Fat Grafting
Fat grafting has emerged as a pivotal technique in facial rejuvenation, addressing the multifaceted aspects of facial aging, particularly volume loss.
What is Fat Grafting?
Fat grafting has emerged as a pivotal technique in facial rejuvenation, offering a natural alternative to fillers and biostimulators while addressing the multifaceted aspects of facial aging, particularly volume loss. As facial fat compartments shrink and underlying bone structure resorbs over time, the face loses support — leading to hollowness, sagging, and deep folds.
This procedure harvests fat from areas of excess (such as the abdomen, flanks, or thighs), meticulously processes it, and carefully injects it into depleted areas like the temples, tear trough, cheeks, and jawline. With expert technique, fat grafting creates soft, youthful contours while also improving skin quality, thanks to the regenerative properties within the fat matrix.
Modern approaches — including microfat for precise volumization and nanofat for skin rejuvenation — make this technique highly customizable, offering longer-lasting results than traditional fillers. Fat grafting can also be combined with facelifts, eyelid surgery, or brow lifts for a more comprehensive facial transformation. When performed by a skilled surgeon, it offers elegant, natural enhancement tailored to your unique facial anatomy.
What concerns does facial fat grafting address?
- Natural or weight loss-induced facial volume loss
- Deep Facial Folds and Wrinkles
- Scarring and Skin Irregularities
- Replacement for fillers and biostimulators
- Hollowness of the Under Eye tear trough
The Dr. Azizzadeh Difference
Dr. Azizzadeh has unparalleled expertise and extensive knowledge of facial anatomy and aesthetics. As a pioneer and leading authority in the field, Dr. Azizzadeh began incorporating fat grafting into his practice more than two decades ago, long before it became widely popular. His early adoption and continuous refinement of fat grafting techniques have positioned him as a leader in this transformative approach to facial rejuvenation. Dr. Azizzadeh’s holistic, personalized approach recognizes that facial aging is a complex interplay of volume loss, tissue laxity, and changes in skin quality, and he tailors each treatment to address these unique factors comprehensively.
As an invited speaker at national and international conferences and the lead editor of the top-selling textbook Master Techniques in Facial Rejuvenation, Dr. Azizzadeh’s expertise has garnered global recognition, drawing patients and colleagues seeking his innovative techniques and deep knowledge. Beyond his technical skills, his artistry, meticulous precision, and genuine patient-centered care distinguish him as a leader in the field, delivering results that seamlessly blend beauty with natural expression.
Dr. A's Insider Tips
“A conservative approach to fat grafting, often spread over multiple sessions, will avoid a rounded or unnatural appearance. “
Fat Grafting
Non-Surgical Alternatives
For patients seeking non-surgical options, injectable treatments may offer effective — though temporary — alternatives to fat grafting. These include:
Hyaluronic Acid (HA) Fillers
Products like Juvederm®, Restylane®, and Teoxane RHA® provide immediate volume with minimal downtime and can be dissolved if needed.
Collagen Biostimulators
Injectables like Sculptra®, Radiesse®, and Bellafill® stimulate collagen production for gradual, longer-lasting volume restoration — though they cannot be reversed.
Considerations for Fillers & Biostimulators
While effective, frequent filler use (especially in delicate areas like tear troughs) can lead to “filler fatigue,” causing puffiness (“pillow face”), inflammatory reactions (malar edema) or uneven texture. Biostimulators also alter tissue planes, which may complicate future facelift surgery by increasing tissue density and making dissection more challenging.
Timing Before Surgery
To optimize surgical results, we often recommend pausing biostimulator treatments for several months prior to facelift procedures, ensuring the safest and most precise outcome.
While non-surgical treatments offer flexibility and convenience, they require ongoing maintenance and may lack the natural integration and long-term regenerative benefits of fat grafting using your own tissue.
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FAQ
It’s normal to have questions before a procedure. If you have additional questions or concerns, book a consultation today.
