Fat Transfer: taking it from where you don’t want it and putting it where you do.
Fat is a natural and predictable filler that has been used for a century to increase volume, fill voids, and plump wrinkles. Some of the main advantages of using fat include the fact that it is a natural filler, since it is harvested from the patient, there is no allergic issue, it is easy to harvest and the average patient has plentiful reserves.
Fat transfer is also referred to as “Fat Injection” or “lipo transfer” and is a popular cosmetic surgery procedure. The basic premise of fat transfer is to harvest fat cells from the patient (from an area where they don’t need it) and inject it into an area on the patient’s body where they do need it.
Common areas of fat harvest include the area around the belly button, the flank region “love handles”, the outer thigh and the buttocks. Fat harvest is a simple procedure that is usually performed with local and tumescent anesthesia. A dilute solution of lidocaine (anesthetic) and epinephrine (decreases bleeding) is injected into the site of the anticipated fat harvest. After waiting about 15 minutes for the tumescent anesthesia to take effect, the fat is harvested with a device called a cannula, which is a narrow hollow rod with a suction source. Depending upon the amount of fat needed, 10 to 100 cc’s are removed.
Processing the Fat
After the fat is harvested it is processed. This may include separating the fat from the other tissue by products by using a device called a centrifuge which spins the “good” (live) fat from the other cells. Some surgeons feel that rejuvenating cells known as “stem cells” are included with the live fat cells.
Many surgeons do not centrifuge the fat, but process it by draining, washing and rinsing. Regardless of the processing, the live harvested fat cells are placed in smaller syringes for the transfer process.
Fat Transfer Procedure
The harvested fat in the small syringes is injected with tiny blunt needles called micro cannulas. A small puncture is made in the skin with a needle and the small, blunt cannula is placed under the skin and the small amounts fat in the syringe are injected. The technique of the fat injection is paramount to the success of the procedure. If large amounts of fat are injected in a single area, the body will attempt to dissolve it. If very small “grains” of fat are injected into multiple tissue planes (over bone, in muscle, in other fat and under the skin) the body does not dissolve the fat as rapidly. Performing multi level, small volume fat injection allows the many of the transplanted fat cells to survive and the augmentation to become permanent.
Where is Fat Transfer used?
Fat can be used as a filler in just about any part of the body. Fat is most commonly injected in the face to increase youthful volume. This includes the temples, regions around the eyes, the cheeks, the jawline, smile lines ,frown lines and lips. Fat can also be used to inject under the skin of the back of the hands for rejuvenation of the skeletonized appearance of aging. Some surgeons use fat to augment the breasts, buttocks and calf’s or to fill in defects from trauma or surgery.
What Type of Maintenance is Required with Fat Transfer?
Some transplanted fat cells will live forever and produce a permanent augmentation. This is not true for all the transplanted cells and many of them will be dissolved by the body. For this reason “touch up” fat transfer treatments may be necessary. Some surgeons will recommend 2-3 touch up procedures to obtain a “permanent” result and this may also require some touch up transfer injections every several years.
For touch up injections, some surgeons will reharvest more fresh fat for each procedure, while other surgeons will freeze extra fat at the first harvest appointment and thaw out this fat at each touch up appointment.
Complications and Draw Backs
Like any filler procedure, complications can include bleeding and infection, both which are rare. A relative drawback of tat transfer is that two sites are required, one to harvest and one to inject. Over correction and under correction can be experienced with any filler. Over correction is a minor problem with injectable fillers such has hyaluronic acid as the filler is digested over time by the body. Fat, on the other hand can be a permanent filler and if over correction occurs, the excess must be surgically removed. While most experienced surgeons obtain lasting results, each patient has specific differences and fat transfer may or may not be the optimal treatment. Like all procedures, the specifics of the procedure and alternative treatments should be discussed with an experienced surgeon. To find out more about cosmetic facial surgery by Dr. Joe Niamtu in Richmond, Virginia visit www.lovethatface.com
Joe Niamtu, III DMD
Cosmetic Facial Surgery