Fat Injection in Ankara, Turkey

Fat injection is a procedure in which fat tissue taken from certain areas of the body is purified and injected into another area to provide volume or improve tissue quality. It is a natural, biocompatible method widely used for aesthetic and reconstructive purposes.

Fat usually taken from the abdomen, waist, or thigh area using the liposuction technique is purified through special processes. It is then injected into areas that require volume such as the face, lips, hands, buttocks, and breasts using fine cannulas. The procedure can be performed under local or general anesthesia.

Fat injection in the facial area is applied to the cheeks, under-eye area, nasolabial region, and chin to enhance facial contours and provide rejuvenation. In body applications, it is especially preferred for buttock augmentation (BBL) and breast volume enhancement.

Some of the fat cells are absorbed by the body over time; therefore, it may take 2–3 months for the results to fully settle. Longevity varies depending on the individual. The fact that the injected fat is rich in stem cells provides an additional advantage by improving skin quality.

What Is Fat Injection?

Fat injection is the procedure of injecting fat tissue taken from the patient’s own body using the liposuction method into different areas after special processing to provide volume or correct shape. It is most commonly applied to the face, lips, buttocks, and breasts. It provides a natural filler effect and has a low risk of allergy. The procedure can be performed under local or general anesthesia, and the results may vary depending on the individual’s tissue structure.

Why is the fat injection procedure considered a “tissue transplant”?

In the past, the perspective on fat transfers was quite mechanical; the logic was simply to fill a hollow if there was one. However, after modern medicine discovered the biological richness of fat tissue, this perspective changed completely. Technically, fat injection is based on the same principles as kidney or liver transplantation: taking living tissue from a place with blood circulation and transferring it to a new bed without blood circulation and allowing it to survive there.

The most critical point in this process is the vitality of the transferred cells. When we take fat from one place and place it in another, we actually break the vascular connections of those cells. When they reach their new location, they do not have their own vessels for the first few days. During this time, they must survive by feeding on tissue fluids leaking from surrounding tissues. Just like a newly planted sapling needs life-giving water until its roots take hold, fat cells survive in this critical first 48–72 hour period through a method called “plasmatic imbibition.” If this process is managed successfully, the body begins to produce new capillaries from the third day onward to carry oxygen to these guest cells. This is exactly where the concept of “tissue transplantation” comes into play; this is not a dead filler material but a living process that becomes part of the body through vascularization.

What determines the permanence and survival rate of transferred fat?

The issue that concerns our patients the most is how permanent the procedure will be. We frequently hear the question, “Doctor, will these fats melt?” The answer is both yes and no. A portion of the transferred fat is absorbed and eliminated by the body through a natural process. However, the part that manages to establish vascularization remains permanent for life. The main factor that determines success, that is, the “survival rate,” is the surgeon’s technique and the particle size of the fat.

A simple rule of mathematics and physics applies here. If we inject the fat as a large lump into a single point, only the outermost cells of that mass can come into contact with nutrients and oxygen. The cells in the center remain without nourishment and unfortunately die (necrosis). These dead cells may turn into calcifications or cysts over time. Therefore, in modern techniques we work with the “micro-droplet” principle. We distribute the fat tissue inside the tissue in particles even smaller than a grain of rice. In this way, it is ensured that each fat cell comes into contact with living tissue and reaches oxygen.

Factors that negatively affect the survival rate of fat include:

• Smoking
• Diabetes
• High-pressure fat harvesting
• Traumatic surgical technique
• Pressure applied to the area after surgery
• Poor nutrition

How do stem cells and SVF within fat tissue rejuvenate the skin?

If you think fat tissue is only the body’s energy storage, you are greatly mistaken. Research has shown that fat tissue is an even richer source of stem cells than bone marrow. We call these “Mesenchymal Stem Cells.” The material we obtain through liposuction does not only contain swollen fat cells (adipocytes). It also contains a cellular cocktail with very high regenerative potential that we call the “Stromal Vascular Fraction” (SVF).

The cells within this cocktail act like the conductors of tissue repair. If there is damage, aging, or circulatory problems in the area where they are injected, they trigger the repair mechanism there through the growth factors they secrete. Collagen production in the skin increases, elasticity returns, and blood circulation accelerates. Especially in patients with thin skin, dull complexion, or sun damage, the effect of fat injection is not only fullness. The skin begins to glow and revitalize from within as if an expensive cream had been applied to it. This is the “biological cream” effect of fat.

The main cellular components found in SVF include:

• Adipose-derived stem cells
• Endothelial cells
• Pericytes
• Fibroblasts
• Immune cells
• Tissue macrophages

What are the differences between nanofat, microfat, and macrofat?

