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Facial Fat Grafting

 

Facial Fat Grafting

 

Many women diet regularly for keeping skinny so as to meet up with the modern beauty standard. However the diet plans often lead to weight loss in undesired body parts (e.g. sunken eyes and hollow cheeks on face) and may cause damage to health.

In general the beauty of what we pursue is an overall balanced body contour with curvy bodyline. For example, we may perform facelift, breast augmentation/reduction and liposuction procedures to improve the face, breast or body contour. If the procedures involve filling the depressions or plumping up the volume, we would choose to use safe, permanent and effective materials to create perfect curves. Applicable materials can be divided into two types: autologous fat or heterologous transplant. Heterologous transplant, include biocompatible substances extract from animal tissues or synthetic implant, has the advantage of no resorption issues compared to autologous fat transfer. But their disadvantage is possible rejection reaction in sensitive individuals.

In addition to pronounced facial features, now more and more people value the smooth and soft face contour, which gives a bright and young look. Some people believe in its positive face reading meanings. For example, full forehead is related to creation, good social relationship and fortune; full temples to good love relationship and marriage life; and round face to wealth and luck.


The above is purely a case description, and the actual situation will vary from person to person.




The above is purely a case description, and the actual situation will vary from person to person.

 

Autologous fat transfer has existed for over a century. However it has not been widely applied for some decades in clinical practices due to its variable and unpredictable results until researches and experiments have been made to bring refinements in the technique. Now it is recommended that during injection, the fat should be dispersed with slow and steady pressure over multilayer thin filtration, so the fat retention can be enhanced to 50-70%. As such, its use in cosmetic surgical procedures is gaining great acceptance.

Furthermore, within one procedure of liposuction, the spared fat can be stored by freezing for many years for future use. The patient will not need to undergo liposuction again, if a second fat transfer is required.

For many years, the author has chosen to use autologous fat transfer in cosmetic surgical procedures involving filling or augmenting, without consider using heterologous filler materials. Even though sometimes a second fat transfer surgery may be required to optimize the outcome, in general it is satisfactory.

The process of autologous fat transfer involves extracting fat with low-pressure liposuction technique, processing the fat (e.g. via centrifugation) to remove impurities, and re-injecting the purified fat into another area that requires plumping. Usually the autologous fat transfer is performed under general intravenous and local anesthesia to help the patient relax and to block pain. The recovery from autologous fat transfer is in general quick. The patient can resume normal activities on the second day. The swellings will subside in a week. Normally the surgical outcome remains stable by 3 months after surgery. If a second procedure is required after evaluation, this can be a good timing, as the preserved fat graft remains viable.



Q 1.Does fat transfer cause lumps or persistent swelling and redness? How to solve it?

What you refer to the lumps should be fat fibrosis and the persistent swelling and redness be inflammation caused by fat necrosis. If limited area is affected, we suggest conservative treatment with observation. Most lesions will disappear within 1-2 months. But if subcutaneous accumulation of fluid or pus occurs, incision or suction drainage is indicated.

 

Q 2.Is it possible to predict the resorption rate of fat grafting before surgery?

The resorption rate of fat grafting is related to the blood circulation of the recipient site, fat transfer techniques, volume of fat graft, etc. Currently fat grafting is clinically plagued by unpredictable resorption rate. What we can do is to keep the transferred fat cells survive as many as possible, but cannot guarantee the retention. In general, fat transferred to eyelid, breast and genital area survive better. Comparatively fat transferred to cheek and forehead tends to be resorbed by the body.

 

Q 3.How effective is plumping with frozen fat? Is it safe?

With the consent of the patient, we can preserve the spared fat graft in clearly labeled sterile test tube by freezing under 4°C. We suggest that if a second fat transfer procedure needed, it should be performed no exceed 3 months after the first surgery. At this time point, the survival rate of the fat graft remains around 50%. We suggest discard the fat graft frozen longer than 3 months to ensure the safety and outcome of the surgery.

 

Q 4.What is the best way for cheek augmentation?

If cheek augmentation involves large area, I recommend autologous fat transfer, as it is more cost-effective with better outcome. Some doctor might suggest cheek augmentation with hyaluronic acid. But it is potentially costly and lasts only for 6-9 months. Although fat transfer is associated with resorption issue, usually with 2-3 times repeating of the procedure, permanent and satisfactory outcome can be achieved.

 

Q 5.Which is better for facial contouring? Fat transfer or hyaluronic acid injection?

It depends on where the recipient site is. For lips, earlobes, or other fine parts, it is better to use hyaluronic acid to create the ideal shape. For other parts with larger area, fat transfer can be a better solution. Because the volume to be filed or plumped is bigger, even fat transfer is associated with the resorption issue, it is worthwhile to extract fat from other body parts with excessive fat and reinject to where it is needed. Approved hyaluronic products especially for use in big volume are available in other countries. However due to the high cost and limited duration (effect lasts no longer than one year), they are not commonly used.

 

Q 5.Is it true the saying that fat cells extracted from the body are dead, so they will not be alive after being injected into the body?

This saying is only half correct. The fat cells extracted from the body are in fact dead. However human cells have re-survive ability within a time ranged from 24 to 72 hours. The fat cells are able to regain vitality if being reinjected to a well-circulated body part within short time. Which means, the fat retention rate can be enhanced by keeping the extracted fat graft in a sterile and suitable environment before reinjecting into the body.

 

 

  1. Do not drive or ride motorbike home after surgery involving intravenous general anesthesia or eye area.
  2. Avoid strenuous exercise or lifting heavy objects within two days after surgery to prevent broken capillaries and swellings.
  3. Do not remove bandages or dressing without doctor indications.
  4. Apply ice compress on the first 2 days (48 hours) after surgery, then change to warm compress since the third day till the swelling fully subsides. But please be cautious that excessive heat or cold can lead to burns.
  5. Take medications as directed, after 3 meals and once before bedtime daily. If needed, painkillers can be given every 3 hours to reduce or control pain.
  6. Wound care: Twice daily (morning and evening) clean the wound with swab soaked in normal saline, and then dry the wound, followed by applying prescribed ointment.
  7. Avoid getting water on the wound within the first two days after surgery to prevent irritation. The wound can be cleaned with water since the third day and with soap or cleanser since the seventh day.
  8. Avoid smoking, alcohol and stimulating food such as tee, coffee and chili that affect wound healing within one week after surgery.
  9. Avoid seafood (except fresh fish) to prevent allergy.
  10. Avoid wearing contact lens, facedown position or any movement that may stretch face muscle or increase blood pressure.

Dr. Yi-Sheng Kao Director | Plastic Surgery Aesthetic Clinic

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