The Beauty Standard with Dr. Roy Kim

Fat Grafting: Science, Techniques, and Patient Management

• Dr. Roy Kim

Share episode

Unlock the complexities of facial fat grafting with insights from Dr. Roy Kim, a leading plastic surgeon renowned for his expertise. Have you ever wondered what happens when a cosmetic procedure doesn't go as planned? We explore the spectrum of complications that can arise, from unexpected nodules and excess volume to the more severe risks like hemiplegia and vision loss. Discover the pivotal role of a skilled surgeon in navigating these challenges and the surprising effectiveness of techniques such as massage in reshaping facial contours. Our conversation highlights essential strategies for managing these outcomes, offering listeners a comprehensive understanding of what to expect and how to address potential issues.

Join us in this enlightening episode as we discuss Dr. Kim's innovative staged approach to fat grafting, where smaller volumes of fat are introduced over multiple sessions for more natural results. We emphasize the importance of personalized consultations and choosing an experienced board-certified surgeon to ensure the best outcomes. Learn about the various solutions available, from steroid injections to advanced options like RF microneedling and surgical excision, each tailored to suit different complications. Whether you're considering the procedure or seeking guidance on recovery, this episode provides expert advice and valuable insights into achieving a safer and more satisfying experience.

Thank you for tuning in to this week's episode of "The Beauty Standard" with Dr. Roy Kim! If you enjoyed this episode, please make sure to subscribe, rate, and leave us a review on your favorite podcast platform. Your support helps us continue to bring you the latest insights in aesthetic medicine and beauty trends.

Connect with us on social media on Instagram - @drroykim - or X - @drroykim- for more exclusive content, behind-the-scenes looks, and expert advice from Dr. Kim. Feel free to submit your questions or suggestions for future episodes – we'd love to hear from you!

Join us next week as we explore another fascinating topic in the world of beauty, and remember: your body, your choice, your standard!

Speaker 1:

Welcome to the Beauty Standard with Dr Roy Kim.

Speaker 2:

Hey everyone and welcome back for another deep dive.

Speaker 1:

Excited to be here.

Speaker 2:

Today we're diving into something that might make you squirm a bit Complications from facial fat grafting.

Speaker 1:

Yeah.

Speaker 2:

We're going to uncover what can go wrong. You know how to spot those little bumps and lumps.

Speaker 1:

Yeah.

Speaker 2:

And, most importantly, what can be done about them. Exactly, and our trusty sources for this deep dive are a YouTube video and blog post by Dr Roy Kim a plastic surgeon with practices in San Francisco and Beverly Hills. Wow, fancy.

Speaker 1:

I know right yeah.

Speaker 2:

And we'll also be looking at some medical research on fat grafting complications.

Speaker 1:

Sounds like a good mix of sources?

Speaker 2:

Sure, so let's start with the basics. You know, I know fat grafting is often talked about as like a natural way to restore volume and smooth out wrinkles.

Speaker 1:

Yeah.

Speaker 2:

But what happens when things don't quite go according to plan?

Speaker 1:

Well, sometimes you get more volume than you bargained for, or you get those unwanted lumps and bumps which we call nodules. It can be really distressing, you know.

Speaker 2:

Totally, and that's exactly what we're here to address.

Speaker 1:

Absolutely.

Speaker 2:

Now Dr Kim seems to really emphasize patients in his video and blog post. He talks about how swelling plays a huge role after the procedure.

Speaker 1:

Oh, yeah for sure. And it's not just swelling from the surgery itself. You know, surgeons often inject a little bit of bonus fat, knowing that your body will naturally absorb some of it over time.

Speaker 2:

It's kind of like overfilling a glass of water knowing that some of it will evaporate.

Speaker 1:

Exactly A perfect analogy.

Speaker 2:

That's a good one, but doesn't that extra fat kind of contribute to those lumps we were talking about?

Speaker 1:

It can yeah, especially in those first few weeks or months.

