Fat Transfer Without Any Centrifuge?

Question

I had an appoint with my Dr. and he proposed doing a fat transfer to help with depressed scars (which he created doing a botched DeepFX laser procedure). He was proposing to correct the scars, correct the under eye and other facial areas to help correct the fat loss and the traumatic damage done by the laser.
I asked him if he planned to add Platelet Rich Plasma to the fat (an increasingly popular protocol). He said no; that he would use the fat straight as it came out of the body. No centrifuge or anything. He felt that the less you did the better.
From the research I’ve done, centrifuging the fat is a standard approach. Introducing fat with body fluids would seem to increase inflammation and reduce effectiveness.   Plus, I am concerned that the uncentrifuged fat would be difficult to apply smoothly in the undereye area without the smoothing effects of the centrifuge.
I was also worried when he said I would be very swollen for a week (i.e. he stressed I would have to stay home) with obvious swelling for at least two weeks. He stressed the difficulty of the recovery.   My gut tells me to not do it, even though I could use the improvement in my scars.
Please let me know your opinion of using fat straight form the body; am I off base my reacting so negatively to this approach? I think I may need to find a new doctor since he  botched a laser procedure then the there's a possibility of a botched fat transfer!
Thank you for you insights,  Dave

Michael A. Persky, MD · Answer

Hi Dave,
Trust is very important in facial cosmetic surgery.  If you trust your physician to do a good job on you, then stick with him.  It never hurts to get many other "second" opinions before committing to a treatment.
Management of fat for fat transfer varies among physicians.  I have transferred fat both directly after straining it, as well as after centrifuging it.  There are many very fine Beverly Hills surgeons who have used simple straining for fat transfer with excellent, long lasting results.  
Discuss your concerns in detail with your surgeon.  At that point stick with your "gut" feeling (no pun intended what with fat transfer) in choosing the physician to correct your complications from the Deep Fx treatment.
Good luck and be well.
Dr. P

Larry S. Nichter, MD, MS, FACS · Answer

There are many "latest and greatest"modifications in fat grafting but to date there is no standardized approach. The reason for this is that if there was overwhelming scientific evidence of the superiority of one technique over another then this would be the standard. This is not the case. There are many variations such as use of a centrifuge, and using enriched growth cell factors (e.g.Platelet Rich Plasma) or enriched stem cells but at present I have not found this to be of benefit. As all fat that is to be used is rinsed in saline or lactated ringer's solution eliminating "body fluids" so that is not the case. Lots of controversy continues - for example there is evidence that centrifuging can damage fat cells vs being able to concentrate stem cells. I personally no longer use a centrifuge and have seen no difference in my results. Fat grafting is a surgical procedure and everyone swells afterwards. The fact that you are concerned over a week of swelling may indicate that you have unrealistic expectations.

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	Of MOST IMPORTANCE is the selection of a skilled plastic surgeon you can trust who is board certified and has experience in this technique. For example injecting the fat with a large cannula or not distributing the fat in a manner so it is interspersed between healthy native fat cells will result in decreased survival, and injecting it too close to the skin can result in nodules that can be visible. It appears you have lost trust in your surgeon which prevents the best possible doctor-patient relationship. It is this factor that is probably most important and probably indicates you should consider another plastic surgeon to care for you.

Scott C. Sattler, MD, FACS · Answer

Dr. Coleman and other pioneers in the field of fat transfer use a centrifuge of various types during the fat transfer process. Others have developed successful fat transfer protocols that don't use centrifugation, and have excellent results. Injection technique is probably the most important aspect of successful fat transfer procedures.

Sam Naficy, MD, FACS · Answer

with fat grafting the proper technique of harvesting and injection are much more important than whether you centrifuge or not

Philip Young, MD · Answer

I think that you doctor is right to some degree regarding platelet rich plasma and centrifuging the fat.  Fat can be something that can improve scars. Although I think depressed scars are a little harder to correct with fat grafting.  Fillers were suggested by another doctor but you better be ready to continue to pay for additional filler every year or less to keep the condition corrected.
Platelet rich plasma will only introduce more inflammation to your fat transfer and will ultimately lead to less survival in my opinion and in agreement with your doctor.  Centrifuging can lead to more fat cell death, but you have to isolate the viable fat cells some way.  If you don't centrifuge the fat, you will have a lot of inflammatory components in the harvest that will affect your fat's survival. So, you do need to somehow isolate the cells that are most likely to survive.
Waiting for the fat to settle is another approach but the time it takes to do this can be a detriment as well because the longer the fat stays out of the body, the more the fat will not survive.
I believe that centrifuging at a slow rate is probably the best median between the two.  This has also been proven in studies on centrifuging fat and fat's ultimate survival. The usual standard is at an rpm of 3000 for 5 min.  This has proven to be too fast and can affect the fat cell's survival.  I typically centrifuge at the lowest speeds and do it for 3 mins max. Good Luck!

Otto Joseph Placik, MD · Answer

I would agree with all that has been said, namely:
1) management of fat varies among surgeons
2) platelet rich plasma is unproven and very costly
3) communication and the patient-doctor relationship is very important in ongoing care
However, I would add one additional piece of information. Before undergoing another surgical procedure, why don't you try a subcutaneous filler such as Perlane to see if it achieves the goals you desire. It may or may not produce the desired results in the scars. If it does, you will be more confident pursuing this surgery with or without this surgeon. IF it does not then, you will have saved yourself from an unnecessary surgery.  I hope this helps.

Fat Transfer Without Any Centrifuge?

Answers (14)

Answer: Just like every powerful tool, the impact comes from the craftsman, not the tool.

Answer: Just like every powerful tool, the impact comes from the craftsman, not the tool.

Answer: A Centrifuge is Not Essential to Successful Fat Grafting

Answer: A Centrifuge is Not Essential to Successful Fat Grafting

Answer: Fat transfer techniques vary

Answer: Fat transfer techniques vary

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Our mission is to create a world where every investment in modern beauty is Worth It.

Fat Transfer Without Any Centrifuge?

Answers (14)

Answer: Just like every powerful tool, the impact comes from the craftsman, not the tool.

Answer: Just like every powerful tool, the impact comes from the craftsman, not the tool.

Answer: A Centrifuge is Not Essential to Successful Fat Grafting

Answer: A Centrifuge is Not Essential to Successful Fat Grafting

Answer: Fat transfer techniques vary

Answer: Fat transfer techniques vary

Recommended reading

Everything you need to know about Facial Fat Transfer

Answer: Centrifuge and fat

Answer: Centrifuge and fat

Answer: Many things can affect your fat transfer procedure

Answer: Many things can affect your fat transfer procedure

Answer: Consider Fillers prior to Fat as a trial run

Answer: Consider Fillers prior to Fat as a trial run

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Our mission is to create a world where every investment in modern beauty is Worth It.