meaning that we can predict with certainty of the volume obtained with hyaluronic acid. This is why HA fillers are so versatile in cosmesis. Fat transfer is less predictable with resorption rates of 5% to 50%, even if newer more stable techniques are employed. Fat is more labile than hyaluronic acid or collagen stimulating fillers in the context of both weight loss & weight gain.

The other disadvantage of fat is malleability, however micro & nano fat can give smaller size droplets. For larger areas of grafting, higher volumes are required. Fat, unlike some fillers, lack ‘G’ prime properties making them harder to employ as structural building blocks. Hence overcorrection is a rare side effect of fat transfer.

Arterial occlusion is a rare side effect of fat transfer. Unlike HA fillers where there is a reversal agent, fat can not be ‘dissolved.’ In the context of how I perform this procedure (larger bore cannula), this side effect is extremely rare.

1-5+ depending on the severity of acne scars, the amount of atrophy, your metabolism , uptake or resorption of fat, & your end goals. The main disadvantage of fat transfer is the unknown variable of initial fat absorption by your own immune system. Though I practice ‘high survival’ fat transfer (a relatively recent advancement in how we transfer fat), the graft survival rate can still vary from 50 to 95%.

In some cases only one session is required, in cases of marked atrophy with lots of subcutaneous – deep scarring, multiple sessions are required for optimal correction.

Results are generally longer lasting compared to hyaluronic acid dermal fillers, however the initial uptake may not be as good. When fat stabilizes at 12-16 weeks, longevity is more predictable. A few caveats; firstly if one loses weight, normally in the region of 4-7% of baseline weight, fat resorption may be seen. Chronological aging will also deplete fat.

Expect duration of improvement to range from 4 to 12 years. If fat decreases in this time, ‘top ups’ with fat or dermal fillers may be required to maintain results. Superficial placement of fat (microdroplets) into the dermis lasts 2-4 years on average.

Patients who lead a healthy lifestyle with a stable weight are ideal candidates for atrophic acne scar fat transfer. In the context of weight, a variance of less than 4-5% of your usual body weight is acceptable. Too much weight loss can result in absorption of facial fat, whilst weight gain of 8% or more may increase the size of the adipocytes in the graft site.

Other factors that contribute to graft survival include smoking, diet, exercise & your body’s immune system.

Inflammation is the enemy of healing. This applies to fat transfer as well as other procedures including lasers, microneedling, RFM, subcision & deep peels. If you have active inflammation, it distracts your immune system by deferring cells to ‘fight’ sites of inflammation, rather than concentrate on building collagen & repairing damaged tissue.

Deep inflammation from acne is also in the level of fat transfer (sebaceous glands). Fat transfer should ideally be a sterile procedure.

Yes. In some cases I combine fat with off label fillers to give synergistic results. I prefer to combine with collagen stimulating fillers rather than HA fillers. Combination treatments enable better volume correction in some patients with large atrophic scars. Cheeks & temples are characteristic sites. This is done on a case basis as of this current date of writing (2021), evidence of combination therapy is still uncertain.

Depending on the skin layer I treat, lasers can be performed in the same session. I do not laser on the same day if the level is superficial or intradermal placement. Lasers & other devices are used if there are superficial scars (pick, boxcar scars, pores), fat transfer, dermal fillers & subcision target deeper dermal & hypodermal deficits.

Abdomen, flanks, & legs. Many pro’s and cons’. Many studies have shown that donor sites do not matter, other studies have shown that adipose tissue harvested from the legs are more stable in the context of weight gain. My most frequent donor sites are the abdomen & flanks.

Probably the biggest hurdle I have is to convince patients that there are many other factors that come into play when it comes to revising acne scars. Tissue support is integral.

With age, the support for scar tissue & the dermis diminishes, this means there is increased laxity & a reduction of collagen, elastin, dermal matrix. Providing support for the dermal layer can only be achieved in one of two ways, namely matrix support in dermis – fat layer with dermal fillers, or support with fat. That’s it. Lasers, microneedling, energy devices can only do so much (improve skin quality, increase collagen). Replacing volume & resorting support, even if scars are not revised will indirectly improve scars. This is especially important in patients who have lost weight, who are slight of build, or who also exhibit age related changes as well as acne scars. Look beyond the scars in this group.

No, this procedure is well tolerated. I often employ both local anesthesia as well as mild sedation. For bigger procedures I use deeper sedation. Pain following the procedure is minimal, often controlled with paracetamol only.

Costs will vary depending on the complexity of the procedure. In Australia Medicare may cover some of the associated costs, including surgical revision & ablative lasers. A benefit applies if the procedure is performed for objectively severe acne scars.

Medicare does not cover cosmetic procedures such as fat transfer for ageing, cosmesis, enhancement or improvement in skin quality.