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Fat Grafting For Volume Restoration
Introduction: Finding A Use
For Your Excess Fat
Fat grafting uses your own fat
stores to replace or add volume to other areas of the face and body. I had a
little fat transfer to my under eye area, cheeks (upper cheek bone area) in May
of 2005 and then again to my
undereyes, chin, nasolabials, temples, brow bone, nose and
lips.in
April 12 of 2007. With proper
extraction methods, including the use of your stems cells. as well as meticulous transfer techniques, fat transfer
can be long-lasting. No need to have tear trough implants nowadays, if you acquire the
services of the right doctor and your facial woes just might practically
eradicate themselves.
What Is Facial Fat Rejuvenation
(Fat Grafting)?
Facial Fat Rejuvenation, more
commonly known as Fat Grafting, free fat transfer, autologous fat
grafting / transfer / transplantation, lipidsculpture, lipostructure, volume restoration, micro-lipoinjection, fat injections,
f/g and even the "Space Lift®." Fat
Grafting or Fat Transfer will be used from here on out, and it is the method
of the extraction of your own fat cells to replace fat or augment with fat where
you may need or want it. Waste not, want not, eh?
Well does it work?
Well that is
controversial. If performed correctly, yes. But there are many variables:
-
fat cell removal techniques
-
handling techniques after
removal
-
spinning/emulsions/serums
-
re-implantation techniques
-
patient's metabolism
-
patient aftercare of
treatment area
-
vascularity (blood vessel
formation to the fat cell)
-
hyperbaric oxygen therapy treatments
(HBOT)
Are You A Candidate For Facial Fat Rejuvenation?
When we age our underlying
collagen and elastic begin to break down and wrinkles emerge. This along with
facial fat loss, brings about a haggard, hollow or even skeletal look.
If you are not overly skinny, with a major metabolism and have a
little extra fat somewhere on your body to spare you may be a good candidate but
only if:
-
you have realistic expectations
-
you do not have underlying medical disorders
-
you do not have blood clotting problems
-
you are emotionally stable
enough to undergo a
procedure
-
you are not doing this solely to make others like
you
-
you are doing this only for yourself
Even after all this, only a qualified surgeon
will determine if you are capable of having a procedure and that your
individual case will benefit from fat transfer.
What
Areas Are Usually Treated?
Almost all areas of the face can be treated but there are the usual requested
treatment sites:
-
correction of hollowness
under eyes,
visible vessels resulting in dark circles, as well as visible tear troughs
-
correction after aggressive removal of
undereye fat fads from lower blepharoplasty
-
temple areas
-
brow bone
-
upper malar
-
sub malar
-
chin
-
lips (it isn't a defining filler
though)
-
jawline
-
forehead
-
inbetween the brow
-
facial scars
-
lower cheek after aggressive buccal fat
extraction
-
area between upper lip and nose
-
bridge of the nose
-
and anywhere else fat is needed or wanted
What
To Expect At Your Consultation
After checking several surgeons' backgrounds and
credentials, you will make appointments for consultations. You will
meet with these surgeons and discuss your goals and you will disclose all
information regarding your health; if you smoke, what medications or vitamins
you presently take. This is very important. Visit the Aspirin
& Supplement List for more information. Your skin will be examined and
the elasticity will be determined. You will discuss your complaints and concerns
and discuss the various techniques available to you. Your surgeon will
explain the technique, removal and reimplantation methods that may be most
appropriate for you. The surgeon should discuss the Risks
associated with fat grafting with you as well. There really are very slight
risks and complications involved but they should be disclosed regardless.
You will also discuss the
available anesthesia that will be used for your procedure. Most extensive fat transfer
procedures are often performed in conjunction with other procedures, so you will
more than likely be sedated. Small fat grafting-only procedures are
commonly performed under local only although some docs may use an oral
sedative to ease tension as well. Either way, discuss this beforehand.
Please
read the All About Anesthesia Page for more information.
