The Science and Technology of 21st Century Fat Grafting for Face and Body Contouring

By Dr. Gregory Wiener, M.D., FACS

Fat Grafting, the transfer of fatty tissue from one part of the body to another, in order to fill in a contour defect, has been utilized in medical procedures for more than 100 years. Notoriously unpredictable due to the low fat cell survival rate, surgeons have now discovered better, more reliable ways to harvest the fat from the body.

Over the past 20 years, Plastic Surgeons have figured out how to effectively harvest fat and implant it in other areas of the body by utilizing a gentle implant technique. This new way of implanting the fat has made the greatest gains over the last 10 years and is finding it’s way into Plastic Surgery procedures ranging from facial fat transfer to butt augmentations.

The advent of liposuction in the late 1980’s gave us a way to harvest fat in a semi-liquified form with a lower content of connective tissue that was easily placed into a syringe and injected into the targeted area. Over the last 10 years, techniques in Liposuction, fat cell preparation and delivery (Injection) have been refined to the point where predictable results are routine.

At The Art of Plastic Surgery, we use a very low power suction (syringe generated) and specially designed cannula’s and needles. We found that this causes low trauma to the fat cells for both harvest and delivery, especially for small volume grafting used for a facial rejuvenation.

We use Ultrasonic Liposuction at low power to liquefy larger amounts of fatty tissue (while not traumatizing the cells themselves) for use in grafting/augmenting larger areas such as the breast or buttocks.

Fat cell delivery, whether in the face or body, is done using a ‘droplet’ technique. By injecting in the face, tiny droplets spread evenly throughout the tissue for maximal survival. We’ve found that there is better oxygen delivery to the fat if it’s not ‘crowded’. We do the same for larger body grafts, however, we tend to use larger droplets.





The Benefits of Using Fat

  1. Soft, natural results. It’s your own tissue.
  2. Better, in most cases, than any commercially prepared filler to fill in a defect for reconstruction of an area, or augment an area for cosmetic, or rejuvenative purposes.
  3. More permanent results. Most of the grafted fat (depending on technique and patient) will live in the area it is grafted to, giving the patient a more permanent result.
  4. Easy to harvest. Most patients will have an ample supply of fat to use for grafting. Grafting to smaller areas such as the face and hands usually requires smaller amounts of fat harvested from localized areas such as the lower abdomen. Larger grafts, such as augmentation of the breasts or buttock will require a more formal, larger volume liposuction to the body (abdomen, back, waistline, arms, thighs) in order to harvest larger amounts of fat. In these cases, contouring of the rest of the body becomes a focus of the procedure as well as the area to be grafted.
  5. Fat has stem cells. Stem cells are cells in our body involved in repair and regeneration of our tissues. We have ‘embryonic’ stem cells when we are developing in utero, and ‘adult’ stem ells throughout our lives. Stem cells have the ability to become (or change into) any cell from any type of tissue necessary. Stem cells have been used for years in the treatment of blood-derived cancers (Leukemia and others) to re-populate the patient’s body with new blood cells derived from bone marrow after chemotherapy destroys the bad, cancerous cells. (ie. Bone marrow transplant)
  6. Fat has more adult stem cells than bone marrow! Currently, when fat is transferred (grafted)

This makes Fat Grafting a truly rejuvenating treatment! And the stem cell issue is currently ‘the next big thing’ not only in plastic surgery, but also in many areas of medicine. Current, ongoing research is being done to attempt to concentrate the stem cells that are harvested during Liposuction into regenerative elixirs that can be used for reconstruction and augmentation of any area (i.e. added to your fat graft to ‘supercharge’ it so that all cells survive, as well as rejuvenate the area.)

Current Uses at The Art of Plastic Surgery

For Breast Reconstruction, after breast cancer surgery and radiation: Grafting fat into the radiated area vastly improves the firm, tight tissues that are thinning from radiation. It thickens the area, makes it more pliable, improves skin color and fills in defects to augment the reconstruction.

For Reconstruction of any other dent, defect or hole in the contour of the face or body brought about by injury, cancer surgery or congenital defects.

For Facial Rejuvenation: Much of the aging of the face occurs due to the loss of volume in the facial tissues, as well as the thinning of the skin and skin laxity. Fat restores volume and, to some degree, improves the quality of the overlying skin. We use it both as a stand-alone treatment done under local anesthesia, as well as in conjunction with Face and Neck Lifts for added volume and a fuller, more youthful result. It is ideal for the area around the eyes to decrease the hollow look that sometimes comes with aging, as well as for the cheeks and temples to plump up the skin, making wrinkles less prevalent.

For Hand Rejuvenation: Fat Grafting fills in the thinning skin and loss of soft tissue in the hands due to the aging process. It can cover visible veins and tendons and improve the color and texture of the skin.

For Breast Augmentation: Although we perform this procedure on a limited basis, we can use Fat Grafting to thicken areas of the chest and breast before an augmentation with implants in patients who are very thin with visible ribs and very little subcutaneous tissue.

Fat Grafting for Buttock Augmentation

Dramatic body contouring results with Fat Grafting in the buttock and waistline have made this treatment one of our fastest growing, most popular procedures. Fat Grafting can safely and effectively add volume to drooping, flattened buttocks and reestablish the youthful contours of the body.

For younger patients who may never have had the volume in their backside, this is a very attractive option. Current cultural trends lean toward a fuller, rounder buttock with a narrow waistline such as those of Kim Kardashian, Jennifer Lopez, Beyonce’, etc.

Recent studies show that the most pleasing ratio of waistline to buttock is .7 and we are continuously trying to create this, and in some cases, exceed it in our patients. Most patients report that their clothing fits much better and their level of confidence has increased due to a more favorable body image.

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