Yes, fat grafting can be an excellent alternative to fillers for enhancing your appearance, particularly if you’ve experienced “filler fatigue” or issues such as inflammation in delicate areas like the tear troughs. Unlike fillers, which may require frequent maintenance and can lead to tissue irregularities or puffiness over time, fat grafting uses your fat to restore volume and contour naturally. The procedure involves harvesting fat from areas such as the abdomen or thighs through liposuction, purifying it, and strategically injecting it into facial areas that need volume, such as the cheeks, under-eye hollows, or jawline. Fat grafting not only offers a more natural look and feel but also provides long-lasting results, as the transferred fat integrates with your tissues and may improve skin quality by promoting collagen production. It offers a minimally invasive and more permanent volumizing solution, reducing the need for synthetic fillers while minimizing inflammation risks.
Fat grafting is an invaluable complementary technique in aesthetic facial plastic surgery, enhancing the results of traditional procedures like facelifts, browlifts, and blepharoplasty. While these surgeries primarily address tissue laxity and excess skin in two dimensions, fat grafting adds a crucial third dimension by restoring lost volume and providing natural contours. This volumetric enhancement is essential in addressing the facial deflation that occurs with aging, allowing surgeons to achieve more comprehensive and harmonious rejuvenation. By combining fat grafting with lifting procedures, plastic surgeons can create a more youthful and natural appearance, as the restored volume supports the lifted tissues and provides a three-dimensional projection that is both elegant and long-lasting. Moreover, the regenerative properties of adipose-derived stem cells in the grafted fat may improve skin quality, enhancing the overall rejuvenation effect.
Fat grafting offers a versatile and longer-lasting alternative to traditional hyaluronic acid (HA) fillers and biostimulators like Radiesse and Sculptra for facial rejuvenation. Using your fat, provides natural-looking volume restoration and may improve skin quality over time due to the regenerative properties of adipose-derived stem cells. While it is a more invasive procedure compared to injectables, fat grafting addresses volume loss and skin rejuvenation simultaneously, offering comprehensive and enduring results. Additionally, since fat is not hydrophilic like HA fillers, it can be a superior option for patients with allergies or inflammatory conditions, reducing the risk of adverse reactions.
Fat grafting is a versatile alternative to traditional dermal hyaluronic HA fillers and biostimulators (Radiesse, Sculptra) for facial rejuvenation. Unlike temporary fillers, fat grafting provides long-lasting volume restoration using the patient’s tissue, potentially offering more natural-looking and enduring results. Additionally, the regenerative properties of adipose-derived stem cells in fat grafts may contribute to improved skin quality and texture over time, mimicking and potentially surpassing the collagen-stimulating effects of biostimulators. While fat grafting requires a more invasive procedure compared to injectable treatments, it offers the advantage of addressing volume loss and skin rejuvenation simultaneously, making it an attractive option for patients seeking comprehensive facial rejuvenation with longer-lasting outcomes. Furthermore, since fat is not hydrophilic like hyaluronic acid (HA) fillers, it may be a superior choice for individuals with allergic issues or inflammatory conditions related to HA, reducing the risk of adverse reactions and providing a more biocompatible solution for these patients.
Fat grafting procedures offer various anesthesia options tailored to your specific needs and the complexity of the treatment. For standalone fat grafting, local anesthesia is often sufficient, providing a comfortable experience with minimal recovery time and no sedation-related side effects. However, if fat grafting is performed with other procedures, such as a deep plane facelift, general anesthesia or intravenous sedation may be used to ensure a safe and comfortable surgical experience. Modern anesthesia techniques also minimize the risk of nausea and other side effects, ensuring a smoother recovery. Dr. Azizzadeh and his team will work with you to determine the most appropriate anesthesia plan based on your specific goals and health considerations.
Fat grafting offers several advantages for treating tear trough hollowness. Unlike temporary fillers, fat grafting provides a long-lasting solution using the patient’s own tissue, potentially offering more natural-looking and enduring results. The procedure can address volume loss while improving skin quality due to the regenerative properties of adipose-derived stem cells. Additionally, fat grafting may be a superior choice for individuals with allergic issues or inflammatory conditions related to hyaluronic acid fillers, as fat is not hydrophilic and provides a more biocompatible solution for these patients.
For scarring and skin irregularities, nanofat grafting has emerged as a particularly effective technique. Nanofat grafting involves processing harvested fat into a liquid emulsion containing high concentrations of stem cells and growth factors, which can be injected more superficially into the dermis, allowing for precise treatment of fine wrinkles, scars, and skin texture issues while promoting skin regeneration and collagen production.
