Surgical Procedures

Fat Grafting

What is Fat Grafting?

Wrinkles begin to appear as collagen and elastin fibers in the skin break down. This breakdown can also be attributed to excessive squinting, frowning and smiling. Injectable fat cells taken from your own body is the most frequently used material for filling facial wrinkles and frown lines. While collagen is popular as an injectable filler, it isn’t for everyone: some people are allergic to collagen or may develop an allergic reaction. Fat transfer(also called autologous fat transfer or micro-lipoinjection),fills facial features with a patient’s own fat. Because the fat comes from your own body, you cannot develop an allergic reaction. Fat transfer to the face is a safe procedure designed to recontour the face and provide definition to cheeks, chin, lips and lower eyes. The fat used for fat transfer is liposuctioned from another part of your body like the abdomen or thighs and injected into another area that requires plumping. Injected fat lasts longer in larger areas of non-movement, so it is successful for the correction of grooves under the eyes and sunken cheeks. Fat grafting can also correct atrophic aging of the hands.

Fat Grafting Procedure

Fat grafting is performed in the operation theatre as outpatient basis. Both the area from which the fat is taken and the treatment site are anesthetized with a local anesthetic. Using a small needle attached to a syringe, fat is removed from a donor site where your fat is most tightly packed, such as your abdomen. Once removed, your fat is processed to remove excess fluids and then reinjected. This process may be repeated until the desired correction has been achieved. Swelling is expected after fat injection but discomfort is easily controlled with medication. Over the first few months your body will absorb about 35% of the fat. The remaining 65% will usually stay in place. For longer lasting results, patients usually receive three or four treatments over six months.

We can broadly classify fat injection into:

1) Microfat injection: Fat injection to the face, breasts, buttocks, hand etc

2) Nanofat injectionor nanofat fill that can be used to treat wrinkles, undereye dark circles, small scars, pigmentations etc.

Microfat injection

It is the procedure where excess fat is removed from areas such as the abdomen, flanks, hips or thighs and, after special preparation, injected into areas of the body that need filling. The process requires gently fat removal using low-vacuum liposuction and the use of thin, delicate, non-traumatic cannulas to protect the survival of each harvested living fat cell. The fat cells are then purified and slowly injected thru tiny skin incisions into the tissue of the recipient site utilizing a small syringe and cannula. Tiny droplets are placed throughout the tissues assuring that each transferred fat cell will have an adequate blood supply to achieve the permanent survival of the injected fat cells.

The most common uses of microfat injection are:

Face : With aging, the fat of the face undergoes atrophy and the dermis under the skin thins out, as a result of these changes the face appears too thin, making the skin of the face saggy. Microfat grafting adds fat to the area beneath the skin, adding fullness where is needed. The fat injection creates a lasting youthful appearance. Areas that can be treated with fat injections include the temples, zygomatic arch, marionette lines, infra-orbital rims (tear trough), jaw line, nasolabial folds, cheeks, and scars due to acne, varicella, trauma or surgery.

Chin Augmentation: Fat injections safely and effectively correct the small or undeveloped chin avoiding the need to undergo a surgical procedure to place an expensive synthetic chin implant. A chin augmentation will strengthen the face profile, bringing better balance to the facial features. A small chin undermines the face, making the nose appear larger and an overbite more pronounced.

Lip Augmentation: Fat can be used for lip augmentation, achieving a permanent natural look. It can also be used for correction of the lines around the mouth. Lip augmentation can increase the fullness and definition of the upper lip, lower lip or both. After 2-5 days the swelling is gone and the lips have a natural fullness. There may be some bruising which can be covered with make-up. Over the first few months the body may absorb some of the fat. For permanent results, 2 injections over a six month period is recommended.

Hand Rejuvenation: Fat injections to the hands achieve the effect of fuller, more contoured hands as those of younger hands.

Buttocks Rejuvenation (Brazilian Lift): Microfat grafting can add fullness to any part of, or the entire, buttocks to create the desired look. Microfat grafting assures lasting results and gives a very natural shape and feel to the buttocks. Once the swelling is down, there is a return to normal sensation, the grafted areas look and feel natural and there are no physical restrictions after the first 2 weeks.

Breast Augmentation: Patients who desire breast augmentation but are wary of implants can have breast augmentation using their own fat. Following the fat transfer the breasts will look and feel normal and the results are long lasting.

Correction of Skin Depressions, Subdermal Attachments and Scars: Facial lines, depressions, folds and depressed scars on the body and face can be successfully treated with injectable fat. However, many deep folds, wrinkles, lines, and scars are resistant to the injected fat or fillers (synthetic and natural) because of the severe attachment of the depression to the underlying deeper tissue. The attachments are released by subcision. Following the release of the skin fat injection is performed to correct the defect and to act as a spacer to prevent reattachment of the released area.

Fat Injection to Labia Majora: In some women with aging the labia majora may undergo a significant atrophy and the dermis under the skin thins out. As a result of these changes the labia majora becomes flat, saggy, wrinkled, and darkened. The fat injections add fat to the areas beneath the skin, creating fullness where needed that results in a lasting, youthful appearance of the labia majora.

Nano fat injection or fat filling

Nanofat grafting is a new concept that takes injections down to small structures and with an injectate, which contains few intact fat cells. With a reduced number of viable fat cells, it would have limited use as a volumizing treatment. Its use appears to be a treatment option to improve skin quality. (Skin rejuvenation)

Improvement in skin quality is a well known by product of fat injections and is presumed to occur through increased collagen production and remodeling triggered by the grafted stem cells. Since nanografts have few fat cells in it due to the mechanical preparation process, its cellular component is the stromal vascular fraction of the graft, which includes a substantial number of mesenchymal stem cells.

The location for nanofat grafting is placement into the intradermal level of the skin to improve its quality. The effects of these injections appear to take months to see. Because its effects are probably due to stem cell activity, it may not really be appropriate to call it a fat graft at all. It appears to be more of a poor man’s tissue engineered treatment that is made without expensive and time-consuming equipment.

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