You will then discuss
your pre-operative instructions and speak about the recovery period
instructions and what to expect in the weeks ahead. You may be
given prescriptions for antibiotics, pain relievers, anti-inflammatory drugs and perhaps a box or
directions for gaining a box of Arnica montana. Your surgeon may or may not advise you of the
benefits of Arnica montana for swelling and bruising. Would you like to learn of
the benefits of Arnica
montana or Bromelain?
Preparing For Your Procedure
You will be given a pre-operative information
packet that explains everything you should do and know before your surgery date.
The packet should include all the medications you should not take for up to 2
weeks before your procedure. These medications will include, but are not limited
to, aspirin containing products. Would you like to view a typical Medication
& Supplements List? (View a
printable PDF
version) It is quite possible that you will have
preliminary blood work
performed. This is normally an extra out-of-pocket expense that the patient must
participate in to check your white and red blood cell count (complete blood
count, CBC) which ultimately alerts the surgeon to disease or disorders beforehand.
So many things to do... so little time. Your
procedure will be here before you know it so relax.
How This Procedure Is Performed
If going for just fat
grafting and depending upon your surgeon you may be given an oral sedative
(valium) and may receive injections of sterile saline, Lidocaine, and possibly epinephrine
as a vasoconstrictor and bicarbonate (to
neutralize the acidity of the preservative in the Lidocaine) in your treatment
area(s) and your donor site. If you are having liposuction for body contouring you will probably be
under IV sedation or other and can have the fat harvested during
your procedure although usually the liposuction/fat removal is removed with more
suction pressure than 1/2 atm. Thereby traumatizing the fat cells. If the fat
cells membranes are destroyed during the removal then fat cell survival is
compromised. But if the removal can be performed without rupturing the
membrane with the use of a special 3mm titanium cannula then liposuction is
perfectly fine.
If primarily for fat grafting, the fat will
more than likely be
removed with a local anesthetic only although some surgeons may prefer
performing the procedure under an oral sedative, light IV sedation or "Twilight."
Do know that even still, some surgeons may prefer General anesthesia. Please
see the All About Anesthesia page to better understand the effects and types
of available anesthesia.
This fat will be removed from the donor site
(usually the buttocks, abdomen, inner knee or the saddle bags) with a small hypodermic
needle using 1/2 atm. (atmosphere) or special cannula with limited suction as so not to damage the membrane
of the fat cell. The fat is then spun in a centrifuge to remove excess fluids
and the damaged fat cells are picked out and only whole,
undamaged fat cells would be used. But don't count on this with all docs.
The fat is then injected with the use of a separate smaller hypodermic either
just under the wrinkle or deep with the muscle in some areas as their is a
higher vascularity within the muscle increasing the longevity of the fat graft.
With very superficial use of large amount of fat, lumpiness can occur.
To increase longevity, some surgeons spin a
vial of your own blood to remove proteins, excess fluid (water), add vitamin C to this mixture to
create a PlasmaGel® type, oxygen rich serum, some even add albumin
[:
serum albumin : a crystallizable albumin or mixture of albumins that normally constitutes more than half of the protein in blood serum, that serves to maintain the
osmotic pressure of the blood (or fat cells), and that is used in transfusions esp. for the treatment of shock]
The use of PlasmaGel® or albumin sort of shrinks
the fat cells or toughens their membrane to prohibit membrane destruction during re-implantation and less
trauma to the fat cell.
The Road To Recovery
You shouldn't wear cosmetics until
at least the day after. You may be swollen and pink so it may be in your best
interest to take off the rest of the day. If you were given any type of sedative
you should have someone drive you home.
Some
patients report mild to even above moderate bruising although swelling can be
pretty pronounced. Most of the swelling may last anywhere from 24 to 48 hours;
although the swelling should completely be gone in 2 weeks. Take
your temperature! Regularly! An elevated Temperature could mean an infection.
Take those antibiotics ON TIME. And don't forget
if you are taking birth control that some antibiotics can interfere so in the
event that you do have relations, use another form of protection as well.
After Fat Grafting With Dr. Rusca (May 4,
2004)
After Fat Grafting With Dr. Kao - I will
admit I like the results better with Dr Kao and the areas he chose to inject.
