I have read an answer from one of the doctors on RealSelf, saying the old method of fat injections involved sucking fat through liposuction. During the fat transfer I had, I stayed awake and the surgeon froze my stomach. He used a small device to suck some fat out, then placed it somewhere to spin it before he injected it in my face. I'm wondering, is this the new method for this treatment?
Modern Method for Fat Injections?
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Fat injections and adult stem cells
Fat injections with stem cell enhanced injections are the new frontier of plastic surgery. The process of centrifugation is critical to this technique. I hope you have the time to watch my video about this exciting new area.
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The techniques vary in harvest, preparation and placement of fat grafts
You are correct. The old technique involved sucking the fat as in liposuction and re-injecting it.
These are the areas where fat grafting technique has improved:
1) During harvest, the fat cell must NOT be exposed to high suction. Fat must be harvested using hand held devices that minimize suction injury to the fragile, living fat cells.
2) Preparation involves removing other components in the aspirate that are not living fat cells. If you include a lot of blood and other cells i nthe injection, they will take the place of living fat cells and will disappoint you!
3) Placement must focus on placing small amount of fat graft in each tissue layer. Placing a large amount of fat in one place, although fast and easy for the surgeon, will result in a lot of dead cells being absorbed quickly.
A gentle and meticulous fat grafting procedure can have very satisfactory long term outcome!
New methods of fat injection
This is the basic technique for obtaining fat grafts and essentially, there is nothing new here.
WHAT IS NEW is the process of handling the fat. In the past, the fat was simply re-injected. However, this included dead fat cells, fluid such as blood and serum, as well as protein. Currently, a new popular method involves centrifuging the fat allowing separation of the components into different layers. The layer containing predominantly live fat cells is isolated, and injected thereby delivering better "quality" fat to the desired treatment areas.
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Fat Injection Techniques - which is best
There are a lot of small modifications and "latest and greatest" "modern" twists on how to do this procedure but there are basic shared essentials. The Fat Transfer Procedure involves harvesting by liposuction with a small cannula, rinsing with sterile saline or lactated ringers solution and reinectiing it (lipoinjection or fat transfer) through a very small cannula (fine metal tube - like a needle with a blunt end and side hole) through a needle stick opening layering the fat in fine layers to improve survival (structural fat grafting) There are many variations such as use of a centrifuge which was used in your procedure, and using enriched growth cell factors or enriched stem cells but at present I have not found this to be of benefit.
Of MOST IMPORTANCE is the selection of a skilled plastic surgeon who is board certified and has experience in this technique.
Fat grafting has been performed by plastic surgeons for decades, but it is just in the last ten years or so that techniques and instruments have been refined to the point that it can be accomplished reproducibly and reliably, making it an increasingly important part of facial rejuvenation surgery. The term 'structural fat grafting' refers to a specific surgical technique in which small amounts (less than 0.1 cc at a time) of fat are carefully microinjected in a series of discrete layers to gradually 'build' new soft tissue structure. As there is space between each microinjection, new blood vessels are able to grow into the grafted fat, allowing it to persist long-term.
Structural fat grafting requires specialized training and specialized surgical instruments, as well as patience, finesse and attention to detail on the part of the surgeon. When performed properly, permanent and natural-appearing improvements in facial contours are possible. This revolutionary technique provides a means for restoring a youthful facial appearance that cannot be accomplished by means of traditional facial cosmetic surgery techniques, which have in the past focused primarily on skin excision for the purpose of 'tightening' facial features.
One of the better ways to harvest fat is to harvest it gently. High suction is probably not the way to go. Spinning it down can remove the liquid part but also may remove stem cells.
I just let it naturally separate and then I inject it with small syringes.
The living cell concept
The increased success of fat grafting is a result of refinement in the harvest,the purification and the injection techniques. The whole concept revolves around treating the graft as living cells and not just a regular filler.
Add stem cell technology to possibly modern methods for fat injections
I must add to the "modern" methods of Fat transfer the idea of stem cell enhanced fat transfer. This is truly a modern method. Though not yet available in US it may add to the longevity of the fat transfer. The jury is still out.
Modern Fat Transfer technique
Fat is a GREAT filler IF it survives the operation.
Fat can be injured and die when
- it is harvested (That is why we prefer to use low suction to reduce barotrauma and cell death)
- when it is without blood (and oxygen) supply (which is why it after it is washed and purified it is kept on ice to reduce its need for oxygen)
- it is exposed to air and drying
- it is injected / grafted by forceful injections (again - high pressures can kill fat cells)
- if it is not kept alive by the blood vessels in the area it was placed it.
It sounds like the method you had was the current technique for fat transfer.
Peter A Aldea, MD
Fat Grafting Microdroplets
Yes, that sounds very much like how it is done today. Fat transfer is my forte. I do it almost every other day. I tend to look at fat transfer as being as important technically to not overfill or underfill a face, as it is artistically to create the right balance and blending. a lot of docs who do fat transfer just stick some in the cheeks. i believe that success in the result comes from sculpting a lot of little areas to make the result look wonderful. here is a video to explain some of my thoughts.
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