Before surgery: what to prepare
Stop aspirin, ibuprofen, naproxen, and blood thinners 10–14 days before. Stop fish oil, vitamin E, ginseng, ginkgo. Smoking and vaping must stop 4 weeks before and through 6 weeks after, nicotine kills grafted fat by constricting blood supply, and graft survival in smokers can be half what it is in non-smokers. Body weight should be at or near stable weight. Buy the compression garment the clinic specifies for the donor site. For buttock grafts, buy a special doughnut or wedge pillow so you can sit while keeping pressure off the graft. Wear loose dark clothing for the first week.
The day of surgery
Fat grafting is performed under general anaesthesia or sedation depending on volume, runs 2–4 hours, and discharges same-day in most cases. You wake up with a compression garment over the donor site, small dressings over the recipient site, and soreness in both areas, donor site feels like a heavy workout, recipient site feels swollen and bruised.
Days 1–3: peak swelling
Donor site pain is moderate, recipient site soreness is mild to moderate. Wear the compression garment over the donor site continuously. Avoid pressure on the recipient site, no sleeping on it, no sitting on it for buttock grafts (special pillows are required, and many surgeons restrict sitting for 2 weeks). Cold compresses on facial recipient sites for the first 48 hours.
Week 1: stitches out, bruising fades
Office work from day 3–7 depending on the recipient site. Facial grafts cause significant swelling and bruising for the first week; breast or buttock grafts cause swelling that is hidden under clothing. Compression garment continues on the donor site. The recipient site looks over-filled, typically 30–50% more volume than the final result because the surgeon over-grafts to account for reabsorption.
Weeks 2–4: back to public
Donor-site bruising fades through week 2. Recipient-site swelling resolves and the apparent volume drops as fluid is reabsorbed. Do not apply cold compresses or massage to a breast or buttock graft (unlike facial grafts), early vascularization is fragile and pressure or temperature changes can disrupt graft take. The over-filled look begins to settle toward the final volume. No sleeping or sitting on buttock grafts continues through week 2–4 depending on the surgeon. Light walking from day 1; full exercise resumes around week 3–4.
Months 2–3: swelling resolves
Graft take is decided in the first 3 months, the fat that has survived by month 3 will largely remain, the fat that has been reabsorbed is gone. The volume at month 3 is roughly what you keep. If significant reabsorption occurred, a second grafting session can be scheduled at month 6 minimum.
Months 6–12: the final result
Final volume is set by month 3 and refines minimally through month 6. The grafted fat behaves like normal fat, if you gain weight, the grafted area gains with you; if you lose weight, it shrinks. This is why patients should be at stable body weight before grafting. Long-term graft survival past 12 months is high; the volume present at month 6 is durable for years. For breast fat grafting specifically, the graft can cause calcifications that show up on future mammograms, always tell the radiologist you had breast fat grafting so the images are interpreted correctly. Small palpable lumps (oil cysts or fat necrosis) are a known risk of higher-volume transfers; most are benign but new lumps should be evaluated by ultrasound.
Red flags: when to call the clinic
Call the clinic the same day for: fever over 38.5°C, sudden firm painful swelling at donor or recipient site, pus or yellow discharge, increasing redness, skin in a treated area that turns dusky white or black, shortness of breath. Go to an emergency room immediately for: shortness of breath combined with chest pain, fat embolism is rare but serious and presents as sudden breathing difficulty and chest pain, the risk window extends up to 72 hours post-op, not just the first 24. Buttock fat grafting (BBL) carries the highest mortality rate of any cosmetic procedure because fat can be inadvertently pushed into deep muscle veins; modern protocols inject only into the subcutaneous plane and avoid the gluteal muscle entirely. Confirm with any surgeon offering BBL that they follow subcutaneous-only injection. Also for one-sided leg swelling and pain (DVT). Routine bruising at both sites, the over-filled look at the recipient site, and reduced sensation are not red flags.