Fat grafting is a procedure in which fat is removed from one area of the body (called the donor area) and transferred to another area with the goal of improving or augmenting the area where the fat is injected. It is also called fat transfer or fat injection. The procedure involves extracting adipose tissue (fat) through liposuction, usually from the belly or thighs, processing it in the laboratory, and injecting the purified fat into an area needing enhancement. Because a person's own natural tissue is used during fat grafting, it is called an autologous fat transfer.
Plastic surgeons have been using autologous fat for grafting since the 1990s to improve body contour in various areas including the face, breasts, buttocks, hips, hands, and feet. More recently, plastic surgeons have realized that a fat graft can also be beneficial in healing scars and wounds. In breast cancer patients who have undergone radiation therapy or cancer surgery, a plastic surgeon can use fat transfer to repair damaged tissue.
History of fat grafting
While the cosmetic use of fat transfer is relatively new, the first fat grafting took place more than 100 years ago when a plastic surgeon in Germany, Gustav Neuber, grafted fat from the arm of a patient to the eye to correct scars. Shortly after this, another plastic surgeon, Viktor Czerny, performed the first fatty tissue transfer to the breast to achieve symmetry in a patient with partial mastectomy (breast removal) on one side.
Despite these early successes, however, the technique did not gain wide acceptance for the next 100 years because modern methods of extracting adipose tissue (fat) had not yet been developed. Grafting procedures yielded poor results because the extracted fat was of inconsistent quality.
Fat grafting for cosmetic treatments gained popularity in the 1990s after a plastic surgeon in New York City, Sydney Coleman, developed standardized techniques to extract, process, and inject fat cells . Over time, various applications for fat grafting have been developed. The most popular are facial rejuvenation, breast augmentation, and Brazilian butt lift.
Fat grafting process
To perform the procedure, the surgeon first extracts the fat cells from the donor site through a small incision using liposuction techniques. The recommendations are for manual fat extraction because laser or ultrasound techniques can destroy the fat cells.
The extracted fat is processed in the laboratory where it is decanted, centrifuged, and purified. Excess fluid and dead cells are removed and the viable fat is washed with saline solution. This ensures that only the cells that can survive after fat injection are used for the graft.
The final step consists of injecting small droplets of the purified fat under the skin in the areas of the body that need improvement. The plastic surgeon measures the fat in cc's and injects the amount that is appropriate for correction. Placement of the fat under the skin ensures there is a good blood supply to every droplet of injected fat so that the graft survives.
Common areas of fat grafting
Fat grafting can help improve or enhance several areas of the body, which are described below:
Typical volumes of fat injections in areas of the face vary from 10 cc to 100 cc. Using fat, the surgeon can restore a more youthful appearance by adding volume to wrinkled, sunken, and hollowed out areas such as under the eyes and in the nasolabial folds. Patients with facial scars can benefit from micro lipoinjection. Fat grafts in the face are also used for cheek augmentation to give the illusion of high cheekbones and to improve skin texture.
Anywhere from 40 cc to 400 cc of lipofilling can be performed in each breast to increase breast volume by 1-2 cup sizes. Besides increasing breast size, fat tissue can be used to improve symmetry in the breasts. In patients with capsular contractures from radiation damage after breast cancer treatment, fat transfer can help treat the contractures and correct the scars left behind after lumpectomy or breast reconstruction.
Plastic surgeons can use anywhere from 200 cc to 13oo cc or more of injected fat to lift the buttocks (make them perkier) and to augment the size of the buttocks - this is commonly called a Brazilian butt lift.
In the hip area, recommendations are to use 100 cc to 300 cc of grafted fat on each side to add volume for a better waist-to-hip ratio and a more feminine silhouette.
Hands and Feet
Roughly 5 to 10 cc of fat grafting into each hand or foot can rejuvenate the limb by reducing wrinkles. Fat transfer can also be used to provide padding for bony feet.
Types of anesthesia for fat grafting
Fat grafting can be performed under both local anesthesia and general anesthesia. The choice of anesthesia is dictated by the volume of fat extracted from donor sites. Local anesthesia is commonly used to remove small volumes of fat. However, larger volumes of fat, more than 500 cc, require sedation and IV anesthesia or general anesthesia for safe extraction. Your surgeon will discuss the type of anesthesia appropriate for the type of fat grafting procedure you are undergoing.
Detailed procedural information
Plastic surgeons use various techniques to ensure the best results from fat injections. For instance, less traumatic methods of harvesting fat increase the viability of the graft and the chances of graft survival. To this end, your surgeon may use a technique like syringe aspiration or vacuum aspiration. Some studies suggest direct fat excision has superior results to aspiration. Cannula size can also affect the viability of the graft (large-bore cannulas reduce damage to the fat cells).
During the processing stage, surgeons use various techniques, such as filtering, washing, sedimentation, and centrifugation to remove debris from the fat which can cause inflammation at the injection site.
At the time of fat injection, choosing a recipient site with high vascularity (many blood vessels) increases the chances of fat survival.
