What are fat grafts used for?
The changes that come about with age are relatively well known to the public. These include facial thinning, sagging skin, the loss of cheek volume and the appearance of deep facial lines. To disguise these and to delay the appearance of ageing, many have opted to undergo treatments such as subcutaneous injections of artificial fillers, or even with preparations from their own blood.
In a fat graft procedure, fat is gently removed from another area on the patient’s body, (usually the tummy or thighs) and can be processed and injected into the target. This can be used to help improve the volume and contour of the shape and used to fill in defects just like facial fillers.
Fat grafts have been popular for volumising the face, hands, lips and more recently the breast. In my practice, I have also used fat grafts for correcting contour irregularities in patients who have received unsatisfactory liposuction procedures elsewhere.
Is fat grafting a new procedure?
No, the technique was invented more than a hundred years ago. Plastic surgeons have used fat grafting for reconstructive purposes throughout the last few decades, but there is certainly a renewed interest in the cosmetic applications of fat grafting procedure in the last few years, with more patients and plastic surgeons now recognizing the merits of this process.
Is it a complicated process?
The basic technique is simple to understand. Essentially we take living fat cells from one part of the body which has more fat tissue, then place the fat cells carefully in minute columns in the areas where one would like a change. The columns of fat cells are also placed in layers to build up shape and volume.
Both the harvesting and the injection of cells are carried out using blunt metal tubes which are of fine diameter – only about 1 -2mm in diameter – so the incisions are almost invisible and most patients are unable to see the incision sites after a few weeks. The difficulty is that fat cells are very delicate. It doesn’t take much to damage them so the placement has to be accurate and gentle.
Is the procedure safe?
Fat grafts are very safe if carried out carefully and in the correct manner. The procedure involves very minimal access incisions, minimal bruising and fast recovery – most patients go home the same afternoon after the procedure.
Customer satisfaction is usually high. However, like any surgical procedure, the process is only as safe as the surgeon makes it. There have been reported instances where patients have had lumpy changes, infections, wound breakdown, bad scarring and very asymmetric results. In extreme situations patients have even developed deep abdominal injuries!
Of course, the results also vary depending on the artistic appreciation of the surgeon – some patients do not like the results of the facial sculpting that they are given by their therapist.
The process is very operator dependent. Thus it is important that patients seek out experienced surgeons with good training and an appreciation for the anatomic detail as well as an eye for facial harmony and balance.
Why should I choose fat grafts, compared to artificial fillers, for example?
There are many ways to achieve changes for contouring the body and patients should be given the opportunity to make their own informed choices.
Having said that, fat grafts do have particular advantages. For larger volume areas, fat grafts are far more cost effective than artificial fillers. The cost of fillers to the face alone for a similar volume is around 450% of that using fat grafts, for example. The cost of using fillers for a similar volume of correction in the hands would be 460% that of using fat grafts.
Large volumes of fillers can cause a slight bluish discolouration under the skin, especially when used in areas such as the back of the hand or the lower eyebag margin. This is not a problem with fat grafts which restores skin colour as it is a substance which occurs underneath the skin naturally.
In the lip, fat grafts can maintain sensation and the correction does not result in overly filled lips, unlike some types of filler injection.
Some of the advantages are due to the transfer of living cells. During the healing process, fat cells actively produce chemical messengers which then recruit local and regional cells for repair. These processes can improve the blood supply to the area, improve cellular division and cause a moderate skin rejuvenation effect in addition to maintaining volume.
Many patients report improved skin tone and texture in their face, hands and even their breasts after fat transfer to these areas. Finally, fat grafts have the potential to be long lasting. They can persist for years and are almost permanent (although there is an initial absorption) while standard fillers last for about 3 – 6 months.
FAT Can Be your Friend (part 1)
by: Dr. Yap Lok Huei
Plastic and Reconstructive Surgeon
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