Fat Fills / Fat Grafting
Fat Fills / Fat Grafting
Fat grafting is the process whereby living fat tissue is harvested from an area of the body, purified and then transferred to another in order to add volume. In the mid 1900’s fat grafting was largely “abandoned” as the results at the time were poor. More recently, in the late 1980’s and 90’s, it was popularized by Dr Sydney Coleman of New York, who demonstrated good results using refined techniques of harvesting, processing and re-injecting fat. Since then, there has been much work on the “healing powers” of fat transfers with the discovery that fat cells are not only hormonally active, but also contain relatively high proportions of multi-potential adult stem cells amongst them – these are cells that are capable of producing other cell lines (like bone, cartilage, muscle and nerve tissue) under certain conditions, and it is highly likely that this work will be key in the future of regenerative medicine. Teams in Italy and the USA (and elsewhere) have published extensively on the benefits of fat transfers beyond the obvious volume enhancement; for example, enhanced tissue healing following radiation type injuries after mastectomy, and a host of other medical applications of the stem cell components in chronic degenerative diseases.
In plastic surgery, fat fills are predominantly used for volume enhancement. In order to be successful, the grafts need to be handled with care and placed in small “pearls” rather than large blobs. The tissue harvested is living, and will be required to re-establish a circulation at the recipient site, in order to remain viable, and not just “melt away”. I currently prefer the Tulip range of micro cannulae with a 2mm harvest cannula and a 0.9mm injection cannula for facial fat fills – typically cheek areas, lower eyelids, upper eyelids, nasolabial and marionette lines and lips being the most common sites grafted. Elsewhere on the body, I tend to use the Coleman cannulae for both harvest and injection (e.g. breast, post liposuction defects and labia majora).
The procedure is usually done under deep IV sedation given by an anaesthetist. The harvest is similar to liposuction, in that a volume of dilute local anaesthetic is injected in to the tissues prior to harvest (wet technique). Whilst any fatty areas can be used as donor sites, studies have shown that the inner knee, upper inner thigh and lower abdomen have the highest proportion of stem cells, and hence are my preferred donor sites, if technically feasible. Special harvest cannulas are then attached to 10cc syringes and the fatty tissue is gently extracted.
The syringes are then placed in a Coleman centrifuge which spins at around 3000rpm for a short time and separates the extracted fat in to 3 layers – a top layer of oil (dead fat), a bottom layer of fluid, and a middle layer of viable fat cells. The top and bottom layers are discarded and only the middle layer of viable fatty tissue is used for transfer.
The viable fat is now transferred to 1cc syringes for injection using either the Coleman or Tulip cannulae (blunt tipped, very fine rods). Small puncture wounds are then made to facilitate the injection process and the fat is then layered in to the areas previously marked – essentially for volume enhancement. The tiny wounds close spontaneously and are not sutured.
Done as day case surgery. Expect some swelling and bruising at both donor and recipient sites. It is important to avoid certain meds in the 2 weeks preceding your surgery, especially aspirin, NSAID’s, and all multivitamins, minerals, arnica etc, as per my advice page. Post operatively, you will be advised on what meds may help to enhance your result.