FAT GRAFTING TOOLS
A surgical fat transfer is cosmetic surgery to move fat from one part of the body to another. It’s also known as a ‘fat graft’ or ‘lipomodelling’
The aim is to remove unwanted fat from one area (such as the tummy or thighs) and use it to smoothen or increase the size of another area (such as the breasts or face). The advantages are related to the fact that one can get rid of unwanted fat deposits and replace them into areas in need of volume or healing. Fat cells are autologous – from your own body – so any adverse reactions related to foreign objects or substances are avoided. These types of reactions are known for implants of other kind – be it injectables or more solid implants used.
Fat grafting has existed for over a century and has long been used for correction of both large and small volume deficits. The German surgeon Gustav Neuber first described the technique in 1893, reporting successful outcomes after transplanting fat beneath atrophic scars. Not long after, Vincent Czerny pioneered the use of autologous fat in breast surgery, employing a patient’s own lipoma for post-mastectomy reconstruction. By 1914, fat grafting had been used for a variety of indications, ranging from craniofacial and breast reconstruction, to improvement of joint mobility after surgery for ankylosis. Today, studies show how fat is incredibly useful in healing our bodies after trauma or injury and can also be used to fill areas in need of it – be it wrinkles or flat breasts.
However, as surgeons continued to expand their use of fat grafting in clinical practice, they also began to note its limitations, chiefly the unpredictability of final volume retention. While some fat cells do well and adjust to their new environment well, others are reabsorbed and die along the way during the process. There are very different reports as to the fat cell viability at transfer ranging from a mere 10% to 90% – depending on the grafting site, injection site, the amount transferred and the methods used. Today much more attention is paid to the factors that can impact the results and the potential side effects that can arise from fat grafting. Thus while the advantages are clear, there are also some risks related to these types of treatments.
The process start with harvesting your own fat
Harvesting fat is typically done from donor sites such as stomach, thighs and flanks. These sites usually offer sufficient deposits to harvest from.
Harvesting itself is usually conducted by first numbing the area harvested from. Local anesthesia (tumescent solutions) will make it painless but may affect the fat cell viability towards the negative. Washing the graft after harvesting has in clinical studies shown that this negation can be avoided. If the harvesting is done in general anesthesia, such issues are less apparent.
The actual harvesting takes places either through manual harvesting of smaller volumes with syringes or with suitable liposuction equipment (suction assisted, mechanically assisted or water assisted are most used) with larger quantities.
In all options using the right type of cannula is also important for cell viability at harvesting. They vary in length, diameter, in type and design. Some cannulas are designed to target larger cells, some larger quantities while others are designed for smaller sized cells, smaller quantities or cell-friendly design and any combination of those. There are plenty to choose from depending on the next steps and injection site intentions.
Then the fat graft is processed and prepared
There are a few different techniques used in preparing the fat graft ready for injection. After harvesting , lipoaspirate is typically processed for removal of the oil and aqueous portions in order to isolate the adipose stroma for grafting. Various strategies for this exist, including centrifugation, decantation, filtration, and mesh/gauze rolling, with multiple studies having been conducted to determine the most appropriate processing technique.
Centrifugation remains the most popular methodology for separation of these components but it is starting to lose its ground as it is important to treat the fat graft gently to allow best possible fat cell quality and viability and thus best survival rate after injection. Some studies suggest that the use of centrifuge – particularly at higher speeds will lead to less viable fat cells and take rates. Also, decantation and filtration techniques considered to be more gentle also allow targeted collection of smaller – micro or nano sized fat cells for injection.
Typically, doctors prefer smaller fat cell sizes for facial and superficial grafts while the larger ones will do just fine for buttocks or breasts. According to some of the research papers, finding a suitable size does seem to affect the cell survival among other things.
And the fat is injected back into your body
The last step of the process is to inject the fat back into the desired placements of the body. The most common sites are the face as well as breasts but recently buttocks are gaining popularity too as the most viable and least dangerous option compared to silicone or other types of foreign material implants. There are some things to consider:
- The less stress at injection leads to better take rates/cell survival – this can be done manually by slowing down the injection speed but standard injection guns are also emerging
- The smaller the injection quantities, the better the cell survival – that means often more injections and several sessions over longer time period, particularly for breast corrections and buttock enhancement
- Sites like breasts and buttocks require quite a bit of patient patience as the the results also depend on the after care between the sessions where the patients must be careful not to distress the areas of injection be it exercise, pressure, or something else.
- There are also some potential adverse events to consider despite the rarity of them. This includes size of the fat molecules injected fitting the recipient area to avoid visible lumps and bumps, risk of fat embolism and necrosis as well as potential tumor inducement due to the hormonal/healing capabilities of the fat cells – not just helping to heal the radiated sites and skin but potentially also reviving the cancerous cells.
All of this being said, the advantages of autologous grafting are also great as the body readily accepts reinsertion of its own tissue and thus various side effects and foreign body reactions can be avoided.