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Anonymous asks:
Hi!

I've heard different opinions in regards to fat transfer and weight loss after surgery.

The reason why I want to do fat transfer in the first place: When I'm happy with the size of my tummy, waist and upper arms and don't feel that I have any excess fat that I dislike, I feel that my hips are to narrow in proportion to the width of my shoulders which gives me a sort of masculine V-shape which I dislike and my hips also have an uneven fat distribution which I want to currect by adding fat mostly or only in the middle part of my hips, the point that I feel should be the widest or fullest, the area from the end of the tummy (about the height of the navel) to the start of the legs (after genital area). My sides from the waist down to the bottom of the but are shaped like an S on each side. My lover tummy ("love handles") and lower part of hips at the bottom of the but are larger than the area in between these to areas. This makes me feel really uncomfortable in all tight dresses and I only feel ok in dresses or clothing that are dark and tight in the waist making this appear a little slimmer and with either a lot of layered fabric on the hips making these appear wider and fuller than they are or a skirt or dress that goes out to the sides after the tummy hiding the shape of my hips completely. I don't feel that a solution would be to remove fat from the two areas that are wider (as previously described: lower tummy and lower hips/end of but) since I also feel that these two areas still are narrow in proportion to the with of my shoulders and upper arms giving me a masculine V-shape that I dislike. The ideal shape I desire is an hourglass figure with the smallest waist a possibly can achieve or I could also describe it as an X-shape.

I also feel that my but is too skinny/has to little fat on it in proportion to the rest of my body (maybe most visibly the back and stomach and thighs), and that from profile my but is too flat/not protruding enough in proportion to size of tummy and thighs. I feel that I have some excess fat on the back of my thighs just before the bum that could be removed otherwise I generally feel that I don't wish to have much fat removed from my thighs either since these are small in relation to the size of my tummy and upper arms when at my comfort weight and removing from them might emphasize this V-shape and make my body further away from the desired X-shape.

Since I've heard that fat transfer can be performed also to make breast larger I would like to do this as well to make my largest breast one size larger and the other the necessary to make them equal. I also wish to make the largest nipple smaller to make them appear equal and I might consider a breast lift on my largest breast to make them point in the same direction since this breast is more pending downwards than my left breast but I will weigh the amount of scarring I will get carefully up against the general improvement I can get, in particularly when it comes to the breast lift because I've heard that the scarring associated with a breast lift can be more evident but this has not been the case with all of the surgeons that I've talked to since one of them has suggested just cutting away some skin after the nipple at the lower side of the nipple in the same time as they reduce the size of the nipple and then sewing the skin around the nipple again resulting in a small lift of the breast and the direction the nipple points. But; I've also heard about lift being performed resulting in a scar in the middle of the breast all the way from the end of the nipple to the end of the breast. Another reason why I might be more hesitant with scarring related to the lift is also don't really feel that the right breast is uncomfortably saggy it's more the fact that it's saggier than my left breast that I'm uncomfortable with.

Returning to the question I started with: After consulting three different doctors I got two completely different opinions on weight changes after the fat transfer surgery. The first doctor that I visited when I was at the weight where I feel comfortable with the areas of my body that get fat easier and that I like to be small and then having very little excess fat on any areas of my body, said that she was doubtful about there being enough fat to take from in order to enlarge any part of my body also given the fact that one needs a lot of fat to augment an area of the body given that a part of the fat that is transferred (30 %?) disappears or dies away after the injections (is therefore not permanent). After this consultation I decided that I wished to gain a little weight before the next consultation and so I did.

Being a weight that I'm generally uncomfortable with having in my opinion too much fat on my upper arms, knees, stomach/tummy and waist, I visited another surgeon.


I told the doctor that there now were a lot of areas on my body that I feel are too chubby and that I'm therefore considering loosing weight before having the transfer done. He responded to this by saying that he thought it was a bad idea to loose weight before the transfer because I then would loose all the fat that could potentially be used for the transfer. He also told me that there was to little fat to take from on my body (still) if I wanted to augment the breast, but and middle part of the hips. In his opinion there might have been enough for only the hip and but augmentation but not also the breast. This surgeon would though not do fat removal from my upper arms saying that there was a danger of getting loose skin and seemed a little more eager to take fat from my inner and outer thighs than my waistline, upper part of stomach on the sides, the whole front of the tummy, inner and upper knees and maybe a little (just a little! (how much is a little depending to my current weight) from the highest part of the love handles (not lower!!) which are the ares that I wished to have smaller at this point. I'm generally hesitant taking away from love handles since as stated before I feel that the whole hip-section from the waist to lower hips at the end of the but is generally narrow in proportion to the rest of my body in particular upper arms and shoulder with, though when I'm a little chubbier as I was at this consultation there might be a little excess to take from the upper love handles/lower waist though other areas have even more need of slimming.

