The fatty boom-boom jab

Fat is the new elixir of youth. As plastic surgeons discover the extraordinary rejuvenating properties of fat grafting, the emphasis is shifting to combination therapies, incorporating both the traditional "nip and tuck" with facial volume restoration to re-contour, shape and even beautify patients.

The aging process manifests itself variably in a combinations of sagging and skin excess, progressive facial volume loss and skin changes. Consequently, comprehensive facial rejuvenation requires not just the traditional nip-tucks but restoration of facial volume.

Developments in the application of fat grafting have revolutionised rejuvenative cosmetic surgery and has enabled surgeons to sculpt their patients' faces with far more finesse.

According to Cape Town plastic surgeon, Dr Stuart Geldenhuys, the development and refinement of fat grafting techniques has created a revolution in traditional approaches to facial rejuvenation.

What is fat grafting?

Fat grafting, also called facial fat rejuvenation, fat transfer, free-fat transfer, autologous fat grafting or transfer, micro-lipoinjection and fat injections, is a minimally invasive surgical procedure that involves removing a patient's own fat and re-implanting it in other areas of the body, as required.

It is typically extracted through micro-liposuction, from areas of the body that contain excess fat, typically the lower abdomen, inner thighs or knees or "muffin tops". The fat is usually centrifuged to separate the fat cells from blood, fat and fluid and is then re-injected into another area of the body that requires shaping or volume enhancement. Typically these areas include the face, breast or buttocks.

When used as a facial filler, fat grafting can restore youthful contours to the cheeks, forehead and eyebrows, plump out creased and sunken areas, restore volume to hollow sunken eyes and add fullness to lips.

Fat grafting is increasingly being used in buttock and breast augmentation instead of traditional implants.

Has fat grafting replaced other traditional facial plastic surgery procedures?

No, according to Geldenhuys fat grafting is typically used in conjunction with other treatments to enhance the end results. A formal consultation with detailed facial analysis determines the degree of sagging and volume loss and defines the optimal surgical technique.

"We have to remember that each patient is unique and, depending on their specific needs, there are a wide range of options to consider in facial rejuvenation, from the more traditional surgical procedures such as face lifts to the less invasive liposuction and collagen treatments."

"Younger patients with slight sagging and good facial volume represent different challenges to older patients with significant facial volume loss with sagging, to patients who have already had their first face lift several years previously typically requiring facial volume restoration (top-up procedure)," says Geldenhuys.

"However, the more recent development of fat-grafting techniques to complement existing procedures has enabled a plastic surgeon to rejuvenate, contour and shape a patient's face with far more finesse, creating a very natural and pleasing result."

What is the practice of beautification?

Canadian plastic surgeon and trend-setter in the rapidly developing field of cosmetic injectables, Dr Arthur Swift, has pioneered and trademarked a revolutionary approach to non-surgical facial enhancement which he has called Beauti'phi'cation.

It is a medical application of the concept that ideal beauty might be a universal notion, provable by the mathematical concept of the golden ratio long used by artists and architects. According to Swift's experience, deploying a combination of strategically placed therapies in specific proportions, he is able to maximise a person's beauty potential by restoring symmetry, harmony and balance.

Similarly, fat-grafting facilitates, not only rejuvenation, may enhance a patient's looks by similarly filling out and accenting certain areas, so balancing facial proportions, with a natural and enduring result in contradistinction to the temporary results of hyaluronic acid fillers.

How long does fat grafting last?

"Aging is a process of continual facial volume loss. It is anticipated that in order to maintain optimal facial volume and to restore fat lost through the natural aging process, the procedure would need to be repeated every five years," says Geldenhuys.

The major determinant of a successful fat-grafting treatment relates to the percentage of fat-graft survival. Determining factors include the age and health of the patient and the quality of the injected fat. Fat harvesting, processing and injection techniques, the choice of fat-donor sites and the use of stem cell enriched fat grafts are additional technical considerations which influence the outcome. Additionally, some areas of the face appear to be better recipients of the grafted fat.

What are the challenges in using fat grafting?

According to Geldenhuys, the beneficial effects of fat grafting have until recently gone unnoticed by would-be patients but this is changing rapidly.

"The process has in the past been subject to a degree of unpredictability due to inadequate fat-graft survival leading to inadequate correction. Although this has not been resolved completely, necessitating repeat, top-up treatments in a few cases."

As this is a relatively minimally invasive day-case procedure, without incisions, Geldenhuys advises that it tends to be well tolerated by patients and only a few days of recuperation are required for bruising and swelling.

What does the facial fat grafting procedure involve?

  1. Local or general anaesthesia – depending on the number of areas, to be treated and the patients' constitution.
  2. Low pressure micro-liposuction to remove fat from resistant fat sites. The consistency of the fat is fine, almost like a soft gel.
  3. Treatment of the aspirated fat, usually by centrifuge to separate the oil, local anaesthesia and blood from the fat cells.
  4. Careful planning as to the areas to be treated and usually drawn pre-operatively onto the patient's face while seated.
  5. Small injections with blunt cannulae into the selected areas.

"Multiple passes are required to ensure even distribution of the fat, prevent clumping and ensure that it remains in close proximity to a good blood supply to ensure optimal graft survival," explains Geldenhuys.

"As there are no incisions, in an isolated facial fat-grafting session, no sutures are required. Fat-grafting is, however, often combined with additional facial procedures such as face lifts, eyelid surgery and neck liposuction or lifts."

What is stem cell fat grafting? Stem cell grafting is a technique of enriching ones own fat cells to enhance fat graft survival. Fat has very high concentrations of multi-potential stem-cells which can be extracted by liposuction. This fat is then processed, rendering a small quantity of stem cells – typically 150-250ml of fat to form 5ml of fluid containing stem cells. In stem-cell grafting this is added to the fat normally used for grafting. The addition of these stem cells is thought to enhance fat survival by releasing growth factors or signalling messages.

"Evidence indicates that stem-cell grafting enhances survival of the transplanted fat and this is a better choice where larger volumes of fat are being grafted, as is the case in single procedure breast and buttock augmentations," says Geldenhuys. "The face is naturally more vascular and fat survival more predictable. However, stem cell fat grafting in the face is more of a luxury and the costs are considerable."

Source: The New Age |

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