Autologous Fat Grafting

Posted by: IAAPS Comments: 0

Fat is nearly a taboo word in our society today, which is obsessed with fad diets, weight loss programs and gym couture. Everybody wants to shed or hide those extra pounds of fat tucked away in the most undesirable locations of our body. It is now well-known that liposuction of this excess fat helps in regaining the contours that the patient desires without much downtime or effort. Rather than discard this precious fat, in the hands of a skilled Aesthetic surgeon, the same removed fat can be converted to “liquid gold” to enhance specific body contours as well to restore a glow to your aging skin. It is now completely confirmed scientifically that our own fat is a tissue with remarkable rejuvenative potential and scientists are discovering newer clinical uses for it in the medical field every day.

Autologous fat grafting is a procedure by which a person’s own body fat can be processed and injected back either as a filler into desired areas or used to rejuvenate the skin. It is a minimally invasive and safe surgery, which can make for a striking improvement in appearance. Since person’s own tissues are used, there are no allergic reactions and the final results can be permanent.

Am I a candidate for fat grafting?

You are a candidate if you are in reasonably good health and have sufficient good quality body fat for harvest & transfer. Autologous fat grafts can be used in any of the following conditions to plump up tissues with your own fat to look youthful or to hide blemishes.

  • Facial hollowing, wrinkling, mild skin laxity-in areas like the temple, cheek, chin, facial folds
  • Facial disproportions, asymmetries and contour irregularities
  • Facial scars due to acne, trauma, surgery, birth defects
  • Hands with aging skin, atrophy, hollowing and prominent veins
  • Contour and surface irregularities present from birth (such as “hip dips”) or following previous liposuction procedures
  • Moderate Breast augmentation or volumizing – if you are not keen on Breast implants or have contour irregularities from birth or after previous surgeries
  • Buttock augmentation- earlier popular as ‘Brazilian Butt Lift’, now called ‘Safe Subcutaneous Buttock Fat Transfer’
  • Genital rejuvenation- to volumize the labia majora

How is Fat grafting performed?

It is critical that Fat grafting must be performed only in authorized clinics and hospitals by qualified Plastic and Cosmetic surgeons. It must be done under strictly sterile conditions under suitable anesthesia. Small volume fat transfers can be done comfortably with local anesthesia which numbs only the area to be treated; larger transfers as in the breasts or buttocks will need general anesthesia. It can be done as a day care procedure or at the most with overnight stay as the situation demands.

Your aesthetic surgeon will perform fat grafting in three steps.

  • Harvesting fat: Fat is collected in syringes from “donor” areas, which are commonly the abdomen, thighs or back through small stab incisions, by using a modified liposuction technique. Scar marks left by these tiny incisions are imperceptible and hidden.
  • Processing fat: The harvested fat is then processed by decantation or centrifugation or washing, separating it from oil and blood residues in the syringe. For facial rejuvenation, a special processing technique is used where fat is further broken down into smaller morsels known as ‘Nano-fat’ and injected into and under thinned skin and wrinkles to rejuvenate it.
  • Transfer of fat: Fat is injected with syringes and special cannulae as small droplets aliquots of less than 0.1 ml size in multiple planes such that each drop has access to nourishment and blood supply from the healthy surrounding native tissue, ensuring its optimum survival.

What kind of results can I expect?

Following the procedure, you will experience swelling and minor bruising in the area which usually subsides in 10-14 days. Mild pain may be experienced for 24 hours in the areas from where fat has been harvested. Similarly, in cases of fat grafting to the face, massages and any salon treatments would not be permitted for 2-3 weeks. The results of this volumization may be apparent to you only by 6-8 weeks. It is anticipated that approximately 10-25% of the grafted fat will be resorbed in the following 6-9 months. You will be counselled right in the beginning that you might need some minor touch up procedures based on your results at the end of this time. The amount of fat resorption is also dependent on your physique, metabolism, lifestyle and physical activities.

What can go wrong & how can it be remedied?

Though it is a simple procedure, like any surgical treatment, fat grafting is a safe procedure when performed by qualified surgeons under adequate precautions. The most dreaded but fortunately exceedingly rare complication is fat embolism where fat droplets / globules can enter the blood stream and find their way into the heart and lungs with life-threatening consequences. However, such complications are quite rare in qualified hands who have extensive knowledge of human anatomy and therefore use the proper techniques.

The most common sequela is under-correction which may need repeat fat injections after 6-9 months. If an excessive amount of fat is deposited into tissue planes, to compensate for anticipated absorption, much more of it (than otherwise) may die off leaving oil cysts and small calcified lumps. This is another reason why it is important that only a precisely adequate amount of fat be injected with care, so that all of it is exposed to nourishment from the tissues and there is optimum survival. Infections are very rare with fat grafting surgery done with adequate sterile precautions.

Bleeding and bruising following the procedure will be more if you are taking blood thinners like Green tea, Garlic pearls, Gingko biloba, Ginseng, Vitamin E or prescription drugs like Aspirin, Clopidogrel, Warfarin etc. To avoid such untoward problems, it is important that you inform your entire medical history and drug history including vitamins, Ayurvedic preparations or hormonal supplements to your Aesthetic surgeon before the procedure. He/she will advise you to stop certain medications for a minimum of one week prior to the surgery. Smokers will be advised to completely stop smoking at least 2 weeks prior to the date of surgery to ensure that the procedure can be safely undertaken with good healing.

What is the Do’s & Don’ts after Fat grafting?

Your surgeon will advise you not to massage or compress the area and to avoid strenuous activities like swimming, jogging and gym work outs for 2-3 weeks. You can however return to your normal routine within 2-3 days following the procedure, unless it is a large volume transfer. There will be certain restrictions imposed on you for 2-3 weeks, such as how to sit or lie down, if the fat grafting is done to the breasts or buttocks, so as to not compress the newly grafted fat.

Though fat grafting has been attempted from late 19th century onwards, the outcome tends to vary with technique, patients and most importantly, the surgeons. It is important to appreciate that the results depend greatly on the expertise in handling of fat grafts to deliver the best results. So, please ensure that you get the procedure done only by a qualified Aesthetic surgeon who is experienced in fat grafting.

Dr Sheeja Rajan T M

Plastic Surgeon, Kozhikode, Kerala