Fat Injections/Grafting
| Fat Injections/Grafting Cost Approximate Cost : $500 and up Recovery: 1-14 days Possible complications: Swelling, redness, scabbing, asymmetry |
Fat injection reportedly started in 1893 when German physician Franz Neuber used a small piece of upper arm fat to build up the face of a patient whose cheek had large pit caused by a tubercular inflammation of the bone. In 1895, another German doctor, Dr. Karl Czerny did the very first documented breast augmentation when he transplanted a fatty tumor from the patient’s lumbar region, or lower back, to a breast defect.
Overview of current techniques
In the 1980s, when the liposuction procedure became more widely available, fat also became much more easily withdrawn from the body. In 1984, Mel Bircoll M.D. introduced micro injection of fat graphs using liposuction techniques. [3] That development allowed more plastic, dermatological and cosmetic surgeons to offer their patients fat transfer for cosmetic reasons. Patients like fat transfer because it is their own tissue and, hence, not subject to rejection by the body, and because most other dermal fillers are absorbed by the body within three to nine months, making regular injections a continuing expense.
Essentially, the fat transfer procedure harvests fat from one part of the body where an excess exists and then places it in another part of the body where the additional bulk is used for cosmetic and aesthetic purposes. Fat transfer—which is also known as fat grafting, fat autographs, autologous fat transplantation, fat injecting or microlipoinjections to physicians—is being used in cosmetic plastic surgery to:
Smooth and repair aged hands
Fill wrinkled, creased faces
Create more shapely, curvaceous buttocks
Enlarge breasts
Procedures
Fat is withdrawn from the patient in one of three ways: with a syringe that has a large-bore needle or with a liposuction cannula. The fat is prepared according to the practitioner’s preferred method and then injected into the patient’s recipient site. The preparation process clears the donor fat of blood, pain killers and other unwanted ingredients that could cause infections or other undesirable side effects. Moreover, some physicians have found that human fat outside the body is incredibly delicate. One researcher (Mendieta) found that, to obtain viable fat, the needle withdrawing the fat can’t be too narrow, the liposuction cannula can’t have too strong a vacuum pressure and the centrifuge used to clear debris from the donated tissue can’t spin too rapidly. Another researcher found that vacuum pressure on the liposuction machine could not be higher than 700 mmHg.
A few doctors excise, or cut, small strips of fat from the body and then place, rather than inject, the tissue in the recipient site, using additional small incisions.Other uses and applications continue to develop as surgeons work with, and learn more about, fat transfer.
Some of the most current and developing applications include:
Cheek and chin implants (medicine)
Repair of inverted nipples
Increasing the girth of the penis
Depending on the surgeon, the patient and several other factors, the body is reported to reabsorb anywhere from 20 to 95 percent of transferred fat.
Due to the varying rates of absorption and the different lengths of time fat is reported remaining in the body, many physicians and other researchers worldwide since the 1980s have tracked success, safety and failure rates of fat transfer. In most applications, fat injections are laid down through several different layers of skin and muscle to provide a better chance for the fat cells to find a nearby blood supply. Because some fat is always absorbed, most physicians inject somewhere around 30 percent too much. Physicians have learned the best donor areas are found in:
The lower stomach
The inner thighs
The inner knees
Current clinical applications
Fat transfer to the hand
A wrinkled, bony hand with large veins, sun spots and deep grooves can reveal an advanced age even though the patient’s face, breasts or body have been surgically rejuvenated. Consequently, plastic, dermatological and cosmetic surgeons have developed techniques to make hands also look younger. A few practitioners use dermal fillers like Restylane and Juvederm but the longer lasting method seems to be fat transfer via injection which is reported to last for years.
Facial fat transfer
A liposuction technique is used to harvest the fat and prepare it for transfer. The fat is then injected in the desired portion of the face. When using a micro injection technique, extremely small parcels of fat are placed into multiple layers of the face. The procedure is most commonly performed under local anesthesia with a light oral sedation.
The most common facial locations for fat transfer include:
Filling in sunken areas beneath the eyes
Fleshing out the folds of skin that physicians know as nasolabial folds, the deep wrinkles next to the mouth often referred to as “laugh lines.”
Filling in forehead creases
Cheek Augmentation
Generally, 40-60% of the transferred fat persists permanently. Although, the long-term efficacy of transferred fat has been documented in numerous studies results are extremely technique dependent.
Lip augmentation
Tiny, punch-like incisions are made at one corner of the patient’s mouth. The surgeon then takes one- to two-millimeter-thick strips of fat from the donor site and gently works them into the upper and lower lips for a plumping effect that is reported to be safer, softer and more natural than lip augmentation with popular injectable facial fillers like Restylane or filler materials like medical Gore-Tex or, e-PTFE (polytetrafluorethylene) as the material is known to doctors.
Buttocks augmentation via fat injections
Lipoinjection to buttock with upper And lower abdomen, upper back, bilateral hips, mons pubis, and bilateral inner thighs.
