WHOLE BODY TRANSFORMATION: A 3-DIMENSIONAL WHOLE BODY LIPOSUCTION WITH AUTOLOGOUS FAT GRAFTING FOR BREAST AND BUTTOCK AUGMENTATION

Case 1: Creating a masterpiece with your own fat!

This 24 year old Singaporean spent SGD 8,000 for Macrolane filler injection to the breasts (100 cc in each breast) only 6 months before she came to Medan. A typical Macrolane filler injection for breast augmentation costs SGD 8,000 to 12,000. Although she was advised that the filler would last at least a year, she noticed her breasts shrunk back to almost their original size barely 6 months later. Not only that, she also noticed several hard lumps which started to occur 6 months after her breast augmentation with Macrolane. A Google search on the internet revealed that complication of hard lumps forming after Macrolane injection is actually quite common. A journalist of The Sunday Times in UK wrote about her first-hand experience with Macrolane injection. It was not until she developed several hard lumps in her breasts, she realized that she didn't read the consent form which said that Macrolane use “for breast enhancement has not been established” and that in small studies adverse reactions had included “development of hardness of the breast, formation of palpable lumps and capsular contraction”. Another report on the Daily Mail, also in UK, stated that 16 out of 20 female clients injected with Macrolane complained of abnormal lumps and pain. UK Health Centre, a patients advisory group, advised against the use of Macrolane injection for breast augmentation. Similarly, Aqualift filler is not approved for use in Singapore due to the lack of clinical data to support its long-term safety and effectiveness in tissue reconstruction. On 7 December 2010, Health Sciences Authority (HSA), a regulatory body in Singapore, sent emails to all doctors to warn them to stop using Aqualift medical filler gel after a patient who was injected with it developed unusual lumps in her breasts.

Fat transfer can be done to the breasts for augmentation and reshaping of the breast to create a long-lasting and natural result. There have been debates amongst surgeons on the long-term implication of fat transfer to the breasts, as fat cells may die and get calcified. On mammogram x-ray, this looks exactly the same as an early breast cancer. When faced with many calcifications on x-ray, the physician is faced with dilemma of whether to take out every single lesion for biopsy, or just to leave them alone, assuming that those are just calcified fat. In a 1987 position paper, the American Society of Plastic and Reconstructive Surgery stated: “The committee is unanimous in deploring the use of autologous fat injection in breast augmentation [underlined in position paper]. Much of the injected fat will not survive, and the known physiological response to necrosis of this tissue is scarring and calcification. As a result, detection of early breast carcinoma through xerography and mammography will become difficult and the presence of disease may go undiscovered.”

Ironically also in 1987, a retrospective study of the mammographic changes after breast reduction reported that calcifications were detectable in 50 percent of all mammograms more than 2 years from the time of surgery. Despite this documented high incidence of calcifications, there was no discussion of discontinuing reduction mammaplasties because the procedure might interfere with breast cancer detection. It was well recognized by 1987 that with all surgical breast procedures, there is a risk of causing lumps and/or mammographic changes. After discussion with experienced radiologists, we noted that a “confident differentiation between benign postoperative calcifications and carcinoma” could be made in most cases. Discussion had already begun in the literature concerning such problems after breast reduction and augmentation with silicone implants. Currently, radiologists can distinguish with a high level of confidence the calcifications that are a result of fat necrosis from calcifications that are related to breast cancers. In a most recent study published on the Journal of Plastic & Reconstructive Surgery in March 2011, researchers found that there was no statistically significant difference between breast density findings before and after fat injection, whether using the American College of Radiology classification or a personalized rating system. Similarly, no significant difference was observed using the American College of Radiology Breast Imaging Reporting and Data System categorization before and after fat grafting. In conclusion, radiographic follow-up of breasts treated with fat grafting is not problematic and should not be a hindrance to the procedure.