While superficial fine lines are often linked to skin texture and quality, deeper facial folds such as nasolabial folds, deep wrinkles, and marionette lines are primarily caused by underlying volume loss in fat compartments and gradual bony resorption. This loss of structural support leads to sagging and more pronounced creases, contributing to an aged appearance. Fat grafting can soften these deeper hollows and creases by augmenting the lost volume at the bony and fat compartment level resulting in a more youthful appearance.
Fat grafting can be a viable option for individuals who have experienced facial volume loss due to weight reduction from Ozempic or other GLP-1 agonists. However, the timing and approach require careful consideration. Ideally, patients should have reached a stable weight before undergoing fat grafting, as further weight fluctuations could affect the results. The procedure can help restore lost volume in areas such as the cheeks, temples, and under-eye regions, potentially addressing the “Ozempic face” phenomenon. It’s important to note that the fat used for grafting may behave similarly to other fat cells in the body, meaning it could be affected by future weight changes. Therefore, maintaining a consistent weight post-procedure is crucial for long-lasting results. Additionally, the success of fat grafting in these cases may depend on the individual’s overall health, the quality of their remaining fat tissue, and the skill of the surgeon. Patients considering fat grafting after weight loss from GLP-1 agonists should consult with a board-certified plastic surgeon to discuss their specific situation and determine the most appropriate treatment plan.
GLP-1 agonists have become increasingly popular for managing type 2 diabetes and, more recently, for weight loss due to their ability to regulate blood sugar levels and reduce appetite. Among the most widely used is semaglutide, available under brand names like Ozempic® for diabetes and Wegovy® for weight loss. Semaglutide works by enhancing insulin secretion, slowing gastric emptying, and significantly reducing appetite, often leading to substantial weight loss. Another prominent option is liraglutide, marketed as Victoza® for diabetes management and Saxenda® for weight loss. It promotes weight loss by reducing appetite and improving blood sugar control.
Dulaglutide (Trulicity®) offers the convenience of a once-weekly injection for diabetes management, helping regulate blood sugar, curb appetite, and support weight loss. Exenatide, available in twice-daily (Byetta®) or once-weekly (Bydureon®) formulations, also aids blood sugar control by enhancing insulin secretion and slowing stomach emptying. Tirzepatide (Mounjaro®), a newer option, acts as both a GLP-1 and GIP receptor agonist and has demonstrated exceptional effectiveness in improving glycemic control and promoting weight loss. Together, these medications provide powerful options for individuals managing type 2 diabetes or obesity, but healthcare professionals should always guide their use to maximize benefits and minimize potential side effects.
No, another person’s fat cannot be used for your fat grafting procedure due to the risk of rejection and complications. Fat grafting relies on using your fat, known as autologous fat transfer, harvested from areas like the abdomen or thighs. This approach eliminates the risk of immune rejection, as your body recognizes and integrates its tissue, making it a safe and effective option for enhancing volume and contour. Using donor fat would pose significant safety risks and is not a medically approved practice for fat grafting.
Fat grafting does not provide truly permanent results, but it can offer long-lasting effects that many patients find satisfying. While some individuals report results lasting five years or more, it’s important to note that over the first few weeks and months, a portion of the transferred fat cells will not be taken by the body, with studies indicating that about 30-50% of the fat may be reabsorbed. The surviving fat cells can integrate with surrounding tissues within three to six months, becoming a permanent part of the body; thus, the results are often considered semi-permanent rather than truly permanent. Factors affecting the longevity of fat grafting results include the quality of the transferred fat, the location of the fat transfer, the patient’s age, and lifestyle factors such as sun exposure, smoking, and weight fluctuations. Generally, younger patients tend to experience longer-lasting results compared to older individuals. Additionally, while fat grafting is typically more enduring than temporary dermal fillers, some patients may require multiple sessions to achieve optimal results. Ultimately, while the transferred fat cells can survive long-term, the natural aging process continues, which may necessitate additional treatments over time to maintain the desired effects.