Main article: Buttock augmentation. Many women, including transwomen, and a growing number of men want a curvier, rounder and shapelier rear end. While thin patients must opt for insertion of special buttocks implants to fill out their derrière, patients who can spare the fat can undergo fat injection in a surgical procedure known as gluteoplasty or Brazilian butt lift. Working through small incisions in each gluteal cheek, the surgeon places fat cells at dozens of levels through the patient’s rear. It’s an exacting procedure; one practitioner (Roberts) reports that a placement of fat cells the size of teaspoon will perish because that many fat cells can’t find a blood supply. Most surgeons who perform the task say the perfect deposit of fat cells is about the size of a single pearl or a pea; the drops are placed in long rows. After the procedure, the patient must wear a compression garment for about six weeks and sleep on the stomach for about a week.
In most cases, non-athletic activities and driving can be resumed in about five days.
Breast augmentation via fat grafting
Fat grafting to enlarge female breasts is done, not only for cosmetic reasons, but to reconstruct deformities like a mastectomy, a lumpectomy, a breast implant collapse , a tuberous breast, a condition in which the adult breasts fail to develop in puberty and result in extremely small, narrow and sagging breasts or for the correction of Polands Syndrome, rare birth defect characterized by underdevelopment or absence of the chest muscle (pectoralis) on one side of the body. Coleman and Saboeiro compiled statistics a series of fat injection breast augmentation patients and reported that improvements in the size and shape of the breasts are possible with a fat grafting technique.
In that procedure, the doctors harvest donor fat, centrifuge it for refinement and to screen out impurities. Then, in a four- to five-hour procedure, they inject the fat into the layers of the breast through six to eight, two-millimeter incisions in each breast. (One millimeter is the width of a single line drawn by a ballpoint pen.) Blunt syringes and cannulas are used to place the fat so that no damage is done to blood vessels or nerves. The fat is layered from the pectoralis major muscle up through the top of the breast; the surgeons rely on the fat injections to shape the breasts for an aesthetic, natural-looking result.
Despite the reports of some small clinical studies (clinicaltrials.gov), no current, standard method exists among physicians for preparing donated fat before injection back into the patient. For this and other reasons, the American Society of Plastic Surgeons (ASPS) and the American Society of Aesthetic Plastic Surgeons (ASAPS) are advising their surgeon members and the public against the fat transfer procedure, at least, fat grafting to augment breasts, unless the patient is part of an ongoing clinical research study.However, an earlier report in 2001 by ASAPS found fat grafting “safe and effective” for augmenting buttocks.
The ASPS issued a new policy paper on Fat Transfer/Fat Graft and Fat Injection (March 11, 2009). In it, the Executive Committee approved the policy paper, “Fat Transfer/Fat Graft and Fat Injection ASPS Guiding Principles”. The paper offers background information on the applications, risks and complications, and techniques of fat transfer procedures. The paper also summarizes scientific evidence. Additionally, four guiding principles are stated, based on the conclusion that fat grafting is a safe procedure in select cases; and that results are dependent on a surgeon’s technique and expertise. Indications for fat grafting included: Micromastia; Post breast augmentation deformity, with or without removal of implant; Tuberous breasts; Poland’s Syndrome, Post lumpectomy deformity; Post mastectomy deformity; Deficits caused by conservative treatment or reconstruction with implants and/or flaps (latissimus dorsi or TRAM); Damaged tissue resulting from radiotherapy and nipple reconstruction. (see full text on www.plastic surgery.org and select Health Policy and Advocacy) There is at least one registered clinical trial, ID:NCT00466765, currently with open enrollment.
In addition these referenced reconstructive procedures fat transfer was introduced ]for use in the high risk breast cancer patient. The patient undergoes standard bilateral nipple sparing mastectomy and liposuction. The lipo-aspirate is stored using known biological tissue storing techniques in liquid nitrogen. After a suitable healing period, the lipo-aspirate is injected in serial treatments to build to a natural contour. Given a relatively small breasted woman with sufficient donor fat, the breasts may be enhanced in size over the preoperative state.
Results
Because the surgeon usually must inject too much fat to allow for reabsorption, the overcorrection can make the patient’s face look too plump or swollen for about a week. However, many patients are able to return to their normal activities immediately. Most notice some bruising, swelling and redness in the donor and injection sites. Results from patients, physicians and other researchers place the durability of fat injections anywhere from half a year up to eight years.
Potential risks and side effects
Fat transfer remains controversial although many plastic, dermatology and cosmetic surgeons offer various fat transfer procedures to their patients because the procedure is so well received by patients.
Potential risks of any fat transfer include bleeding or hematoma, (a pool of blood forming under the skin), infection, nerve damage or wound dehiscence, when a surgical wound opens. Sometimes, fluid collection, or seroma, around a surgical wound happens. While all are normally easily controlled and healed, more serious complications can arise. In the case of the former Miss Argentina, Solange Magnano, the gluteoplasty lead to pulmonary embolism, which she succumbed to on November 29, 2009 after three days in critical condition. [14] A close friend, Roberto Piazza, was quoted as saying the liquid from the injections “went to her lungs and brain.”
Overall, the survival of injected fat seems to depend on how the physician harvests the donor fat, the technique used to treat the fat and how the prepared fat cells are put back into the patient and the site to which the fat was moved. Doctors Summer and Sattler found that fat survives equally well when removed with suction via liposuction or when withdrawn by a syringe. The issue of survivability seems most affected by where in the body the fat is transferred, how much that site moves, how muscular it is and if disease is present. When a large area like the buttocks is treated, the patient may have to stop normal activities for a while and can expect some swelling, bruising or redness.
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