Although more than a decade ago the American Society of Plastic Surgeons (ASPS) did not recommend the use of fat grafting for breast augmentation, more recently, the American Society of Plastic Surgeons Fat Graft Task Force has stated that there is no strong evidence for or against autologous breast augmentation.

For more information on this topic, you may like to read the following articles:

1. Fat Grafting to the Breast Revisited: Safety and Efficacy

2. Advantages, Disadvantages and Complications of Breast Augmentation with Fat

With the recent mass recall of breast implants in France where at least 30,000 women were affected, it appears that autologous fat grafting for breast augmentation may offer a safer option compared to breast implants. After all, implants are still foreign bodies which are inserted into the body, while autologous fat grafting procedure uses one's own fat. If one wants to debate about the risk of causing confusion in detecting early breast cancers later on in life, a breast implant causes even more confusion as it blocks away most of the view in a mammogram. So, the best is of course never to put anything inside the breasts so as not to cause any confusion. However, once a woman has decided to get breast augmentation done, then the safest bet probably is to get autologus fat transfer to the breasts. However, not all autologous fat grafting procedures are the same. There are 3 very important variables which determine the success rate of an autologous fat grafting procedure: technique of harvesting fat cells, technique of processing fat cells, and technique of re-injection into the breasts or any other areas of the body. Look for an experienced surgeon with proven track record. Otherwise, one will end up with a lot of calcified dead fat cells in the breasts!

This client eventually had whole body transformation by getting liposuction done on her arms, abdomen, waist, flanks, lower back, hips, saddle bags, outer, inner, front and back of thighs, as well as knees over 3 sessions in 4 months time. She also had autologous fat grafting to her breasts and buttocks during all those 3 sessions.

Recently we reviewed her again, 21 months after autologous fat transfer to her breasts. Not only has the fat transfer surivived, but the breasts have increased in size as well since the last session of autologous fat grafting! But sadly, the hard lumps which resulted from Macrolane injection still persisted and did not seem to improve over time.

Take home message: Filler injection for breast augmentation does work, but it is extremely expensive! In a typical example given above, this patient increased only 1/2 cup size with 100 cc filler injection in each breast. And it already cost her $8,000! These fillers (for breast augmentation) typically last 1 year or so, but in her case, it was almost completely absorbed by the body in 6 months time. So, she was basically flushing down $8,000 down the drain! Even if it lasted for 1 year, who would be able to afford to pay $8,000 every year? Unless it is given away free, as what Singaporean blogger Qiu Qiu, has received. But, even then as the filler is slowly broken down by the body, just imagine the agony of watching your breasts shrinking day after day before the filler completely disappears, as what Qiu Qiu has experienced! Most will choose to top up before it does. Which means you will probably have to get filler injection every 6 months. That is an extremely expensive exercise! We charge only SGD 1,000 currently, for autologous fat transfer for breast augmentation, which can last indefinitely if the fat cells survive. In this typical case which we followed up for 15 months, this patient's breasts size have in fact increased from C-D cup immediately post-op to a current D-E cup 15 months later!

Although there is still a lot of on-going debate regarding the long term implications of autologous fat grafting for breast augmentation; with the opponents of fat transfer to breasts fearing that calcified fat cells may interfere with breast cancer detection when the patient undergoes mammography in the future, while the proponents say that experienced radiologists are able to differentiate calcified fat cells from early breast cancer on mammogram, as they have different characteristics; we find through years of experience that if done the right way, fat survival actually exceeds 90% and there is not a single case of fat necrosis with calcification because we have been performing micro-fat-injection. Whatever does not survive will just disappear and get resorbed by the body. There is no risk of fat necrosis and calcification at all! Nevertheless, we still advise patients of the possible known long term implication. However, based on years of experience and follow-up of our existing patients years after autologous fat transfer procedures, we find that the risk of fat cells dying and getting calcified is almost zero, by using a special harvesting and injecting technique invented by Dr Arthur Tjandra.