Aftercare and recovery from autologous fat transfer
After a fat grafting procedure, it is common to have some mild pain, bruising, and swelling. These symptoms are temporary and can usually be controlled with pain medication. You can use clean cold compresses up to six times a day to reduce discomfort. Depending on the site of the fat grafting procedure, your surgeon may recommend the use of a binder or compression garment for 2-3 weeks to prevent blood from collecting under the skin.
During the recovery period, be sure to take any antibiotics your doctor has prescribed. Avoid taking aspirin or other blood thinners 1-2 weeks before and after the treatment as advised by your doctor. It is critical that you avoid smoking for at least 2 weeks before and after fat grafting because smoking can significantly affect your circulation and compromise the results.
Benefits of fat grafting
Fat is a natural filler that has ideal properties, meaning, it seamlessly integrates with body tissues and is 100% biocompatible. Because the transplanted fat is obtained by liposuction from the patient themselves, the body does not recognize it as a foreign substance. Therefore, fat transfer is a safe, lasting solution for a naturally youthful appearance. It can be used to address many of the signs of facial aging. It can also be used to fill pitted scars for smoother skin. Fat transfer can be combined with other cosmetic treatments like Botox or dermabrasion. The results are visible almost immediately and continue to improve as time passes.
Limitations and risks of fat grafting
The main limitation of fat grafting is that there is no standard technique and the results can be variable. In the breasts, for example, fat grafting only enlarges one cup size in most patients and a breast lift may still be necessary. Moreover, over the long-term, some patients may have disappointing results due to an unpredictable partial absorption of the fat graft volume. Therefore, the success rates of autologous fat grafting are unpredictable.
Also, fat grafting can interfere with breast imaging examinations in the future. Grafted fat is prone to developing calcifications which are visible on a mammogram and can raise concerns about cancer. Your doctor may suggest having a mammogram before breast fat grafting to differentiate between old calcifications and those from the graft.
The use of standardized techniques to harvest, process, and inject the fat can reduce the risk of poor results. Various techniques have been developed to overcome common fat grafting problems, such as atraumatic fat harvesting, washing to eliminate inflammatory mediators, and incubation of the fat grafts with bioactive agents.
Does fat grafting for the breasts work?
The use of fat grafting for buttock and breast tissue augmentation are some of the most common applications of this technique. The advantages of fat grafting in the breasts are that only very small incisions are needed and your own body tissue is used for the augmentation. No implant is used to change the breast shape. As a result, the breast feels and looks natural. Fat grafting in the breasts has a good safety record and high patient satisfaction.
How long does fat grafting last?
The results of a fat grafting are lifelong. Surgeons typically overfill the target area because a percentage of the grafted fat does not usually survive. Therefore, for the first six months, you may notice changing volumes. After six months, however, an enduring fat graft should be established. Remember, however, that as you continue to age, you may require additional treatments to keep looking youthful.
What are the side effects of fat transfer?
It is common to have symptoms like bruising and swelling as well as numbness after fat grafting. These side effects are temporary and improve over a few days. You should also expect to see small scars in the donor and treatment areas. These scars fade with time but may not disappear completely. Last but not least, there can be some loss of fat in the injected area in the first few months. Surgeons typically overfill to account for this loss.
More serious complications of fat grafting can include hematoma formation (collection of blood under the skin), fat necrosis (death of the fat tissue), fat embolism (blockage of a blood vessel by a piece of fat), and hypertrophic scarring (thick scars). Like all operations, fat grafting also carries a risk of infection, bleeding, blood clot formation, and allergic reaction to anesthetics.
You can reduce your risk of complications from fat grafting by choosing a surgeon with special training in these techniques.
How much does fat grafting cost?
The cost of a fat grafting procedure varies greatly with the area treated, the extent of the procedure (how much fat is injected), and the anesthesia used. It can range from $2,500 to $10,000 and more. On average, fat grafting in the breast costs around $6,500. The average cost of facial fat transfer is $5,000.
Beyond plastic surgery: Fat grafting and adipose stem cells
Clinicians are interested in adipose (fat) tissue for more than just liposuction and cosmetic procedures. This is because adipose tissue contains stem cells that have regenerative properties. These are progenitor cells that can mature into various types of body tissues, such as muscle, bone, and blood. Traditionally, stem cells are found in the bone marrow. However, in 2001, a group of scientists in Pittsburgh discovered that adipose tissue contains a high concentration of stem cells. In the future, the regenerative powers of adipose tissue may be used to treat a variety of medical conditions.
Why choose a board certified plastic surgeon for fat grafting?
Fat grafting is performed by plastic surgeons because they are trained in liposuction, which is a key component of the fat transfer procedure. Plastic surgeons have expertise in selecting the appropriate candidate, providing high quality care, and managing any potential complications. Fat grafting is a complex procedure in which each step must be performed with great care and expertise. It is highly recommended to choose an accredited surgical center or hospital and a board certified surgeon to guarantee the best results and ensure patient safety.
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