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    Day Of Surgery

    Pre-Operative Marking

    Prior to your surgery, you will have the opportunity to speak with Dr Motykie about any part of your surgical procedure and/or recovery process. You will be asked to change into a surgical gown and Dr Motykie will place surgical markings on your face. Lastly, wear loose fitting clothing the day of your surgery that is easy to get in and out of such as sweat pants and a shirt that zippers in the front.

    Anesthesia and Operating Facility

    For almost all fat grafting techniques you most likely receive general anesthesia (you are asleep) for your own personal comfort, safety and surgical ease.  It is Dr Motykie’s opinion that the safest and most effective way to perform fat grafting surgery is under general anesthesia since it allows for the best survival of the fat grafting material after the surgery. It is not in your best interest to undergo fat grafting surgery using awake anesthesia because the local numbing medication used during awake anesthesia has been shown to possibly decrease the survival of the fat grafting material following surgery. When this procedure is performed under local anesthesia, the areas where the fat is harvested as well as where it will be grafted will be injected with numbing solution that most likely contains a substance called “epinephrine”. Epinephrine is produced during the “fight or flight” response of your body and it is one of your bodies most powerful “fat eating” signaling molecules. If local anesthetic containing epinephrine is used to harvest the fat grafting material, the fat that is intended to be injected into you face is essentially being treated with a solution that is poison to its long-term survival. In addition, epinephrine causes decreased blood supply where it is injected, and since blood supply is essential for any grafted material’s survival, it creates a deathtrap for the precious and fragile fat grafting material.

    Dr. Motykie uses only Board Certified Anesthesiologists to administer anesthesia and monitor your safety during your surgery. You may be given medication before reaching the operating room so you will feel relaxed before surgery. The surgery takes approximately 30 minutes to perform in its entirety. Every surgery is performed in a fully accredited, state of the art (AAAASF) surgical facility where your safety, comfort and privacy are of the utmost importance.   Deep vein thrombosis (blood clots) precautions are taken with every patient and include a minimum of anti-embolic stockings and sequential compression devices (SCDs) on the lower extremities during the entire length of your procedure.


    In the “Aging Face” we see loss of facial fat volume that leads to a deflated and sunken appearance in the midface, lips, nasolabial folds and underneath the eyes. Fat grafting can be used to replace the fat that has been lost in these areas due to the natural aging process. In order to perform facial fat grafting, the fat must first be harvested from somewhere else on your body. Therefore, after anesthesia is administered, a tiny  incision will be made for harvesting of the fat grafting material that was determined by you and Dr Motykie prior to your surgery. The donor site selection is very important for fat grafting and “trouble areas” such as the abdomen, knees and thighs work the best because the fat in these areas tends to be more resilient and hardy. If local anesthetic is used, it should be without epinephrine. The fat is then harvested through a tiny incision through the use of a small cannula attached to a 10cc syringe. After the fat is harvested, it should be injected as soon as possible after removal and it should not be allowed to sit outside of the body.  Care must be taken not to cause a contour deformity at the donor site. The fat is collected by hand using small syringes and placed in a centrifuge for purification. Fatty tissue is extremely fragile and is easily damaged. Inexperienced surgeons or sloppy technique can traumatize the fat causing unpredictable results. Over the last century the controversy has always been on the survival of the fat, not the safety of the fat.  The fat must be injected in fine threads in order to allow for adequate survival of the fat grafting material. Soft-edged, blunt instruments are used for placement of fat tissue.  The fat must be distributed evenly, layered and blended between areas. Injection is performed in tiny increments and is constantly molded to the appropriate contour along each facial feature.  Therefore, the fat cannot move, shift or descend and a large  surface area of contact is made in order to ensure proper nutrition for fat survival.  After injection, the grafted fat immediately begins to draw nutrition from the surrounding tissues unlike silicone or artificial fillers. Once it has a blood supply, the fat is extremely stable and is essentially “alive.” It is critical to have this procedure performed by an experienced plastic surgeon in order to have adequate survival of the fat grafting material and an aesthetically pleasing result. A surgeon possessing artistic talent needs to be the one to perform your fat grafting in order to have a beautiful, pleasing result that  does not look over-filled or over-done.  Too much fat grafted into any one area (or any fat placed where it doesn’t belong) can look very unnatural. The fat cannot be simply injected anywhere, it must be artistically placed in strategic areas in order to create a natural, youthful appearance rather than a distorted, “over-stuffed” looking face (i.e. cabbage patch kid). Since all of the fat grafting is injected through tiny stab incisions (typically located inside of the mouth) the procedure is scarless and no incisions, stiches, bandages or compression garments need to be placed after the procedure is competed.

    Recovery Room  

    After surgery you will be brought to the recovery area where you will be allowed to rest and completely recover from anesthesia. Nurses will be on staff by your bedside to make sure you are recovering properly as well as being able to provide you with pain medications and small amounts of water and/or ice chips while you are becoming more awake and alert. After you have fully recovered from anesthesia, you may be released to home with a responsible adult or you may choose to stay overnight in an outpatient recovery retreat where there are nurses on staff 24hrs to assist you with post-operative care and medications.

    The most comfortable position to recover in after surgery is a reclining chair with your head elevated.  Over the first night you will most likely find yourself having to use the bathroom frequently. This is normal and is due to the intravenous fluids you received during your surgical procedure. Leave all dressings intact until the next morning when you will return to Dr Motykie’s office to have your dressings changed and receive further instruction for the rest of the week. The night following your surgery, you may experience some pain and discomfort that can be controlled with your prescribed pain medication. The majority of the sutures used during your surgery will be dissolvable and they will be covered by surgical tape that should be left in place for the first week after your surgery.

    To find out more about facial fat grafting please contact us at 310-246-2355

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