Articles
Fat transfer
Fat transfer goes by many names: liposculpture, lipofilling, liposhifting, microlipoinjection, autologous fat transfer and fat rejuvenation. Essentially it is a three step procedure. Firstly the fat cells are harvested. Secondly they are prepared. Thirdly they are reinjected. This gives a long lasting result, that is natural and soft to touch.
With age there is volume loss and tissue descent. Voluminous curves are perceived as youthful. The reintroduced fat fills and recontours the lost tissue. A good example is replacement of fat in the cheeks. Wrinkles and hollows can be filled. Besides its use for cosmetic procedures it can also be used for reconstructive procedures.
Depending on the amount to be transferred the technique can be performed under local anaesthetic, sedation (by mouth or injection) or general anaesthetic. Local anaesthetic containing small amounts of adrenaline is always used. Adrenaline causes the blood vessels to shut down or vasoconstrict which minimises bleeding and bruising. Local anaesthetic reduces pain so the amount of general anaesthetic, if used, can be reduced. Local anaesthetic also ensures a number of pain-free hours after the procedure.
The donor site is chosen from where the fat is taken. The area is prepared and anaesthetised. Drapes preserve the sterile field. Fat is harvested using a low-pressure liposuction technique. Often the stomach, inner thighs and inner knees are favoured as harvest or donor sites. At all times the fat cells are preserved by minimising the trauma and damage to them. This ensures many viable cells to use.
Fat cells are prepared in many different ways. The aim is to remove blood cells, oils, ruptured fat cells and tissue fluid from viable, live fat cell. Cells are centrifuged, or washed or decanted to allow this separation.
Prepared fat is then reinjected as small droplets or narrow strings. Cheeks, chins, lips, temples, tear troughs, eyes, jaw line and hands are commonly injected. The volume reinjected at each pass is fairly small as the fat cells rely on obtaining a blood supply from the surrounding tissue. For bigger volumes the fat may be layered in various tissue planes, for example deep to muscle, superficial to muscle and then under the skin. Often no stitches are required because the punctures used are so small.
Fat injected as strings
As the fat is taken from the same person rejection cannot occur. There is some degree of absorption of the fat. This amount is variable. The resorption takes place slowly. Usually the procedure needs to be repeated to obtain full correction. Repeat procedures are performed after a number of months to allow full settlement.
Blood supply from adjacent tissue
Swelling and bruising are quite common and variable. Pain is usually mild and related to the amount of fat used. Infection is a low risk when performed in the face. Contour irregularities, clumping and lumps may occur and is usually due to irregular fat absorption, these can be corrected at the planned second procedure.
The idea candidate should be in good general health and have realistic expectations. Smoking can affect the blood supply and therefore the uptake of fat. Aspirin containing medications, non steroidal anti-inflammatories and some herbal preparations can thin the blood and make bruising worse. These should be avoided for ten days prior to the procedure. Both donor and recipient area should be clean and free of make-up.
After injection there may be a feeling of tightness and bruising. Steristrip tapes cover the injection sites. Pain tablets may be required. An information sheet detailing the post procedure protocol is usually given out. Cool, not ice-packs, can give symptomatic relief. The area should not be massaged and movement should be limited.
Fat transfer is a permanent volume replacement technique to rejuvenate certain areas. In general it is very well tolerated and results are very favourable.