Fat Grafting

Last updated date: 18-Apr-2024

Originally Written in English

Fat Grafting

The popularity of liposuction body contouring has coincided with an increase in the utilization of autologous fat transfer for soft tissue enhancement. This results in a readily available, low-cost product for lipografting, or the application of lipoaspirated material. There is no consistent scientific evidence of the transferred fat's long-term survival. Reabsorption rates have been reported to range from 25% to 90% in clinical studies. With overcorrection and the necessity for additional treatments on a regular basis, the results can be unpredictable. Factors in structure and physiology, adipose tissue collection and processing techniques, and fat graft preservation are all considered when collecting reproducible scientific data for conventional in vitro and in vivo fat grafting models. To generate comparable results, adequate histological staining for fat tissue, immunohistochemistry, and viability assays should be employed in all investigations.

 

What is a Fat Graft?

Fat Graft

Fat grafting, also known as fat transfer or fat injection, is a wonderful approach to adding volume to various regions of your body without the use of artificial fillers. Gentle liposuction is used in a fat transfer to remove fat from body parts with excess fat, such as the outside and inside of thighs, hips, lower back, and lower abdomen. The donor site refers to the location from where the fat is extracted.

The fat from the donor site is then moved to places of the body that would benefit from an increase in volume cosmetically. This usually refers to the face. Fat injections are a wonderful approach to repairing the effects of aging on the face without undergoing surgery.

 

Fat Grafting Indications

Fat Grafting Indications

Lipofilling is becoming increasingly popular, and the indications are expanding each year. As a result, having clear guidelines to choose the proper method for the right patient is difficult for the surgeon.

The American Society of Plastic Surgery (ASPS) created evidence-based indications for fat grafting that were backed up by good literature data in 2007.

The first criterion that is used is safety. Despite certain significant differences in fat processing (infiltration, harvesting, processing, and fat layering), the overall risk is modest. Anesthetic problems are rarely recorded due to the light anesthetic required, allowing a larger spectrum of eligible patients to be included based on general health status and comorbidities. Infections, seroma, and hematoma have all been recorded, however, they are usually handled conservatively.

Several studies have clarified doubts about the biological significance of fat and stromal cells in cancer (primarily breast cancer), albeit, in specific instances, such as breast injection, a mammogram or ultrasound is indicated.

The most common indications in the cosmetic field are facial and hand rejuvenation, breast and buttocks augmentation, scar revision, and less typically, penis and calf augmentation.

Aside from safety, cosmetic fat grafting has some limitations, including adipose tissue availability, related risk factors for fat survival, such as smoking, patient approval for multiple sessions (and hence higher costs), and expectations.

Finally, uniformity of fat manipulation and cautious patient selection can help the participants get good results.

 

Fat Grafting Preparation

Fat Grafting Preparation

Prepare to talk about the following points during your consultation:

  • Your surgical goals
  • Drug allergies, health problems, and medical treatments
  • Medications, vitamins, herbal remedies, alcohol, cigarettes, and drug use are all factors to consider.
  • Previous procedures

In addition, the doctor will:

  • Examine your overall health as well as any existing medical issues or risk factors.
  • Take pictures.
  • Examine your fat transfer possibilities.
  • Recommend a treatment plan.
  • Discuss the expected outcomes of fat transfer, as well as any dangers or difficulties that may arise.

You may be requested to do the following before surgery:

  • Obtain laboratory tests or a medical evaluation.
  • Take some medications or make changes to your present ones.
  • Quit smoking.
  • Aspirin, anti-inflammatory medications, and herbal remedies can cause excessive bleeding and should be avoided.

Liposuction should be done at a hospital, a licensed ambulatory surgical center, or a certified office-based surgical facility. Make arrangements for someone to drive you to and from surgery, as well as someone to stay with you for at minimum the first night after surgery.

Make certain to inquire. Asking the doctor questions about liposuction is vital. It's common to have some concerns, whether it's the anticipation of your new look or preoperative stress. Don't be afraid to tell your doctor about your feelings.

 

Fat Grafting Procedure

Fat Grafting Procedure

Depending on the complexity of the technique and whether another procedure is performed at the same time, fat transfer surgery can take anywhere from one to four hours.

Before surgery, the doctor will speak with you and properly mark the regions where fat will be taken and where fat will be reintroduced. During the procedure, these markers will be used as a guide.

 

Anesthesia

Medications are given to keep you comfortable during the surgery. Local anesthetic, intravenous sedative, and general anesthetic are all options. The ideal option for you will be recommended by the surgeon.

A fat transfer can be done under local anesthetic, which numbs only the surrounding area. You may also be unconscious under general anesthesia for treatments involving greater parts of the body. Tumescent fluid is a medicated fluid that is administered into the areas that will be treated by liposuction. This fluid swells the tissues, making fat cell removal easier, numbing the treatment region, and reducing bleeding and bruising.