Speaker 2:

Okay.

Speaker 1:

But here's where it gets interesting. Dr Kim actually suggests massage as one way to help manage those unwanted pockets of fat.

Speaker 2:

Wait massage like you're going to a spa. Yeah, how does that even work with fat grafting?

Speaker 1:

Think of it like gently kneading dough.

Speaker 2:

Okay.

Speaker 1:

Consistent gentle massage can actually help redistribute those fat cells and encourage a smoother contour.

Speaker 2:

So it's not like you're melting the fat away or something, but you're just kind of encouraging it to spread out evenly.

Speaker 1:

Exactly.

Speaker 2:

Yeah, that makes sense. So how often would someone need to do this massage, and is it something they can do themselves at home?

Speaker 1:

Dr Kim actually recommends specific techniques that you can do at home, oh wow. Like gentle upward strokes towards your temples for about five minutes twice a day.

Speaker 2:

Okay.

Speaker 1:

And of course, professional lymphatic drainage massages can also be helpful.

Speaker 2:

That's great. That's actually really helpful advice. I never would have thought of that.

Speaker 1:

Yeah, surprising.

Speaker 2:

Like massage playing a role in this whole thing.

Speaker 1:

Yeah.

Speaker 2:

But what if those stubborn lumps just won't budge?

Speaker 1:

Yeah.

Speaker 2:

What if the massage isn't enough? Dr Kim also mentioned steroid injections and I have to say the word steroids always kind of makes me a little nervous.

Speaker 1:

It's understandable to be cautious. Steroid injections, specifically a type called triamcinolone. They work by breaking down those fat cells and they can be very effective, but the dosage and the frequency are really critical to avoid unwanted side effects.

Speaker 2:

Like. What kind of side effects are we talking about?

Speaker 1:

Well, skin thinning or discoloration are potential risks, especially if the injections aren't administered correctly. Okay, so it's definitely not a DIY solution. You need a skilled and experienced physician to handle this.

Speaker 2:

Okay, so not something to try at home then, moving on, I was really surprised to see Dr Kim mention Kybella.

Speaker 1:

Oh yeah.

Speaker 2:

Isn't that usually for double chins? It is. How does that fit into fat grafting complications?

Speaker 1:

So Kybella, also known as deoxycholic acid. It basically destroys fat cells and while it's FDA approved for under chin fat, using it in other areas to correct fat grafting issues is considered off-label.

Speaker 2:

Off-label, so not technically approved for that specific use.

Speaker 1:

Exactly.

Speaker 2:

That makes me a little hesitant. What are the risks with using Kybella for something like this?

Speaker 1:

Well, much like steroid injections, Kybella can lead to swelling, bruising and even nerve injury.

Speaker 2:

Oh, wow.

Speaker 1:

If it's not handled carefully.

Speaker 2:

Okay.

Speaker 1:

So again, it's super important to work with a board-certified plastic surgeon who understands facial anatomy and has experience using Kybella off-label?

Speaker 2:

So expertise is key here. You don't want just anyone injecting this stuff into your face Exactly. Let's talk about something a bit more invasive. Could liposuction be used to remove excess fat after grafting?

Speaker 1:

Liposuction is great for larger volumes of fat, but it's not really ideal for the delicate contours of the face.

Speaker 2:

Oh really.

Speaker 1:

Yeah, there are too many vital structures and nerves close to the surface.

Speaker 2:

I see.

Speaker 1:

So it's more suitable for areas like the neck and chin.

Speaker 2:

Okay.

Speaker 1:

Where there's less risk of damaging those delicate structures.

Speaker 2:

Got it Now. Dr Kim also mentions RF microneedling.

Speaker 1:

Yeah.

Speaker 2:

It sounds like something out of a sci-fi movie.

Speaker 1:

It does. It's pretty high tech.

Speaker 2:

Yeah.

