Fat Grafting Dallas

What is fat grafting?

Fat grafting or fat injection is transfer of one’s own fat from areas of fat excess to areas of fat depletion. The fat is first harvested using the liposuction technique from areas of fat excess like the lower abdomen or outer thighs.

The harvested material contains fat cells, liquid fat, blood cells and fluid with local anesthetic that was injected to facilitate liposuction. Fat cells are the only component required for fat injection. These cells are then separated from the other components. There are several methods of separation, but typically the harvested material is centrifuged to accomplish this. The separated fat cells are then placed into syringes and are ready for injection into the appropriate areas.

Although fat injection can be done to any area of the body, the common areas are the face, breast and buttocks. Since facial procedures typically require moderate amounts of fat, liposuction to harvest fat is usually not enough to produce a dramatic change in contour over the donor area (lower abdomen or thighs).

How does it work?

For the injected fat to stay long term in the location where it was injected, it needs to establish a blood flow. Surgeon technique is a very important factor in determining this. If a large amount of fat is injected at any one location, it forms a ball of fat. Blood flow cannot establish to such a fat ball. However, if tiny particles of fat are injected into different layers of the tissue at any given location, each particle has a much higher chance of establishing blood flow. Ideally a needle/cannula is passed at least about 50 times into the tissue to inject each 1 cc of fat. So, essentially 1/50th of a cc of fat is injected into any one spot!

Fat provides long term skin thickening and rejuvenation well beyond its filling effect. Its ability to repair skin damage from sunlight and aging has been attributed to its stem cell effect. Besides, fat also reduces pore size of the skin and has a lightening effect in certain locations over the face that results in a better complexion.

Why fat grafting

Fat grafting is performed under two circumstances.

The first involves injection to areas that have lost fat with age, typically the face. One of the components of facial aging is loss of fat. Fat transfer aims to rejuvenate the face by enhancing the volume, altering the contours and reducing the appearance of wrinkles. It is used commonly in areas such as the cheeks, lips, eyelids, temples and for wrinkles around the mouth (marionette lines, nasolabial lines). Fat transferred to deep smile lines, corners of the mouth, hollowed eyes and sagging cheeks can restore the volume and improve the effects of aging.

The second circumstance involves overfilling areas to produce a desired contour, notably the buttocks and breasts.

Advantages of fat grafting

Fat is a natural substance. Since, it is removed from and injected into the same person, it does not produce rejection or allergic reactions.

It also produces a long lasting result when compared with fillers.

The technique is relatively noninvasive as only a few small needle puncture wounds are required.

In addition to providing volume, fat has also been known to significantly improve skin texture, reduce pore size and rejuvenate skin secondary to a stem cells effect.

Drawbacks of fat grafting

Unlike injectable fillers, the process of fat harvesting, separation and injection is time consuming and is usually performed in an operating room. Depending on the volume of injection, sedation or general anesthesia may be required.

No matter how good the injector, some amount of fat is lost after injection as it is absorbed into the body. This amount can be unpredictable and can cause asymmetry if one side loses a little more fat than the other. Hence, additional injection nay be required in the future. The majority of fat loss occurs in the first 6 to 8 weeks following surgery. The results at 12 weeks is expected to be permanent.

Although rare, some patients who gain a significant amount of weight after fat grafting can have over growth of the injected fat that can produce unfavorable contours.

Short term lumpiness is possible that usually resolves with time.

Some locations like the corner of the mouth and lips are more predictably treated with fillers that fat. Similarly some wrinkles are more predictably treated with filler injections.

Who is a good candidate?

Fat injection is ideal for individuals who have lost facial fat from aging. I commonly use fat injection in many patients undergoing face lifts to correct the volume loss component that a facelift cannot correct. Depressed scars and some types of acne scarring can also be addressed with fat grafting. Fat injection can also be used to rejuvenate the hand so that blood vessels and tendons are not readily visible. Some volume increase of the breast is possible with fat although most patients require implants for this purpose. Buttock enlargement can also be accomplished with fat.

Post-operative recovery

The procedure is performed on an outpatient basis and patients go home the same day. Pain is typically minimal and most patients can regain normal activity in a one to two days. Expect significant bruising and swelling of the face especially if larger volumes of fat are injected. Sleeping with the head elevated can reduce some swelling and hasten recovery. Strenuous activity that is likely to significantly raise blood pressure is best avoided for at least 4 weeks after surgery. It can take up to three months or longer for final results.

My approach

I typically use fat to rejuvenate the aging face and to treat certain types of facial scarring. I use small cannulas (micro injection) to produce the best results as very small amounts of fat are placed in the tissues to maximize blood supply. If a large amount of fat is injected into any one location, most of the injected fat is lost as it will not develop blood circulation. Conversely, when very small amounts are placed within multiple layers of tissue, an overall large volume can be placed as the small parcels placed in different tissue planes allow the fat to get an independent blood flow with more predictable outcomes.