I recently had my third "touch up" for a fat transfer procedure where fat was injected into the tear trough areas under my eyes. In the past, the result has been great for a week or two, and then it goes away. Is there anything I can do as a patient (e.g., no alcohol consumption, avoiding movement in the area) to increase the survival rate or take rate of the fat transferred?
How Can I Increase the Take Rate for a Fat Transfer?
Doctor Answers 8
How to improve Fat Graft survival
I believe one of the most important things that fat grafting patients need to do is to minimize motion in the area of the grafted fat. This will hopefully allow the new fat cells to get revascularized (reconnected to blood supply). I don't think that small quantities alcohol will be detrimental in any way. It may actually help as it is a vasodilator.
How to improve fat graft survival
There are several factors that can affect fat graft survival:
- Surgical technique. There is no one agreed upon method to properly perform fat transfer. There is a general consensus that the fat must be handled very gently, using minimal suction to harvest the fat. The fat must be isolated from any blood products, numbing medicine and ruptured fat cells. Some surgeons use a centrifuge whereas others use different methods. This is where finding a plastic surgeon who can show you photos of good long term (ideally 1+ years postoperative) results is very important. The specific details of the grafting process aren't quite as important as long as it leads to good long term results.
- Graft Volume. I find it very important to place the fat as a fine, three-dimensional lattice in order to maximize the surface area available for the new blood vessels to reach the fat grafts. If the fat is placed in too large a volume the blood vessels won't be able to reach the "core", leading to fat cell death.
- Excessive motion to the recipient site. This is what limits fat grafting results to the lips. They're so mobile that it is very difficult for the new blood supply to make it to the new fat cells. The tear trough area generally does very well in this regard as it is not mobile at all. I wouldn't do excessive massage or manipulation of the area, though.
- Smoking cigarettes. Cigarettes constrict the blood vessels of the face, limiting the blood supply to the new fat
- Age. Fat grafting doesn't take as well in patients who are in their 70s and older.
I'm not sure how long you've waited between treatments, but it is important to realize that in my hands patients will have a perceived low point in their result about 6 months after the procedure (when the swelling has all dissipated). Then from 6 months to 18 months after the procedure the grafts will "take" and continue to blossom.
The best way to maximise fat take from your point of view is to minimize muscular movement and avoid excessive massage or pressure on the fat grafts.
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Improving fat graft and fat injection results
The viability of fat cells after fat injections depends on how gently the fat is removed, the size of the fat particles, the manner in which the fat is treated, the recipient site's vascular supply, ensuring that the fat is not placed into an empty space without much blood flow, and that you do NOT smoke.
How to Increase the Take Rate for a Fat Transfer
Good results after fat transfer are obtained when the fat that is transferred survives. If the fat that is transfered dies, the fat is reabsorbed or lost.
The rate of fat survival after fat grafting depends on several factors:
1. HARVEST TECHNIQUE: How the fat is harvested from the body and how the fat is injected in the desired area is important. Gentle technique using small liposuction canulas and low negative aspiration pressure to harvest the fat is shown to improve fat survival.
2. FAT PROCESSING: Gentle processing of the fat after it is out of the body is also very important. If the fat is centrifuged, it should be done at low RPM for a short period of time. For example, 3000 RPM for 3 minutes is a preferred method. The fat may also be allowed to separate from surrounding fluids by gravity suspension.
3. FAT INJECTION: Best results are obtained by injecting small amounts of fat with different passages in different layers of tissues. This assures that each particle of fat injected is in close contact to available blood supply.
4. DONOR and RECIPIENT AREA: Some studies suggest that some areas of the body are better fat donor sites than others. For example, the abdomen and iliac rolls are thought to be excellent sources of fat while fat recipient sites adjacent to well-vascularized muscle are thought to be the ideal recipient area.
Massage to areas of fat transfer and alcohol compsuption have not been associated with increased or decreased fat survival.
Jaime Perez, M.D., Fat Transfer Specialist, Tampa, Florida
Plastic Surgery Center of Tampa
Improving Volume Retention for Facial Fat Grafting
There are many ways to improve the volume retention for fat grafting procedures. I would first suggest you find a surgeon with expert experience in the field. Fat grafting volume retention is dependent on many factors. First is the harvest technique. Atraumatic harvest is key to maintaining the viability of the injected cells. This involves low pressure syringe suction harvest, utilization of state of the art cannulas for harvest and injection, and limiting the manipulation of the grafts. Another important factor is the addition of substances to the fat graft to improve volume retention. The addition of Platelet Rich Plasma (PRP), a product of our own blood, will enhance the graft survival by providing large concentration of growth factors which stimulate cells within the fat. I wish you much luck.....Dr. Corrado
Maximizing fat graft take for facial fat transfer
Aha! that is the million dollar question. Techniques vary greatly on site of harvest, method of harvest, processing, additives, method of injection and post-operative management to maximize fat graft take. There currently is no concensus.
Fat transfer is injector dependant.
the fat needs to be harvested in a very gentle maner with minimal trauma to the fat.
Then the fat needs to be cleaned and centrifuged, and the pure fat injected with a small blunt canula.
Fat in the tear trough is injected deep to the muscle, and take of the graft is usually very good