Speaker 1:

Imagine tiny needles delivering radio frequency energy to heat and melt superficial fat. Oh, wow. It can be quite effective for the neck and face.

Speaker 2:

Okay.

Speaker 1:

But the results depend on how deep that initial fat grafting was done.

Speaker 2:

So it's not a guaranteed fix, but it's a potential option, exactly Okay. Now for the option that no one wants to hear about surgical excision.

Speaker 1:

Right.

Speaker 2:

It sounds pretty drastic.

Speaker 1:

It is the most invasive option.

Speaker 2:

Yeah.

Speaker 1:

It involves actually physically removing the excess fat.

Speaker 2:

Okay.

Speaker 1:

And it's usually reserved for those rare cases where other methods haven't worked.

Speaker 2:

Right.

Speaker 1:

Or the issue is just too complex to address any other way.

Speaker 2:

So it's like the last resort.

Speaker 1:

Exactly. Okay, I remember Dr Kim specifically dismissing CoolSculpting that fat freezing treatment as a viable option for correcting fat grafting issues. Why is that CoolSculpting or cryolipolysis? It freezes and destroys fat cells Okay, but it's not precise enough for the delicate contours of the face and it's also difficult to control how much fat is affected, which makes it unsuitable for those subtle facial features.

Speaker 2:

Your cool sculpting might be great for love handles, but not so much for a botched fat grafting job. Exactly Okay, I think we've covered a good range of solutions, gentle massage to those more invasive surgical options. But before we move on, I want to talk about that research study you mentioned. This one focuses specifically on complications of fat grafting, right that's right the kind that ends up in medical journals.

Speaker 1:

Yeah, the serious stuff.

Speaker 2:

Yeah.

Speaker 1:

This study looked at 38 patients who had 58 complications ranging from mild to severe.

Speaker 2:

Wow. So it's a reminder that even something like fat grafting, which can seem pretty straightforward, still carries risks, absolutely Okay. So let's break down those complications a little bit. What are some of the milder ones that patients might encounter?

Speaker 1:

Well, you have things like lepogranulomas, which are basically tiny hard lumps formed by inflammatory cells.

Speaker 2:

Okay.

Speaker 1:

And then you have mycobacterial abscesses, which are infections requiring antibiotics.

Speaker 2:

Okay. So those are usually treatable and don't cause lasting problems.

Speaker 1:

Exactly.

Speaker 2:

But I imagine there are more serious complications too.

Speaker 1:

Unfortunately. Yes, the study also reported cases of hemiplegia, which is paralysis on one side of the body, and even vision loss.

Speaker 2:

Oh, my God.

Speaker 1:

Yeah, so it's a reminder that we're talking about the face here which is incredibly delicate and complex.

Speaker 2:

And over 50% of the severe complications in this study occurred in the forehead and temporal region.

Speaker 1:

Yeah.

Speaker 2:

What makes those areas so vulnerable?

Speaker 1:

The forehead and temples have a really intricate network of blood vessels and nerves.

Speaker 2:

I see.

Speaker 1:

So if the fat grafting isn't done perfectly, they're more susceptible to complications.

Speaker 2:

Given these findings, it seems like choosing a skilled and experienced surgeon is absolutely crucial.

Speaker 1:

It cannot be overstated. We're not just talking about aesthetics here, we're talking about patient safety. Stated. We're not just talking about aesthetics here, we're talking about patient safety. A qualified surgeon will really understand those complexities of facial anatomy and have the expertise to minimize those risks.

Speaker 2:

So it's not just about finding someone who can make you look good, but someone who really prioritizes your safety.

Speaker 1:

Exactly.

Speaker 2:

I think that's a great place to pause for now. When we come back, we'll delve deeper into how to find the right surgeon and what questions you should be asking during consultations. Welcome back. Before the break we were talking about some pretty serious complications that can come up from fat grafting. It's enough to make anyone think twice about the whole thing. But before we completely write it off, I'm curious about how we can minimize these risks in the first place.

