Introduction:
Fat grafting is surgically transferring the fat from one part of the body to another. The goal is to improve the area where the fat is injected. It involves extracting adipose fat by liposuction, processing the fat, and then reinjecting filtered fat tissue into the area to be improved. In fat grafting, fat tissue is taken from other parts of the body, usually thighs, belly, and buttocks by liposuction. Fat grafting is used to improve and enhance the cosmetic look of the face, breast, hands, hips, feet, and buttocks. However, recently, the benefits of fat grafting in the healing of wounds and scars, and to repair breast damage following radiation treatment.
How Is It Otherwise Known?
-
Fat transfer.
-
Fat injections.
-
Micro-lip injection.
-
Facial fat rejuvenation.
-
Autologous fat grafting or transfer.
How Is Fat Grafting Done?
A standard fat grafting technique is commonly performed in three stages:
-
Harvesting of adipose tissue from a suitable donor site.
-
Processing of the lipoaspiration to eliminate cellular debris, acellular oil and excess of infiltrated solution.
-
Reinjection of the purified adipose tissue.
1. Harvesting:
The aim of removal of adipose tissue is to minimize the adipocyte damage and increase the life of adipose tissue. Fat can be harvested by three methods: vacuum suction, syringe suction or surgical excision.
Vacuum Suction Method:
Negative pressure liposuction is an effective method for aspirating large amounts of fat, but it destroys the adipocytes, reducing the chances of graft survival. High vacuum pressures disrupt the cell structures in up to 90% of adipocytes. The tube size also affects the fat harvesting.
Surgical Excision Method:
Excising and harvesting fat with large-opening tubes reduces the cell damage, preserves the tissue structure, and collects large fat particles. The tube is then pushed back and forth through the harvest site creating a gentle negative pressure. This negative pressure gets filled in the syringe. When filled, the syringe is disconnected from the tube and the syringe is sealed.
2. Processing:
The goal of fat processing is to eliminate cell debris, make free oil, and other unimportant components of the lipoaspiration. These elements cause swelling at the recipient site making graft failure. Blood must be removed as it degrades the transplanted fat.
Sedimentation produces little trauma of the vital adipocyte. During this process stem cells are also obtained. Filtration eliminates contaminants and maintains the viability of adipocytes and a large portion of adipose-derived mesenchymal stem cells. This processing technique removes effective viable graft material for large-volume fat transfers.
Centrifugation is the most widely used for fat processing. The recommended centrifugation speed is 3000 rpm for three minutes, separating the denser components from the less dense components thereby creating layers.
The upper level is the least dense and consists of oil. The middle portion is made of fatty tissue. The bottom most layer is blood, water and any aqueous element. This method obtains the highest possible concentration of stem cells within aspirate and has increased angiogenic growth factors such as fibroblast growth factor (FGF) and vascular endothelial growth factor (VEGF).
3. Implantation:
Re-implantation of fat is based on the blood supply to the recipient site for increased fat survival. Graft can survive up to 48 hours through nutrition by tissue fluid absorption. By that time, new blood vessels appear and progress at the rate of about 1 mm per day. Therefore, the fat should not be deposited greater than 2 mm to avoid central cell death. With the help of the tube the fat graft is placed in the recipient site. Small-gauge cannulas reduce trauma to the recipient site, thereby reducing the risks of bleeding, clot formation, and poor oxygen supply to the graft.
What Are the Applications of Fat Grating?
-
Breast Reconstruction: Autologous fat transplantation is generally used in reconstructive breast surgery.
-
Scars: Patients with retractable and painful scars that hinder the daily activity or movement of the joint are treated with lipofilling.
-
Burns: Regenerative medicine using stem cells is an effective, high-quality, and less-morbid therapy for skin coverage in burns, as there is minimal risk of hypertrophic scarring.
-
Radio Dermatitis: The lipoaspirate containing adult ASCs is highly effective in treating radiation induced disorders.
-
HIV-Associated Lipodystrophy: In facial lipofilling autologous fat injection is the most reliable treatment for facial subcutaneous augmentation.
-
Aesthetic Surgery:
-
Facial Transformation: Autologous fat grafting has a unique regenerative potential of lipofilling and has shown excellent results.
-
Hand Reconstruction: In conditions like aging, wrinkles and irregular pigmentation due to solar purpura, hypopigmentation, actinic keratosis, seborrheic keratosis, and telangiectasia fat grafting is an attractive procedure.
-
Rhinoplasty: Both autologous grafts and synthetic implants produce better outcomes in rhinoplasty.
-
Breast Augmentation and Asymmetry: Fat grafting for breast augmentation is highly preferred as the donor tissue is easily available, no scar formation, faster recovery time avoids prosthesis and performed in an outpatient setting.
-
Gluteal Augmentation: Fat grafting replaces implant-based gluteal augmentation if enough fat is available as a donor material.
-
What Are the Complications of Fat Grafting?
Complications with structural fat grafting are rare. If present can include:
-
Infection.
-
Bleeding.
-
Irregularities.
-
Scarring.
-
Asymmetry.
-
Overcorrection.
-
Placing too much or too little fat.
-
Calcification and lumps can occur after fat transfer.
Studies show structural breast fat grafting is safe and does not increase the chance of breast cancer or make it difficult to detect breast cancer.
What Is the Prognosis of Fat Grafting?
The prognosis is usually excellent. Swelling usually reduces from the third day on, and normal activities can be restarted after a week.
Conclusion:
Fat grafting is a reconstructive and cosmetic procedure to restore the deformities caused by trauma, congenital defects, disease, cancer removal, or natural aging process. Fat is ideal filler as it is readily available; with low donor-site fatality; inexpensive; versatile; and biocompatible. It improves wound healing, describing their regenerative and remodeling capacity by the growth factors. Despite the question about survival and longevity of fat grafts after implantation and long-term outcome, fat graft has been successfully used in different clinical situations.
