Fat grafting: Maximize aesthetic outcomes with time-tested guidelines

MEXICO CITY — Fat grafting has been around for several decades and has become an extremely popular surgical procedure. This is due to the procedure's relative simplicity, as well as the positive aesthetic outcomes achieved. Following simple guidelines and practices tested over many years can assist in maximizing cosmetic outcomes while minimizing unwanted adverse events.

Whether enhancing the breasts, augmenting the lips and malar area in facial reconstruction, or sculpting and accentuating body contours where desired, fat grafting is a state-of-the-art technique that is slowly but surely eclipsing other surgical techniques. The procedure involves taking fat from one area of the body and injecting it into another. This autologous fat transplantation technique has the best chances of effectively and naturally restoring depleted fat areas, and it circumvents the issues of tissue compatibility typically encountered with other volume-enhancing products and techniques.

"Fat grafting has two major indications — namely, to increase the volume of the target area and to improve the quality of the skin, as a successful procedure will impart a natural fullness and plumpness to the skin," says Antonio Fuente del Campo, M.D., plastic surgeon and director of the Aqtuel Plastic Surgery Clinic, Mexico City. "In the proper indication, all cosmetic patients can benefit from the technique, and, oftentimes, fat grafting can prove to be the superior choice compared to other options, such as silicone injections, which very often can result in an aesthetic fiasco."

"When correcting aesthetic surgical blunders resulting from poorly executed silicone enhancement of the lips, it is imperative to first remove as much of the present silicone as possible from the lips. In such corrective and reconstructive cases, I apply the principles of liposculpture by taking fat from the areas where the fat is redundant (donor area) and injecting it in the defect area," Dr. Fuente del Campo says.

HOW IT WORKS The injected fat stimulates neovascularization, increasing the vessels net and the blood supply, which in turn helps to quickly repair and restore the target area. Stem cells laden with growth factors are considered one of the most valuable constituents of the fat tissue aspirate, as they play an intricate role in tissue reconstruction. Therefore, it is critical that the aspirate is carefully harvested, processed, refined and prepared so as to avoid washing out these vital growth factors.

According to Dr. Fuente del Campo, one of the keys to maximizing the chance of survival of the aspirated fat tissue is to harvest and place the fat aspirate in small aliquots instead of larger clumps of fat. This careful step will minimize trauma and help to avoid necrosis of the transplanted fatty tissue, as well as the formation of liponecrotic cysts.

"It is important that the surgeon carefully considers the purpose of the lipo-injection, the area where it will be injected and the amount to be injected," Dr. Fuente del Campo explains. "The diameter of the cannula is also important in order to be able to aspirate the appropriate size of fat drops. These careful steps and precautions will help to ensure a better perspective for long-term and more predictable results."

OTHER OPTIONS Currently, several other artificial injectable products are available that are geared toward enhancing and improving volume. However, according to Dr. Fuente del Campo, they can only be used safely in small amounts. These products — permanent implants or injectable silicone — will never become part of the body and will invariably be prone to a scarring process. This can lead to these devices being palpated through the skin or even extruded from the body. Autologous fat is exempt from such adverse events and is considered by many as the choice procedure for volume enhancement.

"There is no other product which can improve the quality of the skin as autologous fat. The fat aspirate, which is injected in the superficial subcutaneous plane, enhances the blood supply of the skin, improving the color, thickness, elasticity and texture naturally," Dr. Fuente del Campo says.

START SMALL Dr. Fuente del Campo says newcomers to the fat grafting technique should start by injecting only small amounts of fat in reconstructive cases. After they gain experience and more confidence, they can move ahead and employ the technique for cosmetic indications. Surgeons must also remember to never over-correct, as it is always easier to return to the target site and add more fat tissue than it is to remove excess injected fat.

"There are no disadvantages of the fat grafting procedure if it is well-indicated and well-executed. Like any common injection, the procedure should be done properly so as to avoid local infections," Dr. Fuente del Campo says.