How Much Fat Can be Expected To Survive With Forearm Augmentation By Fat Injections?

Q: Dr. Eppley, For fat transfer to the forearms and hands, how long is the surviving fat expected to stay permanently? Would a retouch be necessary after a certain amount of time, or can we avoid this by transferring a significant amount of fat in one session? How much fat will be needed? Since the donation site will be the abdomen, I have attached pictures so that the doctor can let me know if there’s enough fat he can take from there (I think theres more than enough)

A: For fat transfer to the forearms I think it is very important you understand why it is being considered and what its limitations are. Here are the important concepts:

a) The reason fat transfer is being considered for the forearms/hands is NOT because it is an ideal procedure or that it has an assured permanent volume retention. It should be done with the understanding that it is the ONLY treatment option that exists and that it is safe and unlikely to cause any harm. This is actually the reason a lot of fat transfer is done anywhere on the face and body and why it is a widespread volume augmentation technique. But in the end it should be viewed as a roll of the dice surgical technique not one with an assured outcome.

b) Injection fat grafting has a highly unpredictable volume retention rate  (how much survives) based on a variety of factors which include how much fat volume is available for grafting and what is the anatomic site of implantation. As a general rule you need at least 100% more aspirate from the harvest site than what needs to be injected. (your abdominal harvest site is marginally acceptable) The forearms and wrists are very poor fat retention sites, the back of the hands do better. Also any fat that is injected across a movable joint (wrist) will have 100% resorption. Fat does very poorly in high motion sites.

c) Your forearm/wrist/ hand injection outline/goals are not a realistic outcome. You don’t have enough fat to do it and it will never survive with that amount of augmented contour retention.

Dr. Barry Eppley

World-Renowned Plastic Surgeon