A word of caution on the use of dermal filler for breast augmentation: there has been no long-term study to prove that is safe. With the effects of the Macrolane injections not being very long lasting with only an estimate of the enhancement lasting up to 12-18 months, many argue that Macrolane breast enhancement leaves the patient in a more vulnerable situation than that of a person who only has to go through one intrusive operation i.e. breast implants.

Although breast implant has been the gold standard for breast augmentation for a few decades, a recent United States FDA report indicates that there is a possible association between breast implants and breast cancer. The agency is aware of about 60 cases of anaplastic large cell lymphoma (ALCL) in women with breast implants worldwide. This number is difficult to verify because not all cases were published in the scientific literature and some may be duplicate reports. Most cases reviewed by the FDA were diagnosed when patients sought medical treatment for implant-related symptoms such as pain, lumps, swelling, or asymmetry that developed after their initial surgical sites were fully healed. These symptoms were due to collection of fluid (peri-implant seroma), hardening of breast area around the implant (capsular contracture), or masses surrounding the breast implant. Examination of the fluid and capsule surrounding the breast implant led to the ALCL diagnosis.

Anecdotal evidence in our clinic showed that with the right technique, autologous fat transfer to the breasts may last a lifetime, without the need to change breast implant every 10 years and without having to go through the risk of major surgery and general anesthesia, as in the case of breast augmentation using breast implants.

There is currently no standardized technique of harvesting and grafting fat to ensure survival of the grafted fat cells. Moreover, fat grafting is not taught in medical schools or during plastic surgery training. Surgeons acquire the skill needed as they perform more and more cases in their own practice. Ultimately, just like pilots, surgeons who have performed the most fat grafting procedures are the ones who can ensure the highest safety profile and success rate. Although it is hard to compile photos from patients as most of them are lost to follow up, we are glad to have a number of grateful patients who were so happy with the result of their fat grafting, that they emailed to us the photos or returned to us to have their photos taken long after their fat grafting procedures. We are, therefore, able to put together serial photographs which take you through the journey of fat grafting and whole body transformation by removing and transplanting fat!

Hence, amongst the 3 available options for breast augmentation, autologous fat grafting appears to have a very promising future, if performed by experienced surgeons using the right technique to ensure viability of the fat cells. In fact, autologous fat grafting may replace breast implant as the gold standard of breast augmentation in the near future.

Case 2: Can you transform a mother of 3 teenage children in her 30s into a teenager again?

The answer is "Yes"! This mother of three teenage kids had whole body transformation involving whole body liposuction and breasts and buttocks augmentation using autologous fat grafting, as well as upper blepharoplasty, rhinoplasty and face and neck liposuction.

This Singaporean woman who is a mother of 3 children weighed barely 45 kgs, but had pockets of stubborn fat here and there. On the other hand, she has shrunken breasts resulting from years of breast feeding 3 children as well as her hobby running. We performed a head to toes surgeries for her in 3 sessions. During the first session, we performed liposuction of double chin, arms, abdomen, and fat transfer to buttocks. Ten months later, she returned for augmentation rhinoplasty, liposuction of the whole thighs, saddle bags and jowls, as well as fat transfer to her breasts. Thereafter, she had Asian double eye lid surgery and another session of fat transfer to her breasts increasing her breast size from completely flat-chested to a decent B+ cup now.

After completing whole body liposuction and 2 sessions of autologous fat grafting breasts augmentation, this patient returned to Dr Arthur Tjandra of Elixir de Vie Indonesia 4 years later for a third session of fat grafting to breasts as well as to forehead. The result of her autologous fat grafting breasts augmentation after 4 years, as well as immediately after the 3rd session can be seen on videos we have uploaded to YouTube. She is Case No. 102.