As technology develops, our methods of processing fat have also diversified. We no longer talk about a single type of fat injection. We convert fat into different forms according to the patient’s needs. The difference between these forms is determined by the particle size of the fat and the density of living cells within it.

• Macrofat: This is the classical method. It is fat obtained with thicker cannulas and contains larger particles. Our goal is to provide strong volume and structural support. For example, if we perform buttock augmentation (BBL) or want to add volume to the breast, we use macrofat. On the face, it is preferred to support deep planes such as the cheekbones. It cannot be used close to the skin surface because it may be palpable or create irregularities.
• Microfat: This is the form where the fat is thinned by passing through finer filters. This is the method we use most frequently in facial aesthetics. It is ideal for providing soft transitions in areas such as the cheeks, chin tip, temples, and lips. Since the particles are smaller, they can spread more homogeneously under the skin and provide a smooth appearance.
• Nanofat: This is the peak of regenerative medicine. In this method, fat tissue is mechanically broken down and passed through very fine filters. As a result of this process, no “fat cells” remain; the cells are fragmented and a stem-cell-rich liquid is released. In other words, nanofat is not a filler material and does not provide volume. It is literally a “youth serum.” It is used to improve the quality of very thin skin areas such as under-eye dark circles, neck wrinkles, the décolleté area, and the backs of the hands.

Situations where nanofat application is most frequently preferred include:

• Under-eye dark circles
• Fine upper lip lines
• Neck wrinkles
• Décolleté area damage
• Back-of-hand rejuvenation
• Scars
• Acne scars

Why are preoperative preparation and donor area selection critical?

To achieve a successful result, the process begins not in the operating room but during the outpatient consultation. The patient’s lifestyle is the hidden key to success. Smoking in particular is a red line for us. Smoking reduces blood flow by constricting the smallest vessels in the body. For the delicate fat cells we have newly transferred and that are struggling to survive, this means oxygen deprivation. In patients who smoke, the graft survival rate decreases dramatically and the risk of infection increases. Therefore, we strongly recommend quitting smoking a certain period before the procedure.

The donor area, that is, the region from which fat will be harvested, is also a strategic decision. We usually prefer areas where the patient complains of regional fat accumulation (abdomen, waist, hips) so that we can “hit two birds with one stone.” However, the quality of fat may vary from region to region. Fat in areas resistant to diet and exercise, such as the hips or inner knees, tends to be genetically coded for “storage,” making it more likely to remain permanent in the transferred area as well. The harvesting stage requires great sensitivity. Instead of devices using high vacuum power, harvesting performed with low pressure and gentle movements preserves the vitality of the cells.

The most frequently preferred donor areas include:

• Abdomen
• Waist sides
• Hip area
• Inner thigh
• Inner knee
• Back area

What purification processes does the harvested fat tissue undergo?

The fluid we obtain from the body using the liposuction method (lipoaspirate) is not suitable for direct injection. In addition to living fat cells, this fluid also contains blood, ruptured cell debris, free fatty acids, and anesthetic fluids used during the procedure. If we inject this mixture as it is, excessive swelling and bruising may occur, and while the body tries to clean these wastes, the living cells may also be damaged.

For this reason, a “gold standard” purification process is essential. The most common method is centrifugation. The harvested fat is spun at a certain speed in sterile tubes. According to the laws of physics, substances separate according to their densities. At the top of the tube, useless free oil accumulates, and at the bottom, bloody fluid collects. In the middle of the tube remains the concentrated, pure, and living fat tissue that we call “liquid gold.” We use only this middle part. Some surgeons prefer washing and filtering the fat with special solutions. Regardless of the method used, the aim is the same: to send only the highest quality cells with the greatest survival potential to the recipient area.

How does the “Bio-Lifting” effect occur in facial rejuvenation?

Considering facial aging only as “skin sagging” is an incomplete approach. As we age, the bones in our face shrink, deep fat pads melt and shift. In other words, the face loses volume like a balloon that has deflated, and the skin sags because of this. Fat injection creates a “Bio-Lifting” effect by replacing this lost support underneath rather than simply tightening the skin.

This procedure resembles the touch of a sculptor. Depressions under the eyes give a tired expression; micro-touches in this area brighten the gaze. Reinforcements placed on the cheekbones lift the face upward like a tent pole. Defining the jawline creates a younger and more dynamic profile. The best aspect of this effect is its naturalness. When our patients say, “There is a change in my face, I look more rested but no one can understand what it is,” we know we have reached the right goal.

Areas targeted with Bio-Lifting include:

• Temple regions
• Under-eye hollows
• Cheekbones
• Nasolabial folds
• Chin tip
• Jawline

Why is safety important in breast and buttock aesthetics (BBL)?

