Walking into a cosmetic consultation can feel like entering a foreign country for the first time—you’re wholly unsure of your surroundings and don’t know a lick of the language. Which is why we’re launching Beauty Speak, where, every month, leading experts help us break down popular procedures into 10 key terms with easy-to-understand definitions. Consider it the Google Translate of aesthetics.
All natural. 100% recyclable. Zero waste. Fat may very well be the most sustainable beauty product yet. Throw in a little anesthesia, and the harvesting of this renewable resource could even qualify as cruelty-free.
(Too much?)
The technique that allows us to reuse and redistribute our own fat reserves is called fat grafting or fat transfer. During the two-part procedure, a surgeon liposuctions fat from areas of excess and reinjects it, post-purification, into less well-endowed parts of the face and body.
Surgeons began experimenting with fat grafting in the late 1800s, but the surgery didn’t go mainstream until the 1990s, after lipo protocols had been thoroughly researched and refined. It was then that New York City plastic surgeon Dr. Sydney Coleman introduced fat grafting as a revolumization remedy for HIV patients suffering from facial wasting. “As time went on, Dr. Coleman noticed his patients’ skin quality was actually getting better with treatment—but he had no idea why,” says Dr. Ashley Gordon, a board-certified plastic surgeon in Austin, Texas. The answer came in 2001, when scientists discovered the vast community of stem cells living within human fat, giving the tissue its regenerative superpowers.
Today, surgeons enlist fat grafting techniques to restore time-worn faces and to boost the breasts and butt. Since fat grafting methods for the face vary from those used on the body, we’re focusing on facial fat grafting alone for this piece, with 10 terms that best capture the procedure, as explained by Dr. Gordon.
Adipose tissue
Adipose tissue, or body fat, is considered an endocrine organ. “We used to think of fat as something that we have to insulate us and as a reserve for calories, but now we know it’s a super-complex and dynamic structure,” says Dr. Gordon. It secretes hormones and actually communicates with other organs and tissues throughout the body. “There’s much debate as to the best areas to harvest for fat grafting, but I typically find the flanks, outer thighs, and lower abdomen—areas resistant to diet and exercise—work best and have good viability long-term.”
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Autologous
Obtained from your own body; one person serving as both donor and recipient. “This is a really important concept in fat grafting, because I have women all the time asking if we can use their husband’s fat,” says Dr. Gordon. “It has to be your own fat—it cannot be your husband’s beer belly,” she says, laughing. There is currently no “matching” process for fat as there is for other organs, “and your body would likely just reject someone else’s fat.”
Cannula
Stainless steel and straw-like, “this is the hollow-bore instrument we use to gently break up and extract fat from the body and then, later, flow it back into select recipient sites,” says Dr. Gordon. “The diameter of the cannula and the types of holes it has in it are very important to technique, depending on what we’re trying to achieve. For the face, you should use a thin cannula with very small holes, because you want to inject fat cells that are smaller. Generally speaking, the smaller the cells, the greater the take (defined below), because smaller cells can more easily get the nutrients they need once transferred, giving the fat graft the best chance at survival.”
Contour irregularities
The main complication associated with fat grafting, contour irregularities include dimples, lumps and bumps, and fat being perceptible through the skin. Dimples affect the donor site, where fat is taken from, and “are typically the result of oversuctioning an area, which causes the dermis [or deeper skin layer] to scar down to the fascia [connective tissue covering muscles], compromising the soft, smooth look of the overlying skin,” says Dr. Gordon. “Lumps and visibility of the graft are recipient-site complications related to too-superficial injections.”
Harvesting
Removing fat from a donor site, or area of excess, via liposuction prior to grafting or transferring fat to its final destination, the recipient site.
Mesenchymal stem cells
Found in bone marrow and adipose tissue, these cells have “the unique ability to develop into a specialized cell, and they play an important role in tissue regeneration,” explains Dr. Gordon. “They can stimulate collagen production, making fine lines look better. They can regulate pigment cells, to help with melasma. They aid in the creation of new blood vessels, increasing blood supply, to rejuvenate the skin and make it healthier. They can also significantly improve radiation damage in the skin of cancer patients. They really are little unicorns. So while fat transfer used to be all about volume replacement, now probably half of what we use it for is regeneration of the skin—and that’s all due to these stem cells.”
Microfat
Raw fat that’s been sucked from the body is known as macro fat, or more commonly, just plain fat. But “once that material has been processed and purified to isolate the fat cells and it’s made ready for injection, it becomes microfat,” says Dr. Gordon. “Microfat contains intact fat cells that translate to increased volume when we transplant it.” Microfat can be injected deep, to define a jawline or plump the midface, tear troughs, temples, lips, earlobes, and the backs of the hands.
Related: Buccal Fat Removal—and the Debate Dogging the Insta-Famous Fix
Nanofat
Microfat can be further processed into nanofat—a pale-yellow paste composed of ruptured fat cells that delivers stem cell benefits but doesn’t impart any volume. “It helps regenerate and improve the overall quality of the skin and can be used on the face and body to treat crepey texture, hyperpigmentation, dark circles, wrinkles, and scars,” explains Dr. Gordon.
Surgeons create the paste in the OR by using a tool called a luer-lock coupler, which acts as a bridge between two syringes. “When we press on the syringe plunger, the product flows back and forth through a tiny hole inside the coupler, which ruptures the fat cells,” says Dr. Gordon. After 30 passes, she attaches a different coupler with an even smaller hole, to further break apart the cells. The fat is then strained through a filter, ensuring it’s smooth enough to traverse the finest needle without clogging it. “It’s so smooth, we can even deliver it with an Aquagold stamper or use the SkinPen to microneedle it into sun-damaged areas.”
SNIF technique
SNIF is an acronym for sharp needle intradermal fat grafting, which describes a popular technique for injecting microfat into deeply etched lines—around the mouth, between the brows—as an alternative to using a thin temporary filler, explains Dr. Gordon. “It’s also really great for treating horizontal neck lines and the sleep creases some women develop on their décolleté .” The procedure is commonly combined with superficial injections of nanofat or followed with laser resurfacing, “to really eradicate deeper lines, especially around the mouth.”
Take
Also known as survival, take refers to the transferred fat cells’ immediately establishing their own blood supply in the recipient bed and becoming revascularized, explains Dr. Gordon. Long-term survival is referred to as “volume maintenance”—meaning the persistence of the graft over time, especially in cases of weight gain and loss. “Stem cells play a vital role in volume maintenance by supporting the fat cells that have been grafted,” says Dr. Gordon. In fact, “we used to think that the actual fat cells that we transferred were the cells that survived [and created volume], but now it’s widely believed that those mature cells probably die [during or after transfer], but that the accompanying stem cells and preadipocytes, which are like precursor cells, go on to differentiate and become new fat cells, and ultimately create the result.” Fat cells with good initial take are thought to stick around permanently.