Case 3: Extreme Makeover Whole Body Transformation

When we launched our Extreme Makeover Whole Body Transformation in 2010 where clients received 3 sessions of whole body liposuction as well as 3 sessions of complimentary autologous fat transfer to either the breasts or buttocks for slightly more than SGD 10,000, only 2 women signed up. Those 2 were the luckiest persons on earth, as they would otherwise had to spend at least 5 times that amount if they were to get it done elsewhere. We are no longer offering that package anymore. One of those women, a Singaporean in her 20s, is featured below. The other client was featured above.

Take home message: The whole intention of offering a whole body transformation package at a ridiculously low price is to create awareness that to sculpt a masterpiece, all areas of the body should be sculpted in a 3-dimensional form, instead of the current practice where surgeons only work on 1 or 2 areas within the same segment of the body. Of course the current biggest limitation for clients is the cost. Therefore, we have moved our practice to Medan where cost of doing business is ridiculously low, and pass this savings to our clients to enable them to afford whole body 3-dimensional sculpturing. Only by performing a 3-dimensional liposculpture, can a surgeon create a masterpiece!

Case 4: Can a 45-kg woman benefit from body sculpting?

As a matter of fact, someone who is already within her ideal weight range but have ugly pockets of fat here and there, is the best candidate for body sculpting! Exercise burns fat from the whole body, not from targeted spots. Moreover, extreme exercising in someone who is already slim and has small breasts, may reduce the breasts size even more. Hence, targeted body sculpting combined with autologous fat transfer/grafting to areas which need further enhancement is the best method to achieve a perfect figure in this group of patients.

This Singaporean college student in her early 20s presented with slim upper body, but heavy bottoms and small tubular breasts. She had first session of liposuction done on her whole thighs and calves, parts of arms and armpits, as well as autologous fat transfer/grafting to her breasts and buttocks. She will return for her second session during which we will address her abdomen and love handles, and transfer the fat to her breasts again.

This is what she looks like 3.5 years later, after just ONE session of autologous fat grafting breasts augmentation: http://www.youtube.com/watch?v=N2FCFEWiQ9w

She returned to us for a second session of autologous fat grafting to her breasts, after purposely gaining weight, during which we harvested fat from her outer thighs and calves. The videos are uploaded to YouTube: http://www.youtube.com/user/arthurtjandra/videos, Case No. 104.

Case 5: A woman with pear-shaped body

This Singaporean lady in her mid 30s found it very hard to get rid of the fat in her heavy bottom and thighs despite her rigorous physical activities. As a matter of fact, because of her rigorous work out, she noticed her breasts had been shrinking. She presented to us for a whole body extreme make-over transformation. She did not decide on this transformation until a year after she had her thighs done.

Case 6: Body transformation with buttocks augmentation

This Singaporean lady in her mid-20s had 2 sessions of body transformation involving her upper body and mid section.

Case 7: Extreme make-over with combined breasts and buttocks augmentation

This young lady in her early 20s from Singapore had staged whole body liposuction with fat transfer to breasts and buttocks.

Case 8: Whole body transformation after VASER Liposelection liposuction

This 34 year-old Singaporean mother of 2 children had VASER Liposelection done in Singapore 5 months before coming to Medan for revision. She did not get what she wanted: an hour-glass figure, because the sculpting was never done 3-dimensionally. But again, with the high cost of liposuction in Singapore, most patients can afford to pay to get upper and lower abdomen done only, neglecting the rest of the trunk.

Case 9: Whole body transformation with fat transfer to both breasts and buttocks

This Singaporean lady in her mid 20s came to us for whole body transformation. She had fat transfer to her buttocks during the first 2 sessions. She is awaiting her third session which will be combined with fat transfer to her breasts.

Case 10: Buttock augmentation with fat transfer

This young lady in her early 20s from Singapore weighed barely 45 kgs but had heavy bottoms. At the same time she also had flat buttocks. Her lipo-ed fat was put to good use as it was used to augment her buttocks. She ended up having slim thighs and perky derrière.

Case 11: Would a photo model need a whole body transformation?