Speaker 1:

That's a great question, and it really brings us to the most important point. Choosing a qualified and experienced surgeon is absolutely crucial. It's not just about finding someone who can make you look good. It's about finding someone who prioritizes safety above all else and understands the nuances of facial anatomy.

Speaker 2:

So it's not just about aesthetics, but about finding a surgeon who's almost like an artist and a scientist.

Speaker 1:

Exactly, they need to have a deep understanding of the vascular system in the face.

Speaker 2:

Okay.

Speaker 1:

Because that's really key to minimizing the risk of things like fat embolism.

Speaker 2:

Hold on. Can you explain what fat embolism is? I'm not sure all of our listeners are familiar with that term.

Speaker 1:

Sure. A fat embolism happens when fat droplets enter the bloodstream and block blood vessels. It's rare, but it's a serious complication that can happen with any procedure involving fat transfer.

Speaker 2:

So how does a skilled surgeon minimize that risk?

Speaker 1:

Well, they use really meticulous techniques to harvest and inject the fat, making sure they're not damaging any blood vessels Right. They also have a keen eye for facial anatomy and know exactly where and how to place the fat for the best and safest results. That makes sense.

Speaker 2:

So it's not just about injecting the fat anywhere. It's about being really precise.

Speaker 1:

Precisely.

Speaker 2:

And understanding the face Right. Okay, so how do we, as patients, find these skilled surgeons?

Speaker 1:

Right.

Speaker 2:

It's not like there's a big sign that says expert fat grafter, right this way.

Speaker 1:

I wish it takes some work. Yeah, Start by looking for board-certified plastic surgeons who specialize in facial fat grafting. You can check online reviews, look for before and after photos and don't hesitate to ask for referrals from friends or other medical professionals.

Speaker 2:

Referrals are always a good starting point. Word of mouth can be really powerful, for sure. Okay, let's say we found a few potential surgeons. What questions should we be asking during those consultations?

Speaker 1:

Don't be shy. This is your face we're talking about. Ask about their experience with fat grafting, how many procedures they've performed, what their complication rates are and what techniques they use to minimize risks.

Speaker 2:

So don't be afraid to grill them a little bit.

Speaker 1:

Exactly. Get all the details. You should also ask to see before and after photos of their fat grafting patients.

Speaker 2:

Right.

Speaker 1:

Specifically focusing on cases similar to yours. Pay attention to how natural the results look and whether they've achieved that smooth, even contour.

Speaker 2:

That's a good tip. We often get so caught up in the before and after that we forget to really scrutinize the results. Now I'm curious about this staged approach. Yeah, that dr Kim mentions in his blog post what's that all about.

Speaker 1:

So that's a technique where, instead of injecting a large volume of fat all at once, okay the surgeon breaks it down into smaller, more manageable sessions that are spaced out over time so it's kind of like taking baby steps instead of one giant leap. Yeah.

Speaker 2:

What are the advantages of this approach?

Speaker 1:

Well, it allows the surgeon to carefully assess how your body is responding to the fat graphs.

Speaker 2:

Okay.

Speaker 1:

And make any adjustments if needed. It can also potentially reduce the risk of uneven absorption and those lumps and bumps that we were talking about.

Speaker 2:

So it sounds like a more controlled and gradual approach.

Speaker 1:

For sure.

Speaker 2:

Does that mean less downtime overall?

Speaker 1:

Not necessarily. You'll still have some downtime after each session.

Speaker 2:

Okay.

Speaker 1:

But it might be less intense. Got it Than having one single large volume procedure.

Speaker 2:

Yeah.

Speaker 1:

And that gradual increase in volume can also lead to more natural looking results.

Speaker 2:

So you're kind of easing into your new look instead of a dramatic overnight transformation.

Speaker 1:

Exactly. It's about subtlety and achieving results that enhance your natural features rather than altering them drastically.

Speaker 2:

I like that. It's a more nuanced approach to facial rejuvenation. But let's be realistic. Not everyone has the time or patience to go through multiple procedures.