The fat required for a fat grafting procedure varies depending on the specific facial areas being treated and the individual patient’s needs. Facial fat grafting typically requires smaller volumes than other body areas, with total volumes generally ranging from 10-30 ml. For example, cheeks may require 2-4 ml per side, nasolabial folds 1-2 ml per side, tear troughs 0.5-1 ml per side, temples 2-5 ml per side, and the chin 2-4 ml. Surgeons often inject 20-30% more fat than needed to account for expected reabsorption, but excessive overcorrection can lead to complications. Factors affecting fat volume requirements include the surgeon’s technique, the patient’s age, degree of volume loss, facial anatomy, skin elasticity, and treatment goals. Dr. Azizzadeh prefers a conservative approach which may require multiple treatment sessions, allowing for gradual enhancement and reducing the risk of overcorrection. It’s crucial to consider blood supply limitations, as injecting too much fat can overwhelm the local blood supply, potentially leading to fat necrosis and poor graft survival. Skilled surgeons inject small amounts in multiple passes to ensure proper distribution and maximize graft survival. Typically, surgeons harvest 2 times the amount of fat needed, allowing for processing and selecting the highest quality fat for grafting. Pre-operative assessment, facial analysis, and sometimes 3D imaging and computer simulations help determine optimal fat volumes. Ultimately, the exact amount of fat required will be determined by an experienced plastic surgeon based on the patient’s needs and treatment plan, ensuring natural-looking results while minimizing the risk of complications.
The pain associated with Fat Grafting is usually minimal. In many instances, patients can manage any pain they experience following the procedure with oral pain medication.
While there is no strict minimum weight requirement for fat grafting, patients need an adequate amount of donor fat available to harvest for the procedure to be successful. The ideal candidate for fat grafting typically has some areas of excess fat that can be used as donor sites, such as the abdomen, thighs, or flanks. However, even relatively thin individuals may have enough localized fat deposits to undergo small-volume fat grafting procedures, particularly for facial rejuvenation. The amount of fat required depends on the treatment area and desired results, with facial fat grafting generally needing smaller volumes than body contouring procedures. For instance, facial fat grafting may only require 10-30 ml of fat, while breast or buttock augmentation could necessitate more. Patients who are extremely lean or have very low body fat percentages may not be suitable candidates for fat grafting, as they may lack sufficient donor fat. In such cases, alternative treatments like dermal fillers might be recommended for facial volume restoration. Ultimately, the feasibility of fat grafting is determined on a case-by-case basis during a consultation with a board-certified plastic surgeon, who will assess the patient’s body composition, treatment goals, and overall health to determine if they have enough harvestable fat for the desired procedure.
The natural aging process, weight loss, GLP- 1 agonist such as Ozempic, or genetic factors can lead to a hollowed appearance in areas like the cheeks, brows, chin, temples, and under-eye hollows. Fat grafting restores youthful fullness by transferring fat from other body parts to these areas, creating a more balanced, rejuvenated facial contour. It also serves as a great complementary technique to deep plane facelift, blepharoplasty, and brow lift to address laxity and volume restoration.
A typical Fat Grafting procedure takes less than one to two hours to complete, depending on whether it is being done in conjunction with other procedures. The length of the procedure varies based on the areas of a patient’s body in which fat is harvested and grafted.
Fat grafting, while generally considered safe, can lead to various side effects and potential complications. Common minor side effects include swelling, bruising, and temporary discomfort at both the donor and recipient sites, which typically resolve within a few weeks. More significant adverse events may include contour irregularities, over- or under-volumization, prolonged edema, fat necrosis, granuloma formation, and infection. In rare cases, severe complications such as fat embolism can occur, potentially leading to vision loss or stroke if fat is inadvertently injected into blood vessels. Other possible undesirable outcomes include asymmetry, calcification of grafted fat, cyst formation, and unsatisfactory aesthetic results. Some patients may experience acne activation, telangiectasia, or prolonged erythema in the treated areas.
Additionally, there’s a risk of donor site morbidity, including contour deformities or scarring. While the overall complication rate is generally low, with most studies reporting rates between 2-8%, the true incidence may be higher due to underreporting. The severity and likelihood of complications can vary depending on the treatment area, fat transfer volume, and the surgeon’s technique and experience.
Preparation
For the best results and swiftest recovery, we recommend the following leading up to your procedure.
Preparation for fat grafting is essential to ensure optimal surgical outcomes and a smooth recovery. The preparation process may differ based on whether fat grafting is performed as a standalone procedure under local anesthesia or as a complementary enhancement to surgeries such as facelifts, blepharoplasty, or brow lifts, where the primary surgical procedure takes precedence. Consulting with Dr. Azizzadeh and his team will ensure you receive a personalized preparation and care plan tailored to your unique needs.