This runway model from a leading modeling agency in Singapore appeared very good even in tank tops and shorts. She weighed barely 48 kgs! It was only when she undressed herself completely, it was apparent that she had some very mild unsightly bulges here and there. As she would like to look even better, we performed a whole body transformation for her, including autologous fat grafting to fill up the hollowed areas of her buttocks, as well as to augment her buttocks even further. However, her inner thighs were not lipo-ed as per her request. The result would have been much better if liposuction was performed on her inner thighs as well!

Case 12: A revision case with autologous fat transfer to breasts

This Hong Konger in her 20s went to Manila for thighs liposuction. Unhappy with the result, she came to us in Medan to get revision done. She put her fat to good use by having it transferred to her breasts.

Case 13: Another case of whole body transformation with autologous fat grafting

This Singaporean student in her early 20s came to Medan for liposculpting and autologous fat grafting to breasts and buttocks. The following photographs speak a thousand words. She is awaiting her third session, during which we will address her thunder thighs and perform further autologous fat grafting to her breasts and buttocks.

Case 14: A fan of Pamela Anderson!

This flight attendant with a major airline in Dubai who is in her early 20s would like to have au naturel E or F cup breasts without inserting any foreign objects such as silicone implant into her body. As she has heavy bottom and pockets of stubborn fat in her abdomen, we planned for a whole body liposuction in 2-3 sessions, during which we performed autologous fat grafting for au naturel F-cup breasts! After getting thighs liposuction done, she now has very prominent calves, which will be addressed next.

Case 15: VASER Liposelection went wrong and revision with autologous fat grafting to buttocks

This flight attendant with a major airline in Singapore who is in her early 20s, had VASER liposuction done on her outer thighs and buttocks in Singapore. She was left with huge dents in her buttocks. Overall, her thighs still appeared big. She had actually read through our liposuction case studies and understood that to obtain excellent result, 3-dimensional liposuction involving all areas should be done. However, having read some malicious gossip on the internet which said that Medan and other places in Indonesia were very unsafe for ethnic Chinese to visit, she chose to have her liposuction done in Singapore. Completely unsatisfied with the result, she had no choice but to visit us in Medan to get a revision done 4 months later, during which we also performed autologous fat grafting to the dented areas which were caused by over-suctioning. This is one of the most frequent problems often observed with machine-assisted liposuction! Anyway, she was very surprised by what she saw in Medan. The Indonesians were very friendly. She went to Sun Plaza and observed that it was packed with ethnic Chinese people without being robbed or harassed by the Indonesians as what gossipers on the internet said!

Case 16: Does a fashion model need a whole body transformation?

Apparently this Singaporean model in her early 20s thinks she does. Although she weighed barely 48 kg, she has mild unsightly saddle bags, love handles and also a pair of thighs which were disproportionately bigger than other parts of her body. Although her arms were slim to begin with, like most women, she had this unsightly bulge like a drumstick appearance, when pictures were taken from certain angles. Her buttocks were also not as perky as she would like them to be. Since she also models for lingerie and swimwear, it is very important for her to have perky derrière. She came to us in Medan for a major overhaul of her body. During the first session, she had thighs liposuction and autologous fat transfer to her buttocks. Three months later she returned for her second liposuction, this time on her abdomen and arms, as well as further autologous fat grafting to buttocks. She was extremely delighted with the result.

Case 17: Put your extra fat into good use!

This Singaporean student in her early 20s knew just how to put the extra fat in her arms into good use, by having autologous fat grafting into her breasts to increase it one cup size!

Case 18: Another case of putting fat into good use

This is another Singaporean college student in her early 20s who opted for whole body transformation.

Case 19: Look Ma! I've got boobs!

