Fat Grafting Surgery by Jan Stanek at Surgical Aesthetics

Surgeons have always been seeking the ideal material to inject into skin and fat has always been in the forefront of their interest. It is natural and there is usually plenty in supply.

It has been noted that fat provides an essential support to skin and, if lacking, support is lost and the skin creases and wrinkles excessively. It is easy to compare the thin and chubby face; the latter is the more youthful and wrinkle-free.

The main problem with fat grafting/transplant has always been how to make fat cells survive. By simply injecting fat cells with a needle leads to very low cell survival. However, by careful harvesting, cleaning the cells before transplanting and using a special technique of injection it leads to a significant fat cell survival, as high as 50%. The technique uses special blunt needles and fat cells are injected in small quantities into multiple tunnels layered over each other. This technique gives a greater chance to the fat cells to establish themselves in the tissues and acquire a new blood supply.

Fat grafting is very successful in replacing lost fat and filling out deep folds and crevices. It can also be used to reshape certain areas of the face to improve facial balance. Very mobile areas of the face, such as the upper lip area and lips themselves are poor recipients of grafted fat. This is because during the early postoperative period fat cells have to attach themselves to surrounding tissues and establish blood supply. In very mobile areas the fat take can be as low as 20%. However, in most areas of the face it is possible to achieve as much as 50% take, meaning that half of the injected fat will survive permanently.

The fat for transplant is removed by liposuction from areas such as abdomen and thighs, where it is usually in plentiful supply. The amount of fat is very small and its removal should have very little effect on the donor site. The fat removed is then processed by cleaning it and it is then ready for transplant. The injection is carried out with special blunt needles through several punctures. These heal without scarring. By making multiple and layered channels the fat cells are then deposited under the skin until a desired effect is obtained. Certain amount of over-correction is required in anticipation of subsequent fat absorption. This process can last for up to two months after surgery and after that “what you see is what you get”. As with all surgical procedures there may be complications, all of which are uncommon:

Fat Transfer: Possible Complications

As with any type of surgery, this operation may be subject to complications:

  1. Infection: This is very unusual as, in most cases, antibiotics are used during surgery to prevent this complication.

  2. Bleeding: Again, this is very rare, as blunt needles are used to transplant the fat and risk of injury to blood vessels is extremely low.

  3. Skin irregularity: This can occur if, for some reason, fat absorption is excessive in one particular area. It can easily be corrected by further fat injections.

  4. Numbness: This is temporary and may last from a few days to several weeks.

  5. Fat absorption: In some areas fat absorption is unpredictable and may be excessive. It can be corrected by further injections.

  6. Asymmetry: This is a feature of all faces and may be temporarily exaggerated during the early post-operative period due to swelling. It usually corrects itself as the swelling subsides.

  7. Persistent swelling: Very rarely swelling may persist for a very long time, especially in areas such as cheeks and under eyes. It is unusual for it to be permanent.

It is essential that any patients contemplating fat transfer surgery should first discuss in detail the pros and cons of the operation with their surgeon.  It is only then that the patient can decide whether or not to proceed with surgery.

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