The fat for this session was taken from my inner knees. (April 12, 2007)
KEEP YOUR TREATMENT AREA AS IMMOBILE AS
POSSIBLE FOR AT LEAST 3 to 4 DAYS. The stability of the newly, traumatized fat cell can be given a better
'chance at life', if you will, if you are careful not to move it around so much
to give it ideal conditions for gaining proper vascularity. Just as when surgeons
overstuff the inner fat cells have a very difficult time at gaining vital oxygen
unless the blood vessels can grow rapidly towards the middle of the graft to
increase the fat cells' lives.
EXTRA! Another
great boost at survival of ANY fat or tissue transfer
is Hyperbaric Oxygen Therapy (HBOT). Seriously. Persons who have compromised
tissue vascularity can expect to gain increased cell life due to oxygenation of
the deeper or traumatized tissues. This has been shown to help stop necrotic
tissues even in the advanced stages. To read more on this therapy for complete
understanding of the benefits of HBOT, please
visit the Hyperbaric Oxygen Therapy page.
Usually, although this in individualistic, about 40% of the fat may last after
the first 6 to 8 months. Sometimes more if the surgeon uses a conservative
"micro-droplet" technique. Most patients receive up to 4 and 5
treatments, although the average is 3.
The effects can last anywhere from 3 months to
3 years (maybe more). It is highly technique sensitive so choose your surgeon wisely.
Risks And Complications Of Facial Fat Rejuvenation?
You could have an allergic
reaction to the anesthesia if applicable or the local anesthetic that is used in
the area of removal, hematoma and asymmetry. T here is a risk of infection as well the
extremely rare possibility of permanent discoloration due to a ruptured superficial blood
vessel at the treatment site during an injection. There is the possibility,
although rare, of calcification. In this case there would be hard micro-nodules
under the flesh. There is also the possibility of a distorted look, fatty cysts
and fat necrosis if extreme
over correction is used. Possibly intra- and post-operative bleeding, blood
clots at the treatment and removal sites. Also the patient's treatment areas may
be vulnerable to blood borne infections (perhaps from a dental procedure)
perhaps for up to three months, according to some surgeons.
Be aware that the possibility of
scar tissue is probable. I have spoken to a few people who developed excess scar
tissue in their lips and around their mouth which distorted their lips and
smile. I have
also spoken to people who report that their vermilion border (the colored skin
of the lip) has no definition after the injection, even after a year, of the
initial injections were not placed right. Also be aware that fat embolism is a
small risk. This is where fat can be injected into a blood vessel. This can be
really dangerous if your doctor isn't paying attention and does this.
General disappointment is
possible for may reasons, be it the decreased longevity of the graft, the
improper placement or the overall outcome. Many surgeons may try to place fat
into the nasolabial folds/grooves only for a temporary, yet immediate, fix.
The
cheeks usually must receive fat transfer as well to lift it up and out, rather
than sagging and overlapping the nasolabial area. Choose your doctor carefully
for the best result. Although even the best doctor can't perform miracles, if
your body doesn't take the fat transfer, there is nothing that can
be done and another form of filler will be needed.
The Least You Need To Know
-
What:
Facial Fat Rejuvenation, more
commonly known as Fat Grafting, free fat transfer, autologous fat
grafting/transfer/transplantation, volume restoration, micro-lipo injection, fat injections and even the "Space Lift®"
-
Why:
to replace fat where it was lost or augment with fat where
you may need or want it.
-
When: from
the young to the mature. This procedure is so mild that it can be performed
on most patients without ill effects.
-
Who: Research
your doctor very well. Usually the top names in fat grafting unfold
themselves on message boards/discussion forums and word of mouth. Fat
transfer is very technique and handling sensitive.
-
Where: a
sterile physician's office -- no salons!!
-
Risks: READ
THEM!
-
incisions/scars: n/a
-
Anesthesia: usually performed under local anesthetic
only, but may be performed with other procedures under the usual
anesthesia options. Read All About
Anesthesia
-
Duration:
30 minutes to an hour, depending upon extent of work to be done.
-
Pain Factor:
very mild, pain meds should alleviate any discomfort. If not,
call your surgeon immediately!