When we move from the facial area to body contouring, larger volumes and different safety protocols come into play. Especially Brazilian Butt Lift (BBL) and breast augmentation are among the most popular demands in recent years. However, working in these areas requires high anatomical knowledge and discipline.

Fat injection in breast augmentation is an excellent alternative for patients who do not want silicone implants. However, it is important to be realistic; enlarging the breast by 3–4 sizes with fat injection is not possible. Usually, a natural fullness of half or one cup size is achieved. In addition, the fat given to the breast may cause calcification. These calcifications may sometimes resemble suspicious images on mammography. Therefore, regular radiological follow-ups before and after the procedure and working with an experienced radiologist are vital.

BBL (Buttock Augmentation) is one of the most discussed and carefully performed procedures in plastic surgery. The greatest risk here is accidentally injecting fat into deep planes, that is, into the muscle. There are very large vessels within the gluteal muscle. If fat enters these vessels, a serious condition called “fat embolism” may occur. International safety protocols have been developed to reduce this risk to zero. The golden rule is this: fat is never injected into the muscle, only into the fatty plane between the skin and the muscle (subcutaneous). When performed with special cannulas and correct patient positioning, BBL is an extremely safe and satisfying procedure.

Factors that ensure safety in BBL surgery include:

• Use of thick cannulas
• Avoiding intramuscular injection
• Injection while continuously moving
• Applying low pressure
• Correct patient positioning

When compared with synthetic fillers, which is superior: fat injection or synthetic fillers?

One of the most common questions we hear in the clinic is: “Why should I have surgery; can’t I just get ready-made fillers?” The answer depends on what the patient needs. If you only want to slightly enhance your lips or have a very minor asymmetry, hyaluronic acid fillers are an excellent solution. They can be performed in an office environment in about 15 minutes, and you can immediately return to work.

However, if the entire face needs rejuvenation, the temples are hollow, the cheeks have lost volume, and the jawline has disappeared, trying to correct this with ready-made fillers would reach astronomical costs and injecting 10–15 syringes of foreign material into the face could cause an unnatural, overfilled appearance (“pillow face”). The greatest advantage of fat injection is that the material belongs to you. There is no risk of allergy and it is not rejected by the body. Moreover, while synthetic fillers only occupy space, fat tissue repairs the skin and improves its quality. In terms of permanence, fat injection is far ahead; the fat that survives remains with you for life, whereas fillers dissolve within about one year.

Advantages of fat injection compared with synthetic fillers include:

• Complete biological compatibility
• No risk of allergy
• Lifetime permanence
• Improvement of skin quality
• Large amount of material
• Economic long-term solution

How does the recovery process progress after the surgery?

The recovery period after fat injection is generally painless and comfortable, but there are some points where the patient must be patient. During the first 3–4 days, noticeable edema (swelling) in the treated areas is inevitable. Sometimes our patients worry and say, “My face is very swollen; will it stay like this?” This swelling is the body’s healing response and is completely temporary. By the end of the first week, the edema begins to decrease rapidly and returning to social life becomes easy.

During recovery, we treat two areas differently. We apply a tight corset to the area where the fat was taken (liposuction area) so that the edema disperses and the skin settles. However, no pressure should be applied to the area where the fat was injected (for example cheeks or buttocks). Newly transferred cells are extremely fragile to mechanical pressure while establishing their vascular connections. Performing a hard massage on that area, lying on it, or wearing tight clothing may damage the delicate new vascular network and cause the fat to melt.

During this period, we expect our patients to drink plenty of water and follow a protein-rich diet. It takes time for the result to settle. By the end of the first month, the major swelling subsides, but it usually takes about 3 months to say “this is my new face/body.” The result seen in the 6th month is our permanent result.

Things to consider during the recovery period include:

• Drinking plenty of water
• Avoiding pressure
• Sleeping on the back
• Avoiding heavy exercise
• Avoiding hot environments
• Using a corset

What are the possible risks and complications?

As with every medical intervention, it would not be honest to say that everything in fat injection is 100% guaranteed. The most common situation we encounter is unpredictable absorption. The right and left sides of the body may accept fat at different rates, or the patient’s metabolism may absorb more fat than expected. In this case, mild asymmetries or insufficient fullness may occur. This should not be seen as a complication but as part of the process. In such cases, a small “touch-up” session after about 6 months usually achieves a perfect result.

Although rarer, a condition called fat necrosis, where the fat hardens due to insufficient blood supply, may occur. This usually happens when too much fat is injected into a single point. Small cysts or palpable hardness may form, but these often resolve over time or with simple interventions. The risk of infection is extremely low when procedures are performed under sterile conditions.