Discontinue smoking, vaping, and any nicotine products, as these can impair healing and surgical results. Prioritize maintaining a balanced diet, staying hydrated, and exercising regularly to optimize your overall health. Discuss with Dr. Azizzadeh any planned non-surgical procedures, such as fillers, laser treatments, or botulinum toxin injections, to prevent potential interactions. For fat grafting combined with a facelift, blepharoplasty, or brow lift, refer to those sections for detailed preparation, as plans are adjusted accordingly. Standalone fat grafting under local anesthesia typically requires minimal medical clearance, but a consultation with Dr. Azizzadeh is recommended to review the procedure, outcomes, and care instructions.
If required, complete any necessary pre-operative tests, such as bloodwork (e.g., a complete blood count) or an EKG, particularly for complementary procedures involving general anesthesia. Standalone fat grafting under local anesthesia may not need such clearances but should be discussed with Dr. Azizzadeh.
Discontinue aspirin, anti-inflammatory medications, and specific herbal supplements that can increase the risk of bleeding. This is also a good time to complete any personal grooming tasks that may be limited during the recovery period.
Attend a pre-operative consultation with Dr. Azizzadeh to review your treatment plan, expected outcomes, and potential risks. During this visit, you will sign informed consent forms and receive detailed pre- and post-operative care instructions.
Stock up on post-operative supplies, such as ice packs, prescribed medications, and comfortable pillows for head elevation during recovery. Ensure a responsible adult can assist you during the initial recovery period.
For Procedures Involving General Anesthesia (e.g., Complementary Fat Grafting): Avoid eating or drinking after midnight. Follow any specific instructions regarding preoperative medications and practice relaxation techniques to alleviate pre-surgery anxiety.
For Standalone Fat Grafting Under Local Anesthesia: Avoid heavy meals the night before, and follow any specific instructions provided by Dr. Azizzadeh’s team.
On the morning of your procedure, shower with antibacterial soap if instructed, avoid applying makeup or skincare products, and wear loose-fitting clothing that buttons or zips in the front. Arrive at the surgical facility at the designated time.
Recovery
Recovery from fat grafting generally occurs in four phases. It is important to note that if you undergo fat grafting in conjunction with other procedures, such as a deep plane facelift, brow lift, or blepharoplasty, the healing process may vary based on the complexity and combination of these procedures. Each recovery stage may differ depending on individual healing responses, and your timeline may be adjusted to accommodate the needs of each surgical approach.
During the initial phase, swelling and bruising will be most noticeable but should gradually begin to subside. At the donor site where fat was harvested, you may experience some soreness and possible bruising, though no compression dressing is typically used to aid in the healing process. Rest is essential, but taking short, gentle walks outdoors (preferably in shaded areas) can promote blood circulation and speed up recovery. By the end of this period, many patients can start resuming daily activities, work, and errands.
You will start to appear more socially presentable as swelling and bruising continue to diminish. Mild redness at the injection sites may still be visible but should gradually fade. At around three weeks post-procedure, you can return to normal exercise and physical activity, based on your comfort level and Dr. Azizzadeh’s recommendations.
Most soft tissue healing occurs during this phase. Swelling continues to decrease, and your facial contours will appear more natural and refined. Any numbness around the treatment or donor area should gradually normalize. You will begin to see more stable and lasting results from the fat grafting procedure.
Dr. Azizzadeh may recommend additional fat grafting to refine and enhance initial results, addressing areas that may not have retained optimal volume or symmetry. By taking a judicious approach and opting for conservative volumes initially, he avoids the risk of overcorrection, as excess fat cannot be easily removed once grafted. This careful strategy allows for more precise adjustments over time, ensuring refined, natural-looking results tailored to each patient’s unique features.
For a personalized recovery plan and guidance through each stage, work closely with Dr. Azizzadeh and his team to address any unique needs or concerns.
Pain Management: It is critical to Avoid ibuprofen and other non-steroidal anti-inflammatory drugs (NSAIDs) as they can increase the risk of bleeding and bruising. If you experience severe pain, contact your surgeon immediately.
