Fat grafting, Fat transfer, Fat injections: What can they achieve?

Ricardo Rodriguez

by Ricardo Rodriguez | January 7, 2011 @ 08:00AM
Medically Reviewed by Ricardo L. Rodriguez

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graftingFat grafting is the use of your own fat to restore volume to your face, breast, body, or buttocks. The fat transfer creates a natural result that is refreshed, youthful and radiant. Fat is extracted from unwanted areas, carefully processed, and then reinjected in tiny droplets into the area you want to rejuvenate. The reinjected fat fills wrinkles and lifts tissue so that your face looks younger , your breasts look perkier, or your buttocks more prominent. The fat transfer procedure has been performed successfully by plastic surgeons all over the world for many years, but recent advances in technique have made the procedure much safer, reliable, and long lasting.

The terms fat grafting, fat transfer, and fat injections are used interchangeably by plastic surgeons, as they all refer to the same procedure.However, techniques used by individual surgeons vary widely and produce different surgical results. The surgeon you select should be a board certified plastic surgeon with years of fat grafting experience. Your surgeon should have confidence that his results are lost lasting, not temporary.

 

What areas of my body can be improved with fat injections?

The most common areas of fat grafting are to the face and buttocks. Recently, fat injections have been successfully used in breast reconstruction and breast augmentation. Other areas of injection include the hips, hands, and feet.

FACE

As we age, the fat distribution in our body changes. Some areas gain fat, but other areas such as the face, lose fat. In our face, this loss of fat results in sagging facial skin and a tired facial expression."Fat grafting to the face allows a surgeon to restore volume to your face and make your face look younger . Not only does fat grafting help build tissue but it also restores a youthful glow to your skin. Within the fat are stem cells which help rebuild the structure of the skin. Common areas of fat grafting include:

Bags under the eyes
Nasolabial fold lines around your mouth
Facial wrinkles
Facial asymmetry
Lips

BREAST

In July 2009, the American Society of Plastic Surgeons (ASPS) Fat Graft Task Force published a position paper on the Current Applications and Safety of Autologous Fat Grafts. The paper reviewed 283 patients who had fat grafting to the breast. Prior to this paper, there was some controversy among the plastic surgery community regarding the safety of fat grafting to the breast. The report concluded :

"Regarding fat grafting to the breast, there are no reports suggesting an increased risk of malignancy associated with fat grafting."

 

Furthermore, the study concluded that "Fat grafting can be considered a safe method of augmentation and correction of defects associated with various medical conditions."

This report reviewed fat grafting cases for breast surgery with the following indications:

Micromastia (small breasts)
Post breast augmentation deformity
Poland's syndrome
Post lumpectomy defects
Post mastectomy deformity
Defects caused by reconstruction with breast implants or tram flaps
Damaged tissues from radiation therapy

BODY and BUTTOCKS

 

The procedure which requires the largest amount of fat "brazilian butt lift (butt augmentation)". During a brazilian butt lift procedure, the surgeon can transfer up to 1000cc of fat into EACH buttock cheek. Compare this large amount to the small quantity needed for a mid facelift (20- 25cc) and you will no doubt conclude that brazilian butt lift surgeons must be highly skilled and experienced with fat processing.

 

Other ways that fat injections can make your body look younger or more sensuous:

Add curves in the hips "fat injections hips"'apple shaped' body types to give them a curvier silhouette
Restore volume to make hands look younger

What is involved in the fat transfer procedure?

In any fat transfer process there are three steps:

1) Extraction: Fat is removed from unwanted areas of your body such as your stomach, flanks, and thighs. The liposuction should be performed with low pressure liposuction using 3-4 mm cannulas. The extraction can not be performed by any type of laser liposuction as it will damage the fat viability and destroy regenerative cells found in the fat.

2) Processing: The fat tissue is decanted, and then centrifuged under certain conditions of time and speed.

3) Reinjection: Following processing, fat is reinjected in tiny droplets. It is essential that fat is injected at different tissue depths to ensure that every fat droplet is next to a good blood supply source in your tissue.

What type of anesthesia is used in the procedure?

The fat transfer procedure can be performed under local anesthesia or under IV sedation. In summary, it depends on the type of fat transfer being performed and how many hours I expect the case to be. Most facial cases are performed under local anesthesia which means that I numb the areas with a local anesthetic block and you are awake during the procedure. Most patients are given something to help them relax such as valium. Alternatively, if you do not want to be awake during the procedure and cost is not an issue, you can elect to have your facial procedure under IV sedation , also known as twilight anesthesia.

Breast and buttock cases are usually longer than 4 hours and all require the use of IV anesthesia so that you are sleeping during the procedure. In order to eliminate the risk of pulmonary embolism, I avoid using general anesthesia with all of my fat injection cases. This not only reduces anesthesia risks, but it also allows the patient to recover with less nausea.

How long does the procedure take?

Average estimated OR times should vary from 2.5 hours (for a limited facial area) to 8 hours (large volume brazilian butt lift). The time spent in properly processing the fat is very important and should not be shortchanged.

Each step (extraction, processing, and reinjection) requires detailed attention to perform it correctly. In summary all three steps of this procedure can not be performed within a hour. If a surgeon tells you that your procedure will take an hour, I would ask for the details of how he performs each of the three steps!

What is the fat transfer recovery like?

During the initial 10 day post operative period of your fat transfer procedure, the fat grafts are at their most delicate stages. During this period, there should be minimal pressure applied to the grafts. If you have had fat grafting to the face, you should be sleeping on your back and not lying on the side of your face. For large volume fat transfer procedures, such as the brazilian butt lift, the post operative period is even stricter! Patients who have undergone fat transfer to the buttocks should not sit on their buttocks for up to three weeks in order to assure that the fat has grafted securely within the tissue.

How long does the result last?

If the fat is properly extracted, processed, and reinjected, you should have a long lasting result. This should equate to a result that lasts many many years, and not just 6-12 months. Surgeons who tell you that you will need multiple injection sessions for the face or buttocks are clearly not using the best available fat processing techniques.
Furthermore, if a surgeon tells you that the fat injection results are 'temporary' and no better than 'synthetic fillers', consider consulting a board certified plastic surgeon who is experienced with fat grafting.

What is "regenerative" fat grafting?

Although the terms fat grafting, fat transfer, and fat injections are used interchangeably, the term 'regenerative fat grafting' has a slightly different meaning.

Regenerative fat grafting is processing the fat in a special way which can increase the yield of "adipose stem cells (fat stem cells)"stem cells from your own fat. These adipose stem cells will help the fat grafts survive the longest. The stem cells present in the fat graft are what give the fat grafts their special properties. These adult stem cells rebuild tissue and help heal injured areas. A properly performed fat graft will not only fill the tissues, but will also regenerate them.
Regenerative fat grafting is the new frontier of plastic surgery!

By Ricardo L Rodriguez, MD

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