Surgeons who do not purify fat for fat transfers and brazilian butt lifts - why?

Question

I see online that there are two ways that doctors do BBL. Some doctors purify the fat, and some doctors (in Miami) seem to not purify the fat (at most add antibiotics but no additional processing.) Why not? Aren't you injecting dead cells when not purifying, thus leading to large volume loss?

Stan M. Valnicek, MD · Answer

Thank you for your question. There are many components to fat harvest, handling and grafting that can affect survival. Most research in this area involves animals studies since it is easier to randomize various aspects of the process, and this has some limitations in guiding surgeons as to what works best in actual patients.
Fat harvesting technique can impact fat survival. Use of energy such as Vaser or laser, cannula size, suction pressure, water jet extraction and cannula opening diameter can all be factors. The length of time the fat is out of the body (reinfected right away vs. sitting on the side table for 2-3 hours while the surgeon does other parts of the procedure) might have a bearing as well. All of this affects the percentage of living viable fat cells within the total fat volume that is planned for use.
The extracted fat has various amounts of free oil (from shattered fat cells from the extraction) as well as fluid (since some of the injected tumescent fluid is aspirated back out with the fat). So 1 liter of aspirated fat might be 90% fat or 50% fat. There are ways of purifying this such as centrifuging, filtration systems and simple settling over timed in a canister among the more popular techniques. These factors affect the proportion of fat within the fluid that is injected. It is unclear if processing the fat affects outcomes as long as the same total fat is injected in a particular situation (500 cc of pure fat vs 1000 cc of 50% fat) although there might some animal research I am not familiar with that tries to address this for us. Processing might lead to purer fat but the technique of processing the fat might injure the fat cells and lead to lower overall survival.
I am not familiar with any research that supports use of antibiotics or antiseptics mixed into the fat for grafting as being better that giving an IV dose of antibiotic during the surgery.
Over the years we are making slow progress in terms of answering some of these questions. In the interim, individual surgeons still vary widely in how they do things. I think good surgeons with more consistently good clinical results understand what combination of harvest and processing works best in their hands. As always, I would recommend starting with a Board certified Plastic Surgeon who is an ASPS/ASAPS member and well regarded in your community.

Semih Yildiz, MD, FEPOBRAS · Answer

Fat transfer does require preparation, but “purification” can mean different things. Some surgeons wash, strain, decant, or centrifuge the fat; others use a closed collection system that separates excess fluid and oil without calling it purification.

The goal is to remove blood, tumescent fluid, free oil, and debris while handling the fat gently enough to preserve viable cells. Over-processing can also damage fat, so more processing is not always better. Volume retention depends on many factors: atraumatic harvesting, gentle handling, small-packet placement, blood supply in the recipient tissue, avoiding overfilling, and patient healing. For BBL specifically, safety also depends heavily on placing fat only in the safe tissue plane and avoiding intramuscular injection.

Cagil Meric Erenoglu, MD · Answer

Hi! The purification improves the result of the operation. However, purifying and thinning the taken fats more than necessary will create negative results. I recommend that the Ultrasonic Safe and Natural BBL method in order to position the injected fats in the right places, to make the fats much more permanent and to be done in the safest way to optimize this situation. Additionally, your surgeon should be experienced and skilled enough to handle this surgery by this technique. Best regards.

Darryl J. Blinski, MD · Answer

Great question/s.... Easy answer - if the surgeons does not take the time to use purified fat for grafting the % of fat cell survival decreases dramatically. The primary reason is most are working at clinics (chop shops) where speed in surgery is the cause. Adding 30-60 minutes cuts into the profits fir doing more surgeries.  Best to use only private practice boarded Plastic Surgeons. Regards...

Mats Hagstrom, MD (license on probation) · Answer

Terms like purifying fat are in reality sales terms.
Call Fred harvested from Liposuction is inherently both viable and unreliable. there’s no possible way to separate the surface that sells whose membranes have been damaged on a microscopic level.
Purifying fat generally refers to removing the numbing solution that’s injected prior to harvesting fat through liposuction. Circle K potentially add more numbing solution and separate the fat for a second time What does differentiate between viable and non-viable fat.
There are generally three components to fat removed from Liposuction. Watery solution that is primarily based on the numbing solution injected prior to Liposuction, particles of fat which are generally viable with some potentially damaged cells at the periphery of the particles and oil from ruptured fat cells. There is no harm in injecting the watery component that was previously injected for the purpose of liposuction. The amount of liquid fat obtained during liposuction it’s relatively small when good technique is used. there are potentially advantages in removing the fat layer and this is best done in centrifuging the fat which will separate the harvest event into the three different components. This is often done for facial fat transfer procedures. Volumes of fat needed for body contouring such as the BBL or breast fed transfer requires volume so fat that are generally be on wood it’s reasonable to treat with a centrifuge. 
In the end there are only two variables to determine fat transfer results.
Those two variables are patient candidacy and surgeon skill.
In the end any other variable is relatively insignificant.
Circles with sufficient scaler experience know how to do the procedure and the outcomes are not related to processing a fat, the use of lasers, micro cannulas or any other marketing term.
Any technique that is clearly advantageous generally becomes adopted assisted care within medicine. anybody interested in fat transfer procedures should first and foremost get a clear understanding of their candidacy for the procedure.
The second step is provider selection which is best done through multiple in person consultations.
During each consultation ask each provider to open up your portfolio and show you their entire collection before and after pictures.
Did that transfer make absolutely sure that after pictures were taken a minimum of three months from the date of the procedure.
Recognize the fat transfer procedures are in fact two operations done at the same time. They are Liposuction and fat transfer.
Patients need to be assessed for both Liposuction and fat transfer and likewise need to vett plastic surgeons regarding skills for both Liposuction and fat transfer results.
Ask providers to show only before and after pictures of previous patient who have similar body characteristics to your own.
Ask providers to show you examples of excellent results, average results and results that did not turn out as well as they had hoped. Specifically what a revision rate and revision policy is,
Specifically what a revision rate and revision policy is.
For reference and experience provider should have no difficulty showing you at least 50 set a before and after pictures of commonly performed procedures,
Look carefully at all areas treated to make sure there are no skin contour irregularities anywhere in the areas treated with Liposuction.
I suggest patience start with a minimum of five in person consultations and continue scheduling more unless they feel very confident they found the most talented and experience provider in their community.
I recommend people avoid virtual consultations and especially avoid traveling long distances for elective surgical procedures.
In the end patient candidacy and surgeon skills are the only variables that really matter.
Best,
Mats Hagstrom MD

Surgeons who do not purify fat for fat transfers and brazilian butt lifts - why?

Answers (5)

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