-
Swelling: Mild
to moderate -- depending upon individual;
-
Bruising: Mild
to moderate -- depending upon individual. The under eyes can be very prone to
bruising due to the high vascularity of the under eye area but is also
dependent upon the individual.
-
Post-operative
instructions: Keep the treatment site immobile as you can.
This
will give the area and newly transplanted fat cells a good chance to become
vascularized. New blood vessel formation within the fat transplant will
increase it's longevity. Some surgeons use a pressure dressing on the removal
site to prohibit or at east impede bloodclot formation. Movement or massage
on this area is sometimes advised. Adhere to your surgeon's instructions.
Some surgeons prescribe antibiotics. Some suggest Hyperbaric
Oxygen Therapy (HBOT).
-
1st Post-op visit:
sometimes not necessary,
unless ordered by the doc, although repeat applications may be needed
several weeks apart. Depending upon if the transfer took, or your doctor
suggests it.
-
2nd Post-op visit:
read
above.
-
Return to work:
usually immediately. Although you must realize you may be very swollen
or bruised. Your surgeon may not want you to wear cosmetics (concealer) on
the treatment site until the next day so check with him/her first.
-
Activity: These
rules depend upon the amount of work and the surgeon. Usually with any other
procedure it is: "No
exercise until at least 3 weeks post-operative. Be careful not to raise your
blood pressure for several weeks, you don't want to inhibit proper healing
or get an infection." but since fat transfer is a mild procedure you
aren't usually held to the same strict rules. Although immobilization of the
treatment site may help increase the longevity of the results. Check with your surgeon!
-
Sun exposure:
You
shouldn't be exposing your face to the sun anyway!
-
End result: The
results with any type of injectable are usually immediate although, the end
result may never really be a set date as everyone is different and in some
patients it may last and in some it may require several treatments, and even
in others it make never "take." Sorry, no definite answer
available.
-
Loss of Sensitivity:
It is possible to temporarily lose sensation in the treatment
area due to possible nerve damage or swelling.
Long term or permanent loss of sensitivity is possible.
-
Anything else?
Possible eyebrow and eyelash loss from medications such as antibiotics. Possible asymmetry as
well.
-
Longevity:
totally individual, some say a few weeks some say a few years. In some
people the fat just doesn't stay after transplant as well as it could be the
surgeon's technique that impedes the longevity. But if placed correctly, the
fat could be permanent. As I have said it is technique sensitive so choose
that doc wisely!
-
But Wait! There's
More! Research as much as
you can on the subject. Disclose all your medical background. If you
are a smoker, if you are taking medications, or if you have any other
medical concerns. B e realistic in your expectations. NO surgeon can
perform miracles, he can only try and improve upon what you have beforehand.
Also, ask what they do to treat the fat before
transplantation. Do they use anything to maintain the osmotic pressure, do
they use PlasmaGel®, do they place the fat in a centrifuge, do they use a
micro-droplet technique, do they over correct, etc.?
-
The average prices for:
fat
transfer, can be anywhere from for the face $450. -
$750. for about 3cc, collectively. Lips $900. - $1200. up to 3 - 4cc. but
some surgeons' prices can be upwards of $3,000K. But may or may not include
repeat touch ups. Ascertain what the fee includes beforehand.
References
Har-Shai, Yaron M.D., Lindenbaum, Ella S. Ph.D.,
Gamliel-Lazorovich, Aviva M.Sc., Beach, Dvora M. Sc., Hirshowitz, Bernard M.D.,
F.R.C.S. "An Integrated Approach For Increasing The Survival Of Autologous Fat Grafts In The Treatment Of Contour
Defects" Plastic and Reconstructive Surgery; September, 1999, Volume 104, number 4
Smith, A. ; Katz, A.; Huang, C.; Kang, M.; Park, N.;
Benhaim, P.; Lorenz, H.; Hedrick, M. "Fat Recycling: New Tissues From Liposuctioned Fat"
- unknown article, Lake Buena Vista, Florida 05/13/00
Interview with Leonard Grossman, M.D. - New York
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