This Singaporean college student in her mid-20s has never had boobs before in her life, until she came to Elixir de Vie in Medan......... As she was very skinny, she took the effort to put on weight and returned for her third session of autologous fat grafting to further augment her breasts one year later. At that time she already has a feminine womanly figure. She first came to us in year 2010, and had 3 sessions of autologous fat grafting for breasts augmentation within between 2010 and 2012. She returned to us in 2014, 4 years after her initial session to get a 5th session of autolougous fat grafting. The videos of her breasts 4 years later can be viewed on YouTube:

http://www.youtube.com/watch?v=ed6ujnda72E

http://www.youtube.com/watch?v=7W8Kdk_fAuU

Case 20: Can a mother of 2 teenage children look like a teenager again?

This Singaporean woman in her mid 30s is a leading stewardess with a major airline in Singapore. Her job demands her to appear in shape, especially that she needs to wear figure-hugging uniform all the time. She came to Elixir de Vie in Medan, for a complete transformation involving whole body and facial as well as neck liposuction, autologous fat grafting to face, autologous fat transfer to breasts for breast augmentation and possibly nose augmentation as well as upper blepharoplasty.

Case 21: Look Pa! I've got boobs!

This 20 year-old Singaporean woman came to Medan with her father. Her father has been very 心痛 as the daughter has always been teased as "flat-chested" since she was in secondary school. We performed liposuction on her thighs and performed autologous fat grafting to the breasts during the first session. In the upcoming subsequent sessions, further liposuction of her abdomen to correct asymmetry caused by scoliosis will be performed, together with further autologous fat transfer to the breasts.

Three and a half years later, she returned to us again for abdominal liposuction as well as the second session of autologous fat grafting breasts augmentation. This is what she looks like 3.5 years after her initial procedure of autologous fat grafting breasts augmentation and thighs liposuction: http://youtu.be/XR9LBObPp_I

Case 22: Another flat-chested girl

This 20-year old flight attendant with a major airline in Hong Kong has always relied on heavy paddings inside her bras. Although she was pretty slim, she still had some extra fat on her thighs. We made good use of this fat and performed autologous fat grafting to her breasts for breast augmentation. As she has young breasts which were very tight with not much space, we performed very conservative autologous fat grafting, harvesting fat from just her left thigh and part of her right inner thigh. A second liposuction was performed on the right thigh 6 months later, with autologous fat grafting to her breasts again for the second time. One and half years later she came back to us to show us her beautiful breasts!

Case 23: Whole body transformation by combining whole body liposuction with autologous fat grafting for breast augmentation

This Singaporean woman in her late 20s had whole body liposuction to prepare for her wedding photo shoot. As she was a mature student, she had to save up for her procedures and stretched her surgeries over a period of more than 1 year. However, it is much safer to do it this way. We have heard of patients who had whole body liposuction done by getting liposuction surgery done daily over a period of 5 days! That was a very dangerous practice! She did not think about breast enhancement using autologous fat transfer until her last session of liposuction. All the fat from previous 2 sessions was wasted.

Case 24: Even actress needs whole body transformation!

This China-born new comer in the Hong Kong movie scene who is in her early 20s, appears very appealing even in short dresses as she is rather slim. Her only problem was her heavy bottom and saddle bags, which could still be covered by mini skirt and longer shorts. She was, however, unhappy with her flat chest. As she had quite significant amount of fat in her lower body, we advised her to get her thighs done in 2 separate sessions, so as not to put the aspirated fat to waste. Because of her relatively young age and tight space in the breasts, we would rather inject conservative amount of fat cells into the limited space to increase the likelihood of survival. It is better to inject a little at a time, rather than to inject too much only to find that none of the fat cells survive. We also do not like to freeze aspirated fat for future use. We prefer to use it "fresh from the oven", processing and injecting fat cells as soon as they are aspirated. This will significantly increase the chance of survival. We plan to perform autologous fat grafting for breast augmentation for her in 3 separate session, during which we will also perform liposuction and fat harvesting from her left thigh, followed by right thigh, and lower abdomen with love handles.

Case 25: Even artistes need whole body transformation!

