Often on this site there seems to be a great amount of interest in knowing how many cc's a person received after fat grafting. I have heard that approx half of the fat harvested will be suitable for transfer. What do you as plastic surgeons consider "good fat". I've also heard that "new fat", gained in anticipation of harvesting, is better than fat you've had for years. Also if you are someone such as myself, who has fat on top of muscle, is that fat somehow less viable? Thanks
Fat Quality..What Makes Fat Good for Transfer? (photo)
Doctor Answers 5
Fat grafting and fat quality
You are correct, not all of the tissue that is removed during a liposuction is reinjected when the fat is transfered. In most cases, the fat is processed (centifuged, strained, washed, etc.). This processing can help separate viable fat cells from other components, such as blood. With regard to "new" vs "old" fat cells, you do not need to gain weght to "grow" new/better cells. When we gain weight, our old fat cells simply expand in size, no new fat cells are created.
Best fat for grafting
The idea of fat grafting is to transfer fat cells from liposuction to another part of the body, where they will become living fat tissue at that location. However, fat cells from different parts of the body behave differently, which is why liposuction is targeted at the areas where fat is resistant to change with diet and exercise. The fat cells will behave the same way when they are transferred, so the best is from the areas where you would consider doing lipo because the fat there is stubborn. Fat you gained intentionally in other areas will not be as reliable since it will go away if you lose weight.
Viable, living fat cells are best for Fat Transfer. Centrifuge and other treatments help preserve viable fat cells.
Many fat cells are damaged or killed during fat harvesting for Fat Transfer. The key to the best result after Fat Transfer is to transfer viable or living cells that have the potential to survive.
Centrifuging of the fat forces the heavier in tact viable cells to the bottom of the tube leaving damaged cells and other material such as the Lidocaine and Epinephrine used in the procedure at the top of the tube where they can be removed.
Washing of the cells with Lactated Ringers and mixing with Platlett Enriched Plasma has been used to improve viability.
Newer specialized Centrifuges with counterweights such as Adivive claim to produce up to 90% viable cells.
I am unaware of studies showing that newly gained fat has an advantage.
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What is the best fat to harvest
The best fat to harvest is located in the area that is the hardest to lose the fat by exercise. Good areas are the hips, love handles, or inner thighs.
Best donor areas for fat transfer
In my practice, I tend to focus on fat harvesting sites that are the areas where the patient reports they have the hardest time losing fat. This is usually lower abdomen, or inner/outer thighs or hips.
In extremely lean patients, these areas may not yield enough fat, and we may need to use secondary choices such as inner knees and lower back.