Medications and Supplements: To ensure optimal healing and reduce the risk of complications, avoid blood thinners and certain medications for 2 weeks before and 2 weeks after surgery. These include Aspirin, NSAIDs (such as ibuprofen, Advil, and Naprosyn), fish oil, herbal supplements, and vitamins. Additionally, refrain from smoking, vaping, all nicotine products, cannabis/marijuana, and illicit drugs during this period.
Swelling and Bruising: In the first 72 hours after surgery, use cold compresses for 20 minutes per hour while awake to reduce swelling and bruising. After this initial period, switch to warm compresses applied for 20 minutes, three times a day, to help alleviate bruising and promote healing. Additionally, you will be given arnica and bromelain to help reduce swelling and bruising. Arnica is a natural remedy known for its anti-inflammatory properties, and bromelain, an enzyme found in pineapples, helps decrease swelling and bruising. At the time of surgery, you will also receive a dose of steroids to minimize swelling. In some cases, a short course of steroids may be prescribed after surgery to manage excessive swelling. This regimen helps manage discomfort and accelerates the recovery process.
Nausea and Diet: If you undergo fat grafting as a standalone procedure under local anesthesia, you will likely not experience any nausea. If fat grafting is performed alongside other procedures, such as a deep plane facelift that requires anesthesia, modern anesthesia methods, and our specialized protocol help make post-operative nausea much less common and very manageable. During surgery, your anesthesiologist will administer intravenous anti-nausea medications and specialized anesthetics that limit gastrointestinal issues. Additionally, you will be prescribed Emend™ to take three hours before surgery to prevent nausea and Ondansetron (Zofran®) for breakthrough discomfort. It is recommended to avoid complex or heavy foods for 24 to 48 hours after surgery and instead consume clear liquids and bland, easy-to-digest foods, such as broth, plain toast, or crackers. Gradually reintroduce solid foods to ease digestion and minimize discomfort. Hydration is crucial during the post-operative period. If submandibular gland modifications are performed, follow a bland diet, avoid spices, and opt for soft foods to minimize discomfort and swelling in the neck area.
Incision Care: Incision care for fat grafting involves minimal attention. The donor site is typically covered with Telfa or Tegaderm dressings, which are removed after about one week, while dissolvable sutures ensure seamless healing. The injection sites heal quickly and generally require no major attention, as fat grafting is a “scarless” procedure. This approach promotes a smooth recovery with minimal visible signs of the procedure.
Hair Management: Fat grafting requires no special hair management unless performed with a deep plane facelift or browlift.
Additional Support: When performed as a standalone procedure, most patients go home the same day. If combined with facelifts, we often recommend post-surgical aftercare with skilled nurses, ensuring you receive the highest level of attention and support during your recovery. These facilities help you have a smooth and stress-free post-operative period, allowing for optimal healing and peace of mind. Additionally, incorporating hyperbaric oxygen therapy (HBOT) as part of your post-operative care can further enhance your recovery. Hyperbaric oxygen therapy delivers concentrated oxygen in a pressurized chamber, promoting accelerated healing by increasing oxygen supply to tissues, reducing swelling and inflammation, and improving collagen synthesis. Research has shown that HBOT can aid in reducing post-operative complications, enhancing wound healing, and minimizing scarring, making it a beneficial option for many patients undergoing facial and neck procedures. Discuss with Dr. Azizzadeh and his team whether hyperbaric oxygen therapy is appropriate for your specific post-operative care plan.
Post-Surgery Warning signs: After a fat grafting procedure, it is essential to monitor your recovery closely and contact your doctor if you experience any concerning symptoms. Warning signs include a change in vision, pressure in the eye socket, sudden or severe swelling, bruising that worsens instead of improving, intense pain unrelieved by prescribed medications, or any signs of infection such as fever, redness, warmth, or drainage at the incision site. Warning signs to watch for at the donor site after fat grafting include increasing redness, swelling, warmth, drainage, persistent pain, or abdominal discomfort such as pain, distension, or bloating, which could indicate a more serious issue, including rare cases of perforation. If you experience any of these symptoms, contact your healthcare provider immediately for evaluation and appropriate care. Additionally, difficulty breathing, chest pain, or numbness or weakness in the face or neck should be reported immediately, as these may indicate complications. Prompt communication with your healthcare provider can ensure timely intervention and a smooth recovery process.
Healing can vary from person to person, and some individuals may experience a longer recovery period.