Fat Transfer, Fat Injection, Fat Micro-lipo-injection
Young vs Old Faces: What happens?
The aged face is the consequence of several concurrent factors, including skin laxity, soft tissue ptosis, and volume loss. We accept that with age fat redistributes on the body. Slim hips become rounded, breasts droop, knees deposit fat medially, and lower abdomens protrude. Why then are we so reluctant to apply the same cause and common- sense treatment to the aging face?
The young face is full, with an even, ample distribution of superficial and deep fat. It appears homogenized and balanced without demarcation of the cosmetic units. In contrast, the old face shows compartmentalization, with a “hill and valley” topography. There is vivid demarcation of the cosmetic units, which leaves the face unbalanced.
Aging as viewed on a cellular level occurs as a result of a decrease in adipocyte cell size, function, and differentiation. In addition, redistribution of facial fat and atrophy of muscles and bone leads to the structural changes in the face as one senesces. It is also accompanied by loss of underlying connective tissue and reduced collagen causing sagging of skin.
Improving the condition of the skin is most commonly done with resurfacing procedures, laser and light therapy, daily skin care, and ultraviolet (UV) protection.
Correction of soft tissue ptosis is usually surgically treated with a brow lift, mid face lift, and lower face rhytidectomy or non-surgically by energy-based technologies such as radiofrequency or ultrasound. it was obvious that to recapture youth the lost volume must be restored by means at our disposal —prostheses made of silicone, bone, cartilage or recently by fillers or fat injection.
We cannot deny Sub-dermal fat give soft contours to our ugly underlying musclo-skeletal structures and that impart an aesthetically pleasing look to our eyes and interpreted by our mines as health and vitality. Getting rid of your own fat and then injecting it in your wrinkles to eliminate them does sound like the best of all world!!!
What is Autologus Fat Transfer?
Fat transfer is known by a variety of names, of which the commonly used are fat transfer, fat injections, fat grafting, micro-lipoinjection, and autologous fat grafting. The word autologous means material (fat) is harvested from one area and donated to another in the same individual.
Although fat transplantation has been utilized in medicine for more than 100 years, the concept of injecting human fat back into the patient as an effective means to fill in wrinkles and loss of tissue throughout the body and face has been popular only since the mid1980s.
Autologous fat transfer has become an increasingly important method of facial rejuvenation both as a standalone procedure as well as in combination with traditional rejuvenation methods, like face-lifting, brow lifting, and blepharoplasty.
What are the Benefits of Fat Transfer?
Fat transfer is particularly suited for restructuring the proportion of the face. Normal facial structures can also be aided, by adding constructive elements to correct a broad range of perceived facial deficiencies. For example, a stronger jawline creates a youthful, more powerful-looking face; by eliminating the hollowness of lower lids helps eliminate that tired, sad appearance; and fuller lips create a more youthful, attractive appearance. Fat transfer is also used for augmenting body contours, such as the breasts or buttocks.
In certain respects, fat grafting stands in contradistinction to previous efforts at rejuvenation in which the face is augmented with tissue rather than subtracted by lifting, pulling, and excising. A simple analogy to understand the benefits of fat grafting is looking at a full and ripe grape that becomes prune-like (wrinkled, puckered) over a period like a convex, youthful face that undergoes contraction and involution with age. Rather than remove what appears to be redundant tissue and transform that raisin into a pea, perhaps it would be better to re-inflate that tiny raisin back into a grape.
The minimally invasive technique using autologous fat transplantation has become a standard procedure in facial rejuvenation. It is simple, inexpensive, permanent, and effective. It is considered safe because of the autologous property and fat graft longevity. Other indications include congenital, traumatic defects, or surgical defects and scars.
Why autologous fat/collagen is superior to synthetic materials
Autologous fat grafting meets all the fundamental criteria of ideal augmentation materials: availability, low antigenicity, minimal donor morbidity, reproducible, predictable results, and avoids non-auto graft disease transmission or incompatibility, not likely to illicit immune response, least reported complications and longer survivability. Considering these facts, autologous fat transfer provides a very appealing resource for soft tissue volume augmentation in both small and large volumes.
Other areas where fat grafting techniques considered superior to synthetic fillers in terms of the total volume required to perform larger aesthetic corrections include the buttocks and breast. Prof. Moawad and many others insist on the dynamic unique quality of fat as it will age as we age. This unique quality of fat is perfect in soft tissue augmentation since facial structures changes as we age, and a permanent filler will be out of proportion if used. Furthermore, fashion and trends changes, and what is accepted now as beautiful may be not accepted at all later.
