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Fat Grafting: How useful is it?

Article-Fat Grafting: How useful is it?

Dr. Carraway
The first fat graft procedure that I ever performed was 25 years ago and involved a patient who underwent a parotidectomy and had a hollow defect in that area of her face following surgical healing. I removed a section of dermis with 2 to 3 millimeters of fat as a thick composite sheet from the buttock area. This graft was put in place and the skin was placed back over the graft, which subsequently healed beautifully. I still see this patient, who is now in her 70s, when she occasionally returns for some minor procedures. Since this experience, I have used the technique of sheet dermal fat grafting with great results in different situations over the years.

In 1990, I published an article in the Annals of Plastic Surgery on "Syringe aspiration and fat concentration: A simple technique for autologous fat injection." At that time, I advocated using a large, open-bore needle in an area of the body posterior to the mid-lateral line, because this type of harvesting of fat worked best for me. At the same time, I injected this fat with an 18- or 20-gauge needle, and often used the "underlifting" technique to lift the creases away from the underlying dermal attachments.

This has been a great combination for me in my practice over the years, and has accounted for many successful contour improvements, particularly around the perioral area.

I have seen a lot of patients over the years with bad results from fat grafting. I have also seen patients who, despite excellent early results, have not retained their fat graft. However, by far the majority of my patients have shown good or excellent long-term improvement.

Is it useful?

This raises the question: Is fat grafting a useful procedure for cosmetic surgeons? I think to answer that question, we would have to