American society of plastic surgeons - Member

Fat Grafting – Transfer : Concepts and Overview

“I want to look younger!” exclaims the patient who comes in for a consultation for facial rejuvenation. “I feel hollow and if you just do this and that, it looks better” as she molds her skin into the shape that appeals to her – just as she has done each morning in front of the mirror countless times before. Needless to say, and despite the improvement of skin laxity, lines and jowls, the patient still has a look that betrays the age she really is. And despite wonderful results, many of the current methods of facial and body contouring, unfortunately, address only part of the bigger problem.

Aging is a complex process that affects many aspects of appearance. Not only do we see wrinkles and changes in skin tone and quality, we also observe a significant change in the loss of volume. In addition to wonderful skin quality a youthful face is full with curves and contours that are smooth and gentle. So, even when improvement is seen after traditional face lift or eyelid procedures, much of the stigmata of the aging face still remain – the look of hollowness that skin lift/removal procedures just can’t fully address.
Restoring volume is not a new concept but has recently received a greater degree of the attention it deserves. A myriad of new fillers continue to flood the market all with the intent of restoring lost volume. However, all fillers have drawbacks by either being substances that are not natural and/or of very limited lifespan. Is there another alternative?

Actually, there is. It’s called fat. It’s natural and it has the capability to last a lifetime. If this is true, then why isn’t everyone using it? Actually, many surgeons do, but unfortunately with results that are often inconsistent and unpredictable. Using fat is not a new concept, either, and attempts to perfect the permanence and consistency have been investigated for years. The key point of its use lies in the fact that fat, unlike other fillers on the market, is living tissue: it requires a blood supply to exist; otherwise it will simply die, resulting in either loss of the filling effect or become hard and lumpy from the development of scar tissue. So, unlike other fillers, it cannot be simply “injected” but rather has to be transferred as a living substance (called a “graft”) in a manner that does not result in its destruction and, at the same time, allow its “transplantation” to result in new blood flow to it.

Although there are various approaches to fat grafting, one particular method called “Lipostructure™”, developed by Dr. Sydney Coleman in New York City, allows fat parcels to be removed from one part of the body (donor site) and transferred to another (recipient) site to achieve volume restoration. The technique is unique, specific and time consuming. It uses a syringe attached to a special blunt (never sharp) hollow metal tube called a canula so that fat grafts can be collected in a way that minimizes injury to them thereby allowing them to remain intact. Then, after processing, the fat is placed back into the body at the desired areas to be filled. Special blunt canulas are again used to deposit hundreds of very small “parcels” of fat (each the size of a pinhead), within its own nest of living recipient tissue so that new blood vessel growth can occur. This is all done under local anesthesia with the use of sedation.

Because Lipostructure is a technique in which fat is transferred and managed as living tissue and in a manner which promotes new blood vessel growth, it survives. If it survives, it will always be there. Is it “permanent”? Well, after more than 20 years of experience, Dr. Coleman has shown excellent and consistent results in patients who have kept their grafts since the beginning…this is probably as close to permanent as one can get. Results in my own practice have been the same – permanent restoration of volume loss without palpable or visible deformities.

Another aspect of fat is that it can be obtained from any number of donor sites in the body (an aspect that most people are totally happy with) and used in any number of sites that require volume. This not only includes the face, cheek, and lips, hollow of the eye regions, and temples, but other areas as well. For example, the aging hand also looses volume and as this occurs, prominence of veins, bones, and tendons occur. Even defects resulting from previous procedures such as liposuction or blepharoplasty (eyelid surgery), can be improved if not fully corrected, with the use of fat (as seen in patient at top of page). And, finally, what about the breast? Although fat would be an excellent filler, the possibility of any of the fat not surviving does exist with any technique and when this occurs, the deposition of calcifications may take place. Although this is not a problem in itself, their presence may lead to confusion when mammograms are obtained.

There is no question that the issue of volume replacement is a key component to improving the effects of aging and deformities brought about due to other circumstances and that the future of fillers is probably here to stay for a long time to come. However, the search continues since no perfect solution has been realized. Ultimately, the best filler will be a product that is not rejected and gives long-lasting results with minimal risk and cost. In the end, it will be no surprise if fat becomes the final choice.

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