 

Fat Harvest with Liposuction

The doctor will begin the treatment by harvesting your fat with liposuction. The jowls, back, belly, thighs, and buttocks are among the areas of the body where excess fat is removed. The majority of body fat is found immediately beneath the epidermis, on top of muscle tissue. Liposuction removes extra fat with a suction device during surgery, resulting in enhanced contouring in the desired area. Liposuction is carried out using tiny, inconspicuous incisions. To minimize bleeding and trauma, diluted local anesthetic is administered first.

Then, using a controlled back-and-forth movement, a thin hollow tube, or cannula, is introduced through the incisions to free extra fat. A surgical vacuum or syringe connected to the cannula is then used to suck the fat out of the body.

 

Fat Transfer to the Desired Location

The fat cells will be injected into the targeted region using a cannula by the surgeon. Fat is gently applied in different regions using a forward and backward movement until the required volume and contour are obtained.

 

Incisions Closure

Sutures can be used to seal the incisions or they might be left open. Finally, absorbent pads are put to the incision sites to protect them as you recover.

Once the edema and fluid retention that can accompany liposuction subside, your enhanced body contour will become evident. The reduction of excess fatty tissue should be permanent if appropriate eating and exercise habits are maintained. Significant weight gain, on the other hand, can change the outcome.

 

Fat Grafting Results

Fat Grafting Results

While you will most likely see an improvement right after the treatment, the ultimate outcomes will not be apparent for at least a year. After surgery, you should be pleased with the size and shape of the fat transfer; however, some of this is due to swelling, and the benefits may fade over time. Even though fat cells are permanently evacuated during the process, it is crucial to note that fat transfer does not inhibit the expansion of remaining fatty tissue. Fat cells injected into the intended location may also disseminate outside of the injected area. If you gain or lose weight, your findings may also alter.

You could enjoy the effects of your fat transfer treatment for years if you set realistic expectations and maintain them properly. When the edema and fluid retention that can accompany liposuction go away, you'll notice a difference in your body contour.

Liposuction results will persist for a long time if you keep a healthy weight and general fitness. It's natural for your body to lose some firmness as you grow older, but most of your gains should be long-lasting.

Your procedure is expected to provide positive results, but there is no assurance. In some cases, a single surgical treatment may not be enough to provide optimal results, and additional procedures may be required. Following your doctor's recommendations is vital to your surgery's success. During the healing process, it is essential that the surgical incisions are not exposed to excessive strain, swelling, abrasion, or motion. Your doctor will provide you with specific guidelines for self-care.

 

Fat Grafting Complications

Fat Grafting Complications

Fat transfer is a common procedure with a wide range of indications, and the surgeon's knowledge of problems and how to deal with them is essential. It's important to understand that this treatment contains both liposuction and fat transfer complications. A list of problems that can occur within a week of the treatment and late complications will aid the patient in recognizing and managing them.

  • Infection. Although uncommon currently, it can still be found in some instances. The main goal is to avoid it because dealing with infected fat grafts is difficult and often results in deformities. This can be accomplished by having a sterile operating theater and equipment, administering prophylactic antibiotics, and properly screening patients for HIV, hepatitis B, and C.
  • Pulmonary embolism. It could be caused by venous compressions, such as from a calf injection, resulting in thrombus formation and a significant consequence such as pulmonary thromboembolism, which either resolves or results in increased pulmonary infarction and hypertension. Accidental air injection into subcutaneous tissue with the opening of large veins such as those in the neck can be fatal and mimic the symptoms of a severe pulmonary embolism.
  • Blindness. It can happen when fat is injected around the orbit, either directly into veins or through the eye capsule, causing thrombosis and blockage of the central retinal vein. By using a blunt cannula and identifying any visible veins, as well as injecting while withdrawing the cannula, this can be prevented. Not only had blindness been described, but insults in the brain had also been documented.
  • Skin necrosis. This can occur from a serious infection or over-injection, resulting in edema and excessive compression; there are no predefined volumes; however, the average amount injected depends on skin laxity, and under-injection is always preferable to over-injection because there is the possibility of injecting more later; however, skin necrosis is difficult to treat.
  • Seromas and hematoma. This can happen on rare occasions. In terms of hematoma, it can be avoided with good pre-operative management and evaluation by quitting smoking for four weeks and taking non-steroidal medications for one week. The use of a blunt cannula to avoid damaging visible veins. The mainstay of treatment is compression, and in the event of seroma, persistent aspiration and compression are used.
  • Nerve injury. Facial nerve branches may be injured in injections of the face or dorsal nerves in injections of the hand, depending on the site. Depending on the severity and type of injury, the injury could be permanent or temporary.
  • Excessive absorption. The rate of absorption is highly dependent on the atraumatic technique employed in harvesting as well as the locations from which fat is extracted, such as the upper belly and upper back. The rate of absorption varies between 5% and 50%. Some researchers recommended a 30 percent overcorrection. This looks good on the buttocks and breasts, but not on the face, in their opinion.
  • Asymmetry. Because the fat injection is performed on both sides of the body, such as the breasts, gluteal area, and hands, a symmetrical injection should be made unless there is an obvious asymmetry. To achieve symmetry, a combination of liposuction and fat injection is sometimes used. Minimal asymmetry is acceptable because it is only visible to the patient.
  • Cysts and mass formation. After fat injection, cysts of various sizes can develop; the most frequent type is an oily cyst, which can appear anywhere but is more prevalent with increased fat injection. In large cysts, several therapies such as triamcinolone injection, aspiration, and compression have been documented. Enlargement of a portion of the injected fat causes localized bulk or, in certain cases, generalized enlargement of the entire injected area. Over-injecting fat is not recommended to avoid this; instead, the right amount and plane of injection should be used. When fat is over-injected, it can migrate, as has been shown in the forehead where researchers utilized botulinum toxin in conjunction with fat injection.
  • Calcifications. Breast calcifications are the most common cause for concern, yet the size and shape are significantly different for an experienced radiologist. Peri-parenchymal microcalcifications from fat necrosis lack multi-density, rod-like, punctate, or branching spicule.

