By Plastic Surgeon Dr Dirk Kremer. 

Last Monday 4th February on the Alan Titchmarsh Show we discussed fat transfer. 

Nadine Baggott, Beauty editor for Hello Magazine, gave her point of view on breast enlargement and gave tips on getting fuller lips and bigger bottoms, and I gave my point of view as a plastic surgery specialist. 

The fat transfer process has come a long way in the last 5 years. Fat does not like to be 'handled' and cells damage quite easily during the transfer process as firstly the fat needs removing (known as harvesting), then collected and finally injected into the treatment area. 

It used to be the case that fat degenerated in an unpredictable way so plastic surgeons using this method tended to inject more fat than needed.

POSITIVES:

1. New procedures and equipment are now available which make harvesting and collection less traumatic to the fat cells. This means that recovery and the end results can be predicted more accurately. 
2. It's your own tissue so patients who are concerned about silicone need not worry

NEGATIVES:

1. COST: The process can take some time which means this type of procedure can also be quite costly (upwards of £7000.00 for breast enhancement compared to £5500.00 for the split muscle technique, my signature procedure, using silicone implants)
2. RESULTS: only 100cc of fat is transferred at one time so the result does not have the same 'wow' factor when compared to silicone
3. The process might need to be repeated if the transferred fat degrades
4. Candidates have to be around size 14 as there has to be some belly fat to remove - this is the best quality fat to harvest.

Furthermore, I would like to add that fat transfer to the breast is still quite experimental.

You can maximum go up one cup size and even this has to be topped-up every 8 to 12 months  if you want to keep your enhanced cup size because part of the fat dies during or after the procedure. As a consequence, the result is very unpredictable and costly, for what is to me a mediocre result. 

Most importantly, the dying fat tissue builds cysts, lumps and granulomas with calcification,  rendering breast cancer screenings very difficult. Even Radiology specialists sometimes can't make the difference between a lesion due to breast cancer and fat calcification, so you need biopsies to rule out malignancy! The American Society for Aesthetic Plastic Surgery even recommends to take a mammogram prior to this type of breast enhancement procedure and to take regular mammograms several years after the surgery. It is not clear yet if the procedure itself can raise the risk for breast cancer or not. 

WHY BOTHER with the idea of potentially developing breast cancer if you are a young, healthy woman who just wants bigger breasts? I think this is crazy. As long as we don't have reliable long-term data I will not use this technique for breast augmentation, and I think it shouldn't be recommended. Implants stay the gold standard for breast enhancement.

The areas discussed during the Titchmarsh Show were:

Breasts

Personally I prefer to use breast implants to enhance breasts. The split muscle boob job gives women beautiful, natural looking breasts, naturally pear-shaped. The split muscle breast enhancement technique is also much less painful for patients than other techniques using implants. It is also the best way for slim women to have a successful breast augmentation that doesn't give the impression they have "tennis ball" chests.

Butts

Thanks in the main to the likes of big bottomed J-Lo, Kim Kardashian and Beyonce, larger derrières are in demand!

2 main options here...

1. Butt implants. A big industry in Brazil but not an area that has taken off in the UK. Reasons for this are that the recovery is very painful and the incidence of infection is quite high. 
2. Thigh liposculpting with or without fat transfer. I find that some clever thigh fat removal around the outer and inner thighs actually give the impression of a bigger bottom.

Lips

In my opinion fat transfer to the lips isn't that great. I prefer predictable, tried and tested hyaluronic acid filler (essentially a sugar and water mixture). This lasts around 9-12 months, and can be tweaked to the patient's individual requirements. The lip enhancement is reversible as the hyaluronic acid is a dermal filler that can be very easily dissolved.

Silicone implants exist but I definitely prefer dermal filler.