Facial Fat Grafting: How Much of the Transferred Fat Stays?

Autologous fat grafting fills sunken areas of the face with your own fat, but not all of the transferred fat survives. Here is an overview of how much remains and what you should know before undergoing the procedure.

This is the examination room at Seorae Plastic Surgery. The reasons a face looks sunken differ from person to person, so we first assess each patient during consultation before deciding on a treatment method.

What is autologous fat grafting?

Facial autologous fat grafting uses your own fat, so there is a lower risk of rejection, and it can naturally fill sunken or atrophied tissue. That said, it is not free of side effects.

A sunken appearance is not caused by sagging alone. In a study comparing facial CT scans of the same 19 individuals taken an average of 11 years apart, the fat in the midface had decreased. Fat grafting helps restore volume that lifting alone cannot fill.

At Seorae Plastic Surgery, we remove unnecessary components from the harvested fat and use a centrifuge to isolate purified fat for injection. A centrifuge spins the harvested fat at high speed to separate out oil and fluid. Rather than simply adding fat, we also consider the three-dimensional balance of the entire treatment area.

This is a conceptual illustration of the surgical process. It is not an actual surgical scene or a photo of a patient.

Who is a good candidate for fat grafting?

· Sunken cheeks and cheekbones — In a study that tracked 23 women who received only fat grafting using 3D imaging, the added volume in the cheekbone area was still present one year later, and satisfaction also improved.

· Sunken under-eyes and surrounding areas — In an analysis pooling periorbital fat grafting studies, about 91% of patients were reported as satisfied across the 27 studies that assessed satisfaction.

· Faces undergoing a facelift but lacking volume — A review pooling 15 studies that combined a facelift with fat grafting found improvements in volume and aesthetic evaluation scores.

The left side shows a face with sunken cheeks and under-eyes, and the right side is a conceptual illustration of the volume the procedure aims to achieve. These are not photos of actual patients, and results vary from person to person.

How much of the transferred fat survives?

Not all of the fat transferred to the face survives. The survival rate, commonly called the engraftment rate, averaged 47% when pooling 27 studies from other medical institutions (1,011 patients, follow-up of 3 to 24 months), with a wide range of 26% to 83% depending on the study.

At Seorae Plastic Surgery as well, how well the transferred fat takes hold depends on the treated area, tissue condition, and individual differences, so it is difficult to give a fixed figure. We determine the next steps while monitoring your progress together.

In a study that followed up 12 patients five years later, satisfaction had returned to pre-surgery levels, and the authors considered repeat grafting necessary. Some patients complete treatment in a single session, while others undergo it in stages, so we will advise you based on your condition during consultation.

In these cases, we also consider other treatment options.

· If you are concerned about lip volume — In the study of 23 women who received fat grafting, the added volume in the lips did not persist after one year, so we recommend consulting us about our petit (minimally invasive) and laser treatments.

· If sagging is your primary concern — We also consider facial lifts such as midface lifts or lower facelifts.

Sunken or atrophied tissue is not always a problem that can be addressed by fat grafting alone. Depending on the cause, a different treatment may be more suitable.

Side effects and post-procedure care

The following reactions or side effects may occur after surgery.

· Swelling and bruising — These may occur, and swelling may last a long time.

· Asymmetry or an uneven surface — These are relatively common and may occur, and touch-up procedures may be needed.

· The treated area looking overly full or bulging — This may occur.

· Fat clumping that forms firm lumps you can feel — This may appear weeks to months later, is commonly seen around the eyes, and may require touch-up procedures.

· Infection — This may occur.

· Redness, visible small blood vessels, or breakouts (acne) — These may occur.

· Swelling of the whites of the eyes, drooping eyelids, or deepening wrinkles — These may occur if grafting is done around the eyes.

· Less volume retained than expected, requiring additional grafting — This may occur.

· Fat blocking a blood vessel (fat embolism) — Although rare, cases have been reported that led to serious complications such as blindness or cerebral infarction (stroke).

If you experience sudden difficulty seeing, severe pain, weakness in your arms or legs, or slurred speech during or after the procedure, please let us know immediately.

Our three commitments at Seorae Plastic Surgery.

· Principle of Direct Responsibility — From consultation through surgery and suture removal, our head physician personally oversees every step.

· Infection Control Principle — We consistently carry out instrument sterilization and clinic space disinfection according to established procedures.

· Recovery Support Principle — The day of surgery is not the end of your care. We check on your healing progress on a set schedule.

If you have any questions, feel free to contact us at any time. Phone consultation: 02-547-3351. If you notice pain or swelling that is different from usual, please contact us right away. Recovery progress varies depending on the surgical method and individual condition, and side effects may occur, so please consult with a specialist during your visit for details.

Information to share before surgery

· Smoking — It has been reported that smoking may be unfavorable for the survival of transferred fat.

· Plans for significant weight loss — Changes in body weight can also alter facial volume, so please let us know in advance.

· Previous fat grafting — Please tell us the areas treated and when, including cases where frozen fat was reinjected.

Frequently Asked Questions

Q. Should I choose fillers or autologous fat grafting?

Autologous fat grafting uses your own tissue, which carries a lower risk of rejection, and it is used to enhance three-dimensional contour over larger areas. Fillers are offered as part of our petit and laser services, and the most suitable option differs depending on the area and goal, so we decide together during consultation. When nine comparative studies are pooled, satisfaction tended to be higher with fat grafting, though results varied considerably between studies. Hyaluronic acid fillers have the advantages of being simple and reversible.

