My last blog post discussed “recycling plastic surgery,” referring to utilizing tissue taken from one part of the anatomy and re-using it in another. That was about taking the trimmings from the deep layer of a facelift and re-configuring them to help enhance the shape of the lips. Now let’s move onto the more widely-known practice of fat grafting.
Fat is a wonderful substance, and most of us have at least a bit to spare. Some of us have a lot more than a bit, but this piece is not about that. Our body’s fat provides us with warmth, a bank of available energy, and desirable (and not-so-desirable) contour to our faces and bodies. It has the unique ability of being able to survive well when injected into the face, breast, and torso. It is also a surprisingly plentiful source of that mystical, multipurpose little jewel, the stem cell.
Stem cells are the modern buzzwords in both serious research and frankly commercial hype. The “Stem Cell Facelift” is essentially the injection of fat into the face. It’s not clear to what extent the stem cells that exist in the transplanted fat are responsible for any improvement in appearance, but that ambiguity doesn’t seem to hamper the hawkers and publicity hounds from claiming miraculous results.
In any of the fat grafting procedures, fat is carefully extracted from the lower abdomen, the thighs, or any reasonably endowed location, and injected into the face, the breast, or wherever some fullness is desired. Different techniques for treating or not treating the fat before injecting it are common, but usually there is some type of washing or concentrating the extracted tissue.
The amount injected depends on the area…in the face, small amounts can be used to fill in the dents on either side of the chin, the naso-labial folds, or the cheekbone or temple areas. Some physicians claim that simply injecting fat prevents the need for a surgical facelift: those are usually dermatologists or other non-plastic surgery specialists. Some plastic surgeons do fat grafting with each and every facelift. I am concerned that relying solely on fat injections may simply produce a “fat face,” in which the normal human contours are puffed out beyond the point of beauty or normalcy. Personally, I do fat grafting when it’s indicated with a face lift; but usually I find that by carefully lifting the deep layer of the face, I can reposition the existing fat that has dropped down into the jowl from its original position in the cheekbone area. I think that provides a more natural restoration of the original youthful shape.
In the breast, larger amounts are needed, also depending on the specifics. For example, after a breast lift for drooping breasts, fat grafting may eliminate the need for an implant to fill the upper part of the breast. After a post-mastctomy breast reconstruction, fat grafting can be used to fill in the edges around the implant or to smooth out the contours after more elaborate tissue-flap methods. The time may come when fat grafting will totally replace implants for cosmetic augmentation, but I don’t think that’s going to be any time soon.
Fat grafting is not without limitations; despite best efforts, not all the grafted fat will survive. In general we transplant a bit more than we hope to have, anticipating a 25-30% loss in the weeks following the operation. Another problem is that of “fat memory.” Fat seems to maintain its relationship to whatever source it came from. If fat is used to fill in facial contours, and later, even years later, the patient gains a significant amount of weight, the transplanted fat will grow too. That can yield an odd, doughy appearance; the only remedy is a significant weight loss.
Negatives aside, we can look to fat to be a major source of contour enlargement now and for the future. The unknown quantity is what can we expect from the stem cells that we’re transferring with the fat? And now that techniques to isolate the stem cells are becoming readily available, will these cells provide an answer to the many diseases as they have been hyped to do?
Time will tell…in the meantime, we can take advantage today of the ease of availability and tolerance of our friendly fat.
Fat is a wonderful substance, and most of us have at least a bit to spare. Some of us have a lot more than a bit, but this piece is not about that. Our body’s fat provides us with warmth, a bank of available energy, and desirable (and not-so-desirable) contour to our faces and bodies. It has the unique ability of being able to survive well when injected into the face, breast, and torso. It is also a surprisingly plentiful source of that mystical, multipurpose little jewel, the stem cell.
Stem cells are the modern buzzwords in both serious research and frankly commercial hype. The “Stem Cell Facelift” is essentially the injection of fat into the face. It’s not clear to what extent the stem cells that exist in the transplanted fat are responsible for any improvement in appearance, but that ambiguity doesn’t seem to hamper the hawkers and publicity hounds from claiming miraculous results.
In any of the fat grafting procedures, fat is carefully extracted from the lower abdomen, the thighs, or any reasonably endowed location, and injected into the face, the breast, or wherever some fullness is desired. Different techniques for treating or not treating the fat before injecting it are common, but usually there is some type of washing or concentrating the extracted tissue.
The amount injected depends on the area…in the face, small amounts can be used to fill in the dents on either side of the chin, the naso-labial folds, or the cheekbone or temple areas. Some physicians claim that simply injecting fat prevents the need for a surgical facelift: those are usually dermatologists or other non-plastic surgery specialists. Some plastic surgeons do fat grafting with each and every facelift. I am concerned that relying solely on fat injections may simply produce a “fat face,” in which the normal human contours are puffed out beyond the point of beauty or normalcy. Personally, I do fat grafting when it’s indicated with a face lift; but usually I find that by carefully lifting the deep layer of the face, I can reposition the existing fat that has dropped down into the jowl from its original position in the cheekbone area. I think that provides a more natural restoration of the original youthful shape.
In the breast, larger amounts are needed, also depending on the specifics. For example, after a breast lift for drooping breasts, fat grafting may eliminate the need for an implant to fill the upper part of the breast. After a post-mastctomy breast reconstruction, fat grafting can be used to fill in the edges around the implant or to smooth out the contours after more elaborate tissue-flap methods. The time may come when fat grafting will totally replace implants for cosmetic augmentation, but I don’t think that’s going to be any time soon.
Fat grafting is not without limitations; despite best efforts, not all the grafted fat will survive. In general we transplant a bit more than we hope to have, anticipating a 25-30% loss in the weeks following the operation. Another problem is that of “fat memory.” Fat seems to maintain its relationship to whatever source it came from. If fat is used to fill in facial contours, and later, even years later, the patient gains a significant amount of weight, the transplanted fat will grow too. That can yield an odd, doughy appearance; the only remedy is a significant weight loss.
Negatives aside, we can look to fat to be a major source of contour enlargement now and for the future. The unknown quantity is what can we expect from the stem cells that we’re transferring with the fat? And now that techniques to isolate the stem cells are becoming readily available, will these cells provide an answer to the many diseases as they have been hyped to do?
Time will tell…in the meantime, we can take advantage today of the ease of availability and tolerance of our friendly fat.