What is Fat GRAFTING?
Fat grafting, also referred to as fat transfer or fat injections, is the surgical process by which fat is transferred from one area of the body to another area. The surgical goal is to improve or augment the area where the fat is injected. The technique involves extracting adipose fat by liposuction, processing the fat, and then reinjecting purified fat into the area needing improvement.
Since the 1990's Plastic Surgeons have reliably used fat grafting as a way to improve and enhance the cosmetic appearance of the face, breast, hands, feet, hips, and buttocks. However, more recently, clinicians have documented the therapeutic benefits of fat grafting in the healing of wounds and scars, as well as fat's ability to repair damage to breast tissue following radiation treatment.
Fat grafting process
The process of fat grafting involves three steps:
extraction of the fat from the harvest area with liposuction
decanting, centrifugation, and processing of the fat
reinjection of the purified fat into the area needing improvement
In the first step, fat is extracted from harvest area using liposuction techniques. This is best accomplished by manual methods using thin liposuction cannulas with small holes. Laser or ultrasonic liposuction should not be used for the extraction as it may destroy the fat cells.
The fat is then processed with decanting and centrifugation to separate debris, excess fluid, and dead cells from the viable adipose fat cells. An alternate method is to wash the fat with a sterile saline solution. The fat that is discarded are the fat cells which will likely not survive in the graft and they can even create problems for the good cells.
In the final step, the fat is reinjected in small droplets throughout the subcutaneous tissue of the recipient area. This is to ensure good blood supply to every fat droplet so that the fat graft can survive.
The amount of fat injected is measured in cc's and ultimately varies according to patient case specifics and the area of the body where the processed fat is being injected.
Types of anesthesia used
Fat grafting is performed with a wide variety of anesthetics. The choice of anesthesia usually depends of the volume of fat that is extracted from the harvest area via liposuction. Extraction of small volumes of fat can easily be tolerated using a local anesthetic. However, larger volumes (>500cc) almost always require that the patient be sedated with IV anesthesia or General Anesthesia.
While local anesthesia can be administered by the surgeon, IV anesthesia or General Anesthesia should be administered by a CRNA (Certified Registered Nurse Anesthetist), or better yet, a Board Certified Anesthesiologist.
Common areas of fat grafting
A summary of common fat grafting applications and the associated volumes of fat injected is as follows:
Breast (25cc-400cc, each breast)
Increases the breast size by one or two cup sizes
Corrects breast asymmetry
Repairs radiation tissue damage and can treat breast implant capsular contractures
Helps correct scar deformities from lumpectomy or breast reconstruction
Hips (100cc-300cc, each side)
Adds volume to achieve a more feminine profile and better waist-hip ratio
Buttocks (200cc-1300cc+, each cheek)
Makes buttocks appear perkier
Augments buttocks size (aka Brazilian butt lift)
Hands and Feet (5-10cc, per extremity)
Reduces wrinkles and rejuvenates appearance
Provides padding for bony feet