Speaker 1:

Yeah.

Speaker 2:

Is this staged approach really feasible for everyone?

Speaker 1:

It's not one size fits all.

Speaker 2:

Right.

Speaker 1:

You really need to discuss your individual needs and goals with your surgeon.

Speaker 2:

Okay.

Speaker 1:

To see if a staged approach is right for you.

Speaker 2:

So again, it comes down to communication Absolutely With your surgeon.

Speaker 1:

Yes.

Speaker 2:

Making sure you're both on the same page. Okay, I think we've covered a lot here.

Speaker 1:

Yeah.

Speaker 2:

We've talked about finding a skilled surgeon. The key questions to ask.

Speaker 1:

Yes.

Speaker 2:

And this intriguing staged approach to fat crafting.

Speaker 1:

Definitely. And let's not forget about the importance of having realistic expectations Right. No cosmetic procedure is without risks.

Speaker 2:

Yeah.

Speaker 1:

And it's important to understand those risks before making any decisions.

Speaker 2:

Absolutely, and even with the most skilled surgeon and a well-planned procedure, there's always a chance that things won't go exactly as planned Right. So being prepared for the possibility of complications is really important, absolutely. Speaking of complications, yeah. Before we wrap up this part of our deep dive, I want to talk about the emotional side of things. Dealing with a complication, it can be physically and emotionally draining.

Speaker 1:

Oh, for sure.

Speaker 2:

How do we navigate those challenges?

Speaker 1:

Yeah, that's such an important point. It's understandable to feel disappointed or frustrated, even self-conscious, if the results aren't what you expected. Right it can really affect your confidence and self-esteem.

Speaker 2:

So it's not just about the physical changes.

Speaker 1:

Right.

Speaker 2:

But about how those changes make someone feel Exactly Physical changes Right, but about how those changes make someone feel Exactly? What advice would you give to someone struggling with the emotional side of a fat grafting complication?

Speaker 1:

Well, first and foremost, don't be afraid to seek support. Okay, talk to your surgeon about your concerns. Reach out to friends and family, or even consider talking to a therapist if you need to. It's important to have a support system during this time.

Speaker 2:

It's so easy to isolate yourself when you're feeling down.

Speaker 1:

Yeah.

Speaker 2:

But reaching out for help is really often the best thing we can do. For sure, and remember, you're not alone. Yeah, a lot of people experience complications after cosmetic procedures and there are resources out there to help you cope and navigate this challenging time.

Speaker 1:

And remember, true beauty comes from within. So while cosmetic procedures can enhance our appearance, they shouldn't define our worth or our happiness.

Speaker 2:

Well said. It's a good reminder that self-love and acceptance are so important, no matter what we look like. All right, I think that's a good place to take a pause. Okay, when we come back for the final part of our deep dive, we'll look at some more resources for those dealing with complications and leave you with some final thoughts as you continue on your fat grafting journey. Welcome back to the Deep Dive. So far, we've talked about a lot.

Speaker 1:

We have.

Speaker 2:

From those potential complications of fat grafting to the importance of finding that skilled surgeon and managing those expectations. But what happens if, despite all those precautions, you're still dealing with a complication? Where do you turn for help and information?

Speaker 1:

That's where reliable resources and support systems come in. Online forums and communities dedicated to cosmetic procedures can be really helpful for connecting with others who have experienced similar things.

Speaker 2:

So it's important to remember you're not alone in this.

Speaker 1:

Absolutely not.

Speaker 2:

Other people have gone through this and come out on the other side.

Speaker 1:

For sure.

Speaker 2:

Are there any specific organizations or websites you'd recommend?

Speaker 1:

Yeah, the American Society of Plastic Surgeons, or ASPS.

Speaker 2:

Okay.

Speaker 1:

And the American Society for Aesthetic Plastic Surgery, ASAPS.

Speaker 2:

Okay.

