Fat Transfer Without Any Centrifuge?

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

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.

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.

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

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.

There are many different protocols used for fat transfer today. Spinning the fat before the transfer is only one of them (and the one, I personally use). Other surgoens blot the fat with sterile gauze or put it through a strainer. And they do report good patient outcomes which is all that counts at the end!
Although less frequently, some plastic surgeons may find a direct transfer without further handling of the fat useful. Personally, I see a few potential issues/ disadvantages with such a technique, but who is to argue about a protocol that may have proven successful in another physician's hands? Especially if you consider that there is no double-blinded and case-controlled study out there (that I know of, at least) demonstrating the real "winner".
Anecdotal data always have to be evaluated with a grain of salt. Platelet rich plasma is just one of many additives, which make some sense on the basic science level, but is a long way from proven beneficial in clinical practice (meaning improving results).
But you appear to have lost confidence in your physician, and that's not a good starting point for further treatments. I think you understand that already.

Many doctors talk of their own anecdotal experiences, but what do the studies show:

1- Centrifugation at 1287G's (common to most physicians) will kill the majority of the cells.

2-Centrifugation at 50G's for no more than 2 minutes will filter the live fat from the contaminants with minimal to no trauma to the fat. The only system doing this is the Viafill System.

3- Fat is exactly like chicken soup. If you pour water on the fat, it will die and look like those oile droplets on the top of your soup, so washing fat is a bad idea.

4- Injecting it directly out of your body, as described by your doctor is not a bad thing, but the injectate will be very dilute, requiring overfilling. Overfilling makes it difficult for the surgeon to decide what is the proper amount. Perhaps he gives you too much/ or too little? who knows?

Fat transfer is a very powerful and effective technique to recontour the body and face. When we perform this technique we perform liposuction to different areas of the body and then cleaned and process this fat before transferring it to another part of face. Keep in mind that successful results of a fat transfer depend on the quality of fat that is used and the technique for cleaning and transplanting the fat. One method to clean the fat is through a centrifuge. However, this is not the only technique. In our practice, we commonly centrifuge when we are processing the fat for use in small areas of the body such as the face.
 

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!

Fat used for fat grafting is harvested from the abdomen, thighs, hips or buttocks using specially-designed instruments and a specialized technique. Centrifugation eliminates components of the harvested material (which is not viable fat), and meticulously injected into the facial areas to be enhanced. As some of the other surgeons have pointed out, you seem to have lost confidence in your surgeon. I agree that it is best for you to take some time before proceeding with fat grafting.Fat grafting is a surgical procedure. Check the credentials of your surgeon the same way you would for any surgical procedure. Be sure that they have completed a minimum of five years of formal surgical training and that they have hospital privileges to perform fat grafting