In fact, they need it even more than anyone else, as their livelihood largely depends on how they look. This Taiwanese artiste in her early 30s looked astonishingly good when she was younger. However, when age catches up with her, she becomes more and more out of shape. She came to us for whole body transformation, including autologous fat grafting for breasts augmentation as well as fat transfer to her sunken buttocks, which would be done over at least 3 sessions. As she also had scoliosis, we performed liposculpting to correct the appearance of her scoliosis.

Case 26: I usually could cover my saddle bags under my shorts, but the beauty pageant committee wanted me to wear swimsuit! How??

This 20 year-old Hong Konger woman who stood at 170 cm and weighed barely 48 kg, came to us moments before the selection process of a beauty pageant. As it was too close to her selection date, we advised her to just take away her saddle bags which were the ugliest part of her body. Although the saddle bags could be easily covered under a pair of shorts or even mini skirt, as the rest of the thighs were pretty slim, she would still need to wear a swimsuit in front of the judges during the selection process! There was high chance she could not even get selected if she did not rectify this problem area. As she would be required to wear a bikini top and it was too hard to enhance a completely flat chest with padding, we also performed autologous fat grafting to her breasts for breast augmentation, as this was another area which she clearly lacked of. We also performed autologous fat transfer to correct the sunken areas under her eyes, but she preferred for her facial photos not to be published here. There were other areas which could benefit from liposuction as well, such as her tummy, love handles, lower back and frontal thighs. However, that could wait until after the pageant was over. Besides, we would rather put that fat into good use for a second or even third fat transfer procedure to further augment her breasts. We cannot inject too much into the breasts in one session due to space limitation, or else all the fat cells will not survive. She proceeded to go into finals and won that beauty pageant!

Case 27: Your face may look young and attractive, but what about down there?

Many women neglect the appearace of their external genital at the expense of their sex lives. Autologous fat grafting can be used to rejuvenate the appearance of female external genital. If injected underneath the vaginal mucosa, it can be used to tighten the vagina wall as well. This procedure can be combined with the trimming of the inner lips (labia minora) making the whole appearance of the female external genital more appealing! After all you don't want your partner to get so hyped up after seeing your new face and new body after whole body transformation, but only to feel disappointed once you take off your pants!

Case 28: A patient who purposely gained weight after liposuction

This Singaporean woman in her early 20s who was heavy on her upper body came to us for whole body transformation, including face and neck liposuction as well as autologous fat grafting breast augmentation. After completion of upper and mid-body liposuction, she purposely gained weight again, so that we could harvest more fat from her arms and abdomen for a third session of fat grafting to her breasts.

Case 29: Does a 38-kg woman need liposuction?

The answer is "Yes", because first of all, like many other slim and fit women, she was saddled with stubborn unsightly saddle bags, and secondly, she needed fat for autologous fat grafting breast augmentation. It is like hitting 2 birds with one stone! We performed a combined liposuction on the left inner thigh and saddle bag, and autologous fat transfer to her breasts, followed with liposuction of her arms and right saddle bag and inner thigh, five months later. She was pleasantly surprised with the result, as now she has boobs!

Case 30: Making use of stubborn fat to augment the breasts on a slim woman

This young woman who was in her early 20s weighed less than 50 kgs, but had some stubborn fat in her arms, tummy as well as thighs. Although her breasts were of decent B cup size, the upper part of her chest was relatively fat and bony, with the majority of the fat occupying the lower part of her breasts. The advantage of autologous fat grafting is that targeted injection of fat can be done to areas which need the fat most, which were the upper parts of the breasts, in this case. Dr Arthur Tjandra of Elixir de Vie Indonesia performed liposuction on her flabby arms and tranfers the fat to her breasts with satisfactory result. Liposuction of her jowls and double chin was also performed at the same time.

To view her result one year later, and subsequent session(s) of autologous fat grafting breasts augmentation as well as whole body liposculpting, you may view the videos on YouTube, Case No.118: http://www.youtube.com/user/arthurtjandra/videos

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