Speaker 1:

Those are great starting points.

Speaker 2:

Yeah.

Speaker 1:

They have a lot of patient education resources and they can also help you find board-certified plastic surgeons in your area.

Speaker 2:

Those are excellent resources for finding reputable professionals and getting that reliable information. Yeah, what about support groups specifically for people dealing with complications?

Speaker 1:

There are actually several online support groups and forums where people share their experiences and offer advice. Okay, but it's important to approach those with a discerning eye. Not everything you read online is accurate or reliable.

Speaker 2:

That's a good point. It's so important to be critical of what we see online.

Speaker 1:

For sure.

Speaker 2:

And always consult with a qualified medical professional, absolutely For personalized advice. Yeah, okay, let's say you found a support group.

Speaker 1:

Yeah, that seems trustworthy. Mm-hmm.

Speaker 2:

What kind of benefits can someone get from participating in these communities?

Speaker 1:

Connecting with others who understand what you're going through can be incredibly validating and empowering.

Speaker 2:

Right.

Speaker 1:

It can help you feel less alone, reduce anxiety.

Speaker 2:

Yeah.

Speaker 1:

And you can also gain valuable insights from those who've navigated similar challenges.

Speaker 2:

It's like having a virtual support system right, exactly A group of people who really get it. Yeah, okay, before we wrap up this deep dive, I want to go back to something we talked about earlier the emotional side of dealing with complications.

Speaker 1:

Yeah.

Speaker 2:

It's easy to focus on those physical changes.

Speaker 1:

Right.

Speaker 2:

But the emotional impact can be just as significant.

Speaker 1:

Well, if not more so.

Speaker 2:

It's huge. So how do we acknowledge and cope with those feelings?

Speaker 1:

It's so important to acknowledge those feelings of disappointment, frustration or even anger. Don't try to brush them under the rug. Allow yourself to really process those emotions.

Speaker 2:

Well, it's about giving ourselves permission to feel those difficult emotions rather than trying to suppress them.

Speaker 1:

Sure.

Speaker 2:

What are some healthy ways to cope with those feelings?

Speaker 1:

Talking to a therapist can be incredibly helpful for processing those emotions and developing coping mechanisms. Okay, you can also practice self-care.

Speaker 2:

Right.

Speaker 1:

Things like meditation, yoga or just spending time in nature can be really beneficial.

Speaker 2:

It's about finding those activities that help us feel grounded and connected to ourselves, and sometimes just talking to a trusted friend or family member can make a world of difference.

Speaker 1:

Yeah, just having that support system those people who can listen without judgment and offer support can be so helpful.

Speaker 2:

Exactly and remember true beauty comes from within. While cosmetic procedures can maybe enhance our appearance, they shouldn't define our worth.

Speaker 1:

For sure.

Speaker 2:

Or our happiness. I think that's a beautiful message to leave our listeners with.

Speaker 1:

Well, I think we've officially reached the bottom of our deep dive into the world of fat grafting complications. We explored the potential risks, the importance of finding a skilled surgeon, the different management options and the emotional roller coaster that can come with this whole journey.

Speaker 2:

It's definitely a journey. It's been a really comprehensive exploration covering both the practical and emotional aspects of this complex topic.

Speaker 1:

Yeah, and hopefully our listeners feel more informed and empowered to make those thoughtful decisions about their facial rejuvenation journeys.

Speaker 2:

Absolutely. And remember if you're considering fat grafting or you're dealing with a complication, do your research.

Speaker 1:

Yeah, ask questions. Ask all the questions.

Speaker 2:

And don't be afraid to advocate for yourself.

Speaker 1:

Please.

Speaker 2:

Knowledge is power and being an active participant in your health care decisions is crucial. Until next time, stay curious, stay informed and embrace your unique beauty. Thank you for listening to the Beauty.

Speaker 1:

Standard with Dr Roy Kim. Make sure to follow for future topics and episodes.