I asked this surgeon about the alternative that I lost some weight after the surgery to get the size I want of my upper arms, waist and tummy of it wasn't possible to remove sufficiently fat on these areas with liposuction and/or he didn't remove from all of the parts of the body that I feel have too much fat resulting that I feel a need to loose a little weight to slim these down being uncomfortable with their size. He told me that if I lost weight after the surgery I would loose weight evenly, not more on the injected areas, which would mean that the change in proportions would stick with me even though I loose weight (or gain?) after the surgery, thought the injected areas would of course also become smaller with weight loss the effects of the fat transfer wouldn't disappear in the sense that I previously described; that the change of proportions remains. I'm not sure if this is also the case with weight gain, but I have not asked about this since I didn't imagine this to be highly relevant for me. Hearing this I would think that it is better to alter the proportions as much as possible that means by doing this surgery while having more excess fat to take from given that I wish a breast augmentation of at least one breast size and the fact that some of the injected fat dissapears after the transfer.

Another alternative might be having liposuction on the areas of my body that I still feel are too chubby after the transfer but I have heard from a doctor that liposuction is not used mainly to loose inches or weight but to change proportions on ones body which and also heard from another surgeon that the amount that could be removed would very little and give just the slightest visible change. This along with the fact that my face is also prettier at a certain weight and now has to much fat, is a reason against liposuction on other areas of my body being sufficient to make these areas skinny enough.

Being 2-3 pounds chubbier than I was at this visit, now also having excess fat on thighs (though still not particularly much in comparison than other parts of my body), I e-mailed another surgeon who wrote that it is extremely important that the weight is stable after the surgery to maintain the effect of the transfer since one otherwise cannot completely predict what will happen to the fat transfer augmented areas. The secretary I talked to on the phone said that to loose weight after the fat transfer would make having the surgery completely wasted as in her opinion one generally loose weight first on breast, hips and but. Maybe she meant that genes play a part in determening where one will loose weight first and the most thereby resulting in a bodyshape closer to ones shape prior to the transfer. I would assume this to be the same with weight gain after the surgery if one thinks this is likely to happen.

After these two completely different answers to weight loss after surgery I am really in doubt about wether I should loose weight prior to the fat transfer to the point where I still have some excess fat to take from but not a lot aiming at not feeling a strong need to loose weight on my own after the surgery with the risk that the areas I wish to augment might not be possible to augment to my wish or wheter I should do the fat transfer while being a weight that means that I have a lot of fat I wish to remove with the risk that I might feel the need to loose weigt after the surgery if liposuction cannot remove enough of fat from the areas I feel I have to much.

The difference would be 10-12 pounds lighter or heavier.

What would you advise?

On: 10/27/2013 08:23 am

To doctors from: New York

Category: Body (General)

Answers

DrBeverlyFriedlander on 10/28/2013 01:06 pm wrote:
You pose many thought provoking questions which have been answered fairly correctly by the doctors you have consulted with. I understand your confusion, and there is no right or wrong answer to your question. The best answer is related to how much fat you actually have for contouring. This can be best ascertained by a face to face consult. It is important that prior to surgery you have a realistic expectation about what can be achieved, and that is best done in person. Good Luck. Please feel free to schedule a consultation for a complete evaluation and discussion of your particular needs.
Beverly Friedlander, MD
DrTheoDiktaban on 10/28/2013 11:55 am wrote:
Liposuction with Fat Transfer is a procedure which I regularly perform in my practice. It would be ideal to see you for a consultation in my office so that I can give you my advise in person after having seen your areas of concern. That being said, patients do need a decent amount of "donor fat" in order to perform a fat transfer with good results. Also, I typically advise my patients to maintain their weight after fat transfer for the best results. If you are interested in a consultation with me, feel free to contact my office.
DrJosephFodero on 10/28/2013 11:35 am wrote:
Dear Potential Patient,

After reviewing your message, we believe it is best that you call our office and schedule a consultation. This way you can speak directly with the doctor and address all your concerns in person. Our office is open Monday through Friday, 9am to 5pm. The doctor is available for consultations Wednesdays 9-5 and Fridays 9-12. Please note consultations are free; however, a credit card number is required to hold the appointment. Any cancelations with less than 24 hours notice is a fee of $100. Thank you and we look forward to speaking with you.

The Staff at Northeastern Plastic Surgery
DrTitoVasquez on 10/28/2013 11:11 am wrote:
Hi Anonymous. That is quite a question with a lot of different questions and issues raised. There is no simple answer which is why a consultation, sometimes with several doctors may be the most helpful. If there is something you don't quite agree with with one doctor, you may find another doctor gives you a better answer. You may also find that they both agree, which may tell you something you don't necessarily want to believe. I think all your concerns are valid, but I cannot give any specific recommendations without seeing you in person and also understanding all your concerns. I would be happy to discuss with you one-on-one so that we are both on the same page about your goals. Thanks for your question.
DrKatherineHein on 10/28/2013 11:04 am wrote:
Thank you so much for your interest in our practice. Unfortunately we don't perform fat grafting.
DrWilliamRosenblatt on 10/28/2013 10:43 am wrote:
You may be disappointed with fat transfer as 1- you need a lot of fat to make a difference as often a lot of it goes away. 2- Weight loss and gain will change the result. Also, I do not give you a consultation without seeing you. I am not sure that there is such a difference in opinions between surgeons.