 

Fat Grafting and Adipose Stem Cells

Adipose Stem Cells

Plastic surgeons are increasingly interested in fat grafts, not just for their cosmetic potential, but also for their regenerative properties. The adipose tissue's regeneration characteristics are related to the large concentration of mesenchymal stem cells (MSCs).

In tissue engineering, a group of plastic surgeons and researchers from the University of Pittsburgh described the implications of adipose tissue in cell-based regenerative therapies. Adult MSCs were previously thought to be primarily bone marrow products, so this was a breakthrough for the scientific community. Adipose tissue, rather than bone marrow, turns out to be a considerably more abundant source of MSCs. When compared to bone marrow tissue, mesenchymal stem cells (MSCs) are 350-500 times more plentiful in adipose tissue. This, together with the simplicity with which adipose tissue may be extracted (as opposed to bone marrow), has opened up a whole new chapter in the science of regenerative medicine.

We've been trying to figure out how to unlock the regeneration potential of adipose tissue since 2001. Fat grafts are currently being used in the clinic to renew skin, cure autoimmune skin illnesses, and aid restores radiation tissue damage. However, if we treat adipose tissue further, we may be able to use MSCs produced from it in all regions of the body. Most processing steps beyond simple fat grafting, however, are regulated by the Food and Drug Administration and need an IND (Investigational New Drug) application.

 

Fat Grafting Beyond Plastic Surgery

Fat Grafting Beyond Plastic Surgery

Adipose tissue can be treated in a variety of ways. Fat grafting is the simplest basic way for applying MSCs' healing potential to injured tissue. However, a fat graft is not appropriate for all injured locations. Isolating MSCs from adipose tissue using collagenase digestion has even more potential in this situation, as these cells can subsequently be administered intravenously or intra-arterially to areas where fat grafts are not suitable. Finally, MSCs can be cultivated ex vivo in the lab to greatly increase the number of these regenerative cells.

Many clinical trials using adipose-derived stem cells (ASCs) are currently underway to treat conditions such as COPD, pulmonary fibrosis, congestive heart failure, osteoarthritis, Parkinson's disease, diabetes mellitus, Autism, Crohn's disease, multiple sclerosis, macular degeneration, urinary incontinence, neurological diseases, and many others. 

Fat grafting has driven plastic surgeons and other medical disciplines to new heights. Its potential is only beginning to be realized, but adipose tissue will play an important role in regenerative medicine. Who'd have guessed that your own fat, the most unloved and undesirable tissue on your body, is suddenly ushering in a new era in which your body can heal itself?

 

Fat Grafting Breast

Fat grafting to the breast entails harvesting and transferring fat cells to a more desirable area, in this case the breasts. A standard liposuction procedure is used to retrieve fat. The majority of patients want to have fat removed from their love handles, belly, or hips.

The plastic surgeon then sterilely extracts the undesired fat in the operating room. The processed fat is then stored in small syringes and carefully injected into the breast tissue to increase the size of the breast and cleavage, as well as to restore the fullness of the upper pole that is typically lost after pregnancy and breastfeeding.

 

Conclusion

Because of its filler and regenerative effects, lipofilling can be employed in a variety of sectors of plastic surgery with minor patient discomfort. One of the major drawbacks is that the amount of fat graft is directly proportional to the amount of adipose tissue in the patient. With the implementation of the findings of experimental research on tissue engineering and adipose stem cells (ASCs), the role of lipofilling could become even more important.