The best of all is fat grafting is forgivable while the mistake of permanent filler is permanent!!! ,” Prof Moawad says. The only relative drawback of fat injection has been the resoption of some of the fat graft. However, with proper technique, approximately 30–70% of the fat is retained Prof Moawad says. In my opinion the Disputes about longevity and the technique variation has postponed the announcement of fat as the perfect filler, added Prof. Moawad.
Nevertheless, its use remains relatively limited compared to commercial fillers. It also appears that surgically trained and oriented cosmetic practitioners are far more likely to use fat, and often as a complement to other surgical procedures such as face–neck lifts and blepharoplasty.
In sheer numbers, less surgically aggressive dermatologists, and now a wide array of non-surgically trained “cosmetic practitioners” – not to mention non-physician “extenders” such as physician assistants and nurse practitioners, and even simple registered nurses – inject the bulk of commercial filler. While synthetic fillers can smooth out wrinkles and folds, it cannot restore fullness that is naturally lost as fat and bone diminish and it is not for everyone.
Some individuals are allergic to synthetic materials and may develop an allergic reaction. Furthermore, synthetic materials cannot be used in large quantities to restore body deformities, to augment breast or buttocks or even hands due to high cost, making fat grafting a much more desirable and economical treatment option.
Who is the Best Candidate for Fat Graft? (Patient Selection)
Patient selection plays a vital role in success or failure of any procedure. It never pays to operate on patients with unrealistic expectations, as they are never satisfied with the outcome. It is vital to have detailed history including their past, personal, and psychiatric history.
In people with severe depression, facial outlook acts only as a part of the problem and probably will only help but not treat the cause of depression. It is noticed during consultation that some patients are not sure what the most appropriate procedure is for them. For those and others the procedure should be explained to them in nonmedical terms, along with its potential complications and alternatives.
An ideal candidate will be an individual in good health, with no active or preexisting medical condition, who is not on any immunosuppressive or anticoagulation therapy, and who has realistic expectations. Fat grafting could be considered ideal for those areas where you really need a lot of filler, such as in those patients who have full-face lipoatrophy.
Individuals who are allergic to bovine collagen (animal origin) or other synthetic materials, but want youth-enhancing results, are good candidates for fat transplantation. People with “contour deformities” may benefit from fat transplantation as well. By contour deformity, we mean a large surface area of skin which is sunken or otherwise uneven as the result of a traumatic injury or surgery, for example after liposuction.
Another indication could be the atrophy typically seen in the aging dorsum of the hands, Prof Moawad says, offering a more lasting treatment solution for this cosmetic thorn.
Most often, autologous fat transplantation has been used for aesthetic purposes however, it has also been used for non-aesthetic purposes such as migraine headaches, clival chordoma surgery, congenital short palate, vocal cord paralysis, lumbar laminectomy, sulcus vocalis, vocal cord scar, hemifacial atrophy, myringoplasty, eye socket reconstruction, frontal sinus fracture, temporo-mandibular joint reconstruction, and other disorders.
For fat transfer, patients with a history of underlying current infection, smoking, anticoagulants, coagulation disorders, herpes simplex, and marked acne scarring are not ideal candidates.
Patients with gross rhytids and poor skin tone will need additional procedures for optimum results. One must be careful in dealing with patients having a history of poor or delayed wounds.
People with bleeding disorders, or those who are diabetic, are not suitable candidates for the procedure. Additionally, people who are extremely thin, with inadequate donor fat sites, should not undergo this procedure.
Consultation at MSI
During your consultation with Prof. Moawad, a complete medical history is taken in order to evaluate the general health of the patient. A careful examination is conducted; examine those areas to be worked on. You are provided full details of the procedure, including the type of anesthesia to be used (local anesthesia for donor/recipient sites usually is sufficient). Additionally, Prof. Moawad will cover any possible risks and/or complications associated with the procedure and discuss realistically what results you can expect. Depending on each case, Prof Moawad may advise having Botox injections to enhance results: when combined, both procedures give impressive results. Botox is effective for the upper part the face (dynamic wrinkles), while fat transfer is suitable for augmenting the nasolabial, lips chin, cheeks and areas around the eyes. Another advantage of Botox is that muscles are relaxed with less movement, thus the fat grafting is maintained in areas longer.
How do I prepare before surgery?
A careful examination is conducted, and areas to be worked on are meticulously marked.
Preoperative and postoperative photographs may be taken to serve as guide and determine the amount of improvement.
Preoperative instructions may include the elimination of certain drugs such as aspirin, non-steroidal anti-inflammatory, and Vitamin E supplements to minimize the possibility of bleeding. Antibiotics are prescribed one day prior to the procedure to prevent infection.
Topical (Red Out cream) and/or oral Vitamin K is prescribed prior to the procedure to lower the likely hood of bruising.