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Dr Tim Neavin
Surgery with Symmetry
Dr Tim Neavin

Fat Transfer: Adding Volume for a Natural and Youthful Look

Are you bothered by scarring following treatment for diseases such as cancer? Do you feel younger than you look? Would you like to repair some of gravity’s effect on your body over the years?

Fat grafting may be the answer for you. This procedure uses your own fat so there is no risk of rejections. The fat is processed to make it purer for use in another part of your body.

This procedure has gained interest as a treatment for more than cosmetic reasons. Grafted fat can also repair breast tissue after radiation treatment. This may one day prove helpful for diseases like Parkinson’s Disease and diabetes.

If you think this procedure may improve your body image and self-confidence, learn more about treatments, goal, and risks. Then talk with a certified plastic surgeon to see if the procedure will benefit you.

What is Fat Grafting?

You may hear many terms used that refer to the same procedure. Fat grafting is also called fat transfer or fat injections. This surgical procedure moves fat, taken from one area of the body, to another part.

This treatment can improve the cosmetic appearance of the face, breast, hands, feet, hips, and buttocks. Surgeons have also found it useful in healing wounds and scars. For example, fat can help to repair damaged breast tissue after radiation treatments.

Procedure for Fat Grafting

The fat grafting surgery takes place in several stages.

First, liposuction removes fat cells from the donor area. Liposuction involves controlled manual suction through small holes to remove fat. This decreases potential harm to the fat cells.

The fat is then processed with decanting and centrifugation. This separates debris, excess fluid, and dead cells.

The final phase involves injections of the purified fat is in small droplets throughout the tissue layer immediately beneath the skin. This allows every fat droplet to receive a good blood supply. This may take place during several separate sessions.

Anesthesia for this procedure may include sedation and local anesthesia or general anesthesia. It may depend on the volume of fat needed for grafting.

The procedure has appealing outcomes because it uses the body’s own natural fat. The result looks more natural without exaggerated augmentation. It also poses no risk of rejection.

Common Areas of the Body Treated with Fat Grafting

Fat grafting provides positive clinical outcomes to many parts of the body.

Face. By adding volume to wrinkled or sunken areas below the eyes and between the cheeks and nose, you can regain a more youthful look.

Fat grafting also helps with scars and smooths out rough facial skin. Adding fat over the cheekbones can provide the appearance of high cheekbones.

Breast. Used for breast augmentation and to correct uneven breasts. Repair breast tissue damage following radiation treatment. Fat grafting also helps correct scar deformities from implant capsular contractures, lumpectomy, or breast reconstruction.

Hips. Fat grafting can increase volume in the hips to create the desired waist to hip ratio.

Buttocks. The procedure, also called a Brazilian butt lift, increases the size of the buttocks and decreases sagging.

Hands and feet. Fat grafting can make the hands and feet look younger by reducing wrinkles. It can also add padding over bony feet.

Risks Associated with Fat Grafting

As with all invasive procedures, some unfavorable outcome may occur.

More common risks associated with fat grafting include:

Infection. Infection can occur anytime bacteria enters broken skin. Sterile technique decreases infection risk. Some physicians order antibiotics to prevent infection.

Bruising or collection of blood under the skin. All invasive procedures carry a risk for bruising or collection of blood under the skin.

Swelling. Swelling my occur after injection underneath the skin. Treat inflammation with elevation, cold therapy, and external pressure bandages. The patient is also asked to avoid heavy pressure on the treated area for 7 to 10 days to prevent movement of the

Irregularity of the donor area. There may be an unevenness to the donor part of the body. This is more often seen in very thin patients.

More Problematic Complications include:

Oil Cysts. If a drop of fat oil is not completely absorbed, a collagen shell can form around it. This becomes inflamed and a sand-like macrocalcification can develop over the first 5 years.

If a large amount of fat tissue dies, it creates an oil cyst that occurs in the first 6 tom12 months after the grafting. This causes ongoing inflammation that does not go away.

An ongoing study has shown that injecting smaller amounts of fat cells under less pressure over several session decreases the risk of these complications.

Stroke, blindness, and tissue death. Severe complications involve fat entering the blood system causing a fat embolism. If it stops the blood flow in the vessels of the eye, blindness results.

If the fat embolism blocks a vessel in the brain, a stroke occurs. Skin and tissue die if their blood flow stops, as with an embolism.

These risks can decrease by using a larger, less blunt instrument. Injection of small amount of fluid with low pressure, especially around the face, also lowers risks.

Finding a Qualified Healthcare Provider for Fat Grafting

Many people have cosmetic procedures performed by unqualified practitioners. This can result in undesired results and even death. Fat transfers to the buttocks, for example, have resulted in several deaths due to excessive fat transfer.

The American Board of Cosmetic Surgery provides the following checklist to help you choose the right practitioner:

  • Are you certified by the American Board of Cosmetic Surgery or the American Society of Plastic Surgeons?
  • How did you train to perform this procedure?
  • How many years have you been performing this procedure?
  • How many times have you performed this procedure?
  • Is the surgical facility accredited by an agency such as JCAHO?
  • Ask to see before-and-after pictures
  • How will you perform my procedure?
  • How often have you had patient complications that required further intervention?
  • What kind of anesthesia will be given?
  • What does the recovery process involve?

Questions to ask yourself after the visit:

  • Do I feel comfortable with the physician and staff at the clinic?
  • Do I feel like my questions were answered truthfully and without hesitation?
  • Did I feel like I was getting a sales pitch?
  • Do I feel comfortable asking the physician and staff members questions?
  • Am I sure that I am ready to have this procedure done?

Once you have researched your surgeon, stop and listen to your heart. Do you feel completely comfortable with your decision? If you have doubts, wait. Take your time in making your decision.

Future Improvements to Decrease Loss of Volume in Fat Grafting

A variety of studies conducted over the past 30 years have focused on using Plasma Rich Protein (PRP) to improve outcomes with fat grafting. The studies, unfortunately, used different circumstances and protocols. This makes it difficult to draw conclusions from their outcomes.

Studies are now looking at injecting autologous PRP as part of the fat grafting procedure. The optimal goal would be to improve retention of injected fat volume over time. 

Time for science. PRP, found in our platelets, contains a significant amount of growth factor. Autologous means that it comes from you. The immune system uses platelets to repair damaged parts of the body.

Blood platelets come from your blood and then get activated in a glass and subjected to freezing cycles or by adding calcium or thrombin. The growth factor is most active in its first 4 hours, but continues for up to 7 days.

The growth factor stimulates healing and tissue repair. It also causes more cells to form.

Of great importance, PRP makes cells more resistant to stress caused by decreased oxygen. In the first few days following fat grafting, the fat cells must fight to survive in a environment that has less oxygen than where they came from. The PRP also stimulates growth of blood vessels to supply more oxygen.

Finally, PRP tells the body to make an extracellular matrix. This helps the transferred fat tissue to move into a proper arrangement. Thus, improving the cosmetic effects. 

Once further research has been completed, this may offer greater outcomes for fat grafts in the future.

Future Disease Treatment Using Fat Cells

Many ongoing clinical trials are using adipose (fat) derived mesenchymal stem cells to treat the following conditions:

  • Congestive obstructive pulmonary disease (COPD)
  • Pulmonary fibrosis
  • Congestive heart failure
  • Osteoarthritis
  • Parkinson’s disease
  • Diabetes
  • Multiple sclerosis
  • Muscular degeneration
  • Urinary incontinence
  • Neurological disorders