Q. How long does swelling last after fat grafting?

According to the literature, swelling lasting up to two to three weeks is considered a typical part of recovery, while swelling that persists beyond three weeks is regarded as prolonged. If you have an important event coming up, please let us know during your consultation.

Q. Where is the fat harvested from?

The harvest site is determined during consultation. In an animal study in which fat from the abdomen, flanks, and thighs was grafted into mice, the amount of fat retained did not differ by donor site.

Consultation and Appointment Information

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References

· Lv Q, Li X, Qi Y, Gu Y, Liu Z, Ma GE. Volume Retention After Facial Fat Grafting and Relevant Factors: A Systematic Review and Meta-analysis. Aesthetic Plast Surg. 2021;45(2):506-520. PMID 31940073.

· Tuin AJ, Schepers RH, Spijkervet FKL, Vissink A, Jansma J. Volumetric Effect and Patient Satisfaction after Facial Fat Grafting. Plast Reconstr Surg. 2022;150(2):307e-318e. PMID 35666147.

· Schipper JAM, Tuin AJ, Loonen TGJ, Dijkstra PU, Spijkervet FKL, Schepers RH, Jansma J. Volume and patient satisfaction, 5 years of follow up after facial fat grafting. J Plast Reconstr Aesthet Surg. 2025;102:231-237. PMID 39938464.

· Yang F, Ji Z, Peng L, Fu T, Liu K, Dou W, Li J, Li Y, Long Y, Zhang W. Efficacy, safety and complications of autologous fat grafting to the eyelids and periorbital area: A systematic review and meta-analysis. PLoS One. 2021;16(4):e0248505. PMID 33793573.

· Molina-Burbano F, Smith JM, Ingargiola MJ, Motakef S, Sanati P, Lu J, Taub PJ, Hill ME. Fat Grafting to Improve Results of Facelift: Systematic Review of Safety and Effectiveness of Current Treatment Paradigms. Aesthet Surg J. 2021;41(1):1-12. PMID 31907534.

· Boehm LM, Morgan A, Hettinger P, Matloub HS. Facial Aging: A Quantitative Analysis of Midface Volume Changes over 11 Years. Plast Reconstr Surg. 2021;147(2):319-327. PMID 33165293.

· Gornitsky J, Viezel-Mathieu A, Alnaif N, Azzi AJ, Gilardino MS. A systematic review of the effectiveness and complications of fat grafting in the facial region. JPRAS Open. 2019;19:87-97. PMID 32158860.

· Schiraldi L, Sapino G, Meuli J, Maruccia M, Cherubino M, Raffoul W, di Summa PG. Facial Fat Grafting (FFG): Worth the Risk? A Systematic Review of Complications and Critical Appraisal. J Clin Med. 2022;11(16):4708. PMID 36012947.

· Brucato D, Ülgür II, Alberti A, Weinzierl A, Harder Y. Complications Associated with Facial Autologous Fat Grafting for Aesthetic Purposes: A Systematic Review of the Literature. Plast Reconstr Surg Glob Open. 2024;12(1):e5538. PMID 38260755.

· Moellhoff N, Kuhlmann C, Frank K, Kim BS, Conte F, Cotofana S, Piccolo NS, Pallua N. Arterial Embolism After Facial Fat Grafting: A Systematic Literature Review. Aesthetic Plast Surg. 2023;47(6):2771-2787. PMID 37563433.

· Jerliu A, Watters A, Harrison L, Hughes CD, Babigian A, Castiglione C. Fat Necrosis After Facial Autologous Fat Grafting: A Systematic Review of Reported Complications and Management Strategies. Aesthetic Plast Surg. 2026;50(17):7248-7259. PMID 42423965.

· Hassan A, Hamza A, Javed S, Siyyam M, Farooq S, Coleman G. Autologous Fat Grafting Versus Facial Fillers in Facial Cosmesis: A Systematic review and Meta-analysis. Aesthetic Plast Surg. 2026;50(17):7372-7387. PMID 42458045.

· Özalp B, Çakmakoğlu Ç. The Effect of Smoking on Facial Fat Grafting Surgery. J Craniofac Surg. 2017;28(2):449-453. PMID 28045829.

· Li K, Gao J, Zhang Z, Li J, Cha P, Liao Y, Wang G, Lu F. Selection of donor site for fat grafting and cell isolation. Aesthetic Plast Surg. 2013;37(1):153-8. PMID 23232729.

· Fisher C, Grahovac TL, Schafer ME, Shippert RD, Marra KG, Rubin JP. Comparison of harvest and processing techniques for fat grafting and adipose stem cell isolation. Plast Reconstr Surg. 2013;132(2):351-361. PMID 23584621.

This article is general information compiled by Seorae Plastic Surgery based on abstracts and full texts of papers indexed in PubMed, as well as our in-clinic guidance. It does not guarantee any diagnosis or treatment outcome. All cited studies come from other medical institutions and do not reflect results at Seorae Plastic Surgery. The effects and recovery periods of procedures and surgeries may vary depending on individual conditions, and side effects may occur. For details, please consult with a specialist during your visit.

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