Facial Fat Grafting
Facial fat grafting is when small amounts of fat, often nanofat are being placed into areas of your face which requires volume regeneration, to revert signs of aging.
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What is Fat Grafting?
Fat is also known as adipose tissue or adipocyte.
When we transfer fat grafts, we not only transfer the adipocytes, we also transfer other active tissue like adipose-derived stem cells and progenitor cells.
Some of the adipocytes will immediately survive, some adipocytes will undergo replacement during the first 3 months after fat grafting and some of them will break down into oil cyst and gets reabsorbed by the body.
Factors that improve the fat survival:
- Recipient tissue with better vascularity and oxygen tension
- Immobilization during the first week to help with neovascularization of the fat graft
- Size and surface of the fat graft, recommended to be <2mm
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Benefits of Fat Grafting
- Fat is abundant and readily available
- Easily harvested repeatedly
- Compatible
- Adipose derived stem cells
- Versatile and it can be placed in different planes – periosteal, subcutaneous, subdermal or intradermal to achieve different desired effects
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How is it done – where is fat harvested
Liposuction is done to harvest the fat grafts. Suitable areas for use are the abdomen, flanks, medial thighs. I generally prefer to use the lower abdomen and inner thighs as studies have shown that they provide a higher concentration of adipose-derived stem cells. Furthermore, these 2 areas are often easily accessible during the procedure and its own contours can be enhanced with the liposuction.
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How is it done – type of anaesthesia
It can be performed under general anaesthesia, local anaesthesia with or without sedation depending on the patient’s comfort level.
For concomitant larger volume liposuction, it maybe more comfortable to be done under general anaesthesia.
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How is it done – how is the fat prepared and injected
The fat grafts are harvested using cannula. These are then centrifuged to separate out the unwanted components (oil, blood, local anaesthetic and other noncellular material). These fats are then placed in tiny aliquots to the desired area.
Placement of fat in tiny aliquots is crucial to the survival of the fat grafts, as it will allow for adequate blood vessel to supply the fat graft and reduce complications. The fat grafts are gently injected into the recipient areas via multiple passes in different planes and directions.
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Types of Fat Grafting
- Small volume <100mls for facial rejuvenation
- Moderate volume 100-300mls for body contouring and breast contouring
- Large volume >200mls for buttock augmentation
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Complications of Fat Grafting
Not all of the grafted fat will survive, some will undergo necrosis and turn into oil, cyst or become calcified and ultimately resorbed by the body. This process can take from 3 months to 9 months.
Bruising and swelling is expected for about 1 to 2 weeks.
The area harvested can be firmer and harder initially and this will gradually soften over time. Bruising and swelling can be reduced with compression garments, cold compress and elevation.
Irregularities from superficial fat harvest or larger aliquots of fat being grafted.
Asymmetry may occur as the amount of fat graft survival is hard to predict. Generally, about 60-70% will survive. Once the fat graft stabilizes at about 3 months, a repeated procedure can be performed if required.
Infection is rare.
Fat embolism from injection of the fat into a vessel.
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Uses of Facial Fat Grafting
Facial aging and volume loss. Fat will improve the texture of the skin, improve skin thickness, reduce wrinkles, reduce pore size and improve facial scarring.
Breast augmentation. This can be done as a primary procedure to increase the size of the breast by about half to one cup size each time. The procedure can be repeated till the desired results are achieved. It can also be used as a hybrid augmentation together with breast implants to further enhance certain areas like the cleavage.
Back of the hands. An often overlooked area that does reveal our age. With fat grafting, it can fill out the hollows between the fingers to give the hands a younger and fuller appearance.
Any scars that are indented. A combination of treatment with subcision and filling with fat graft will improve the overall contour.
Previously irradiated tissue and chronically inflamed tissues that are stiff and inelastic, free fat grafting can bring in soft pliable fat cells that act as a additional layer of cushioning, and together with the adipose-derived stem cells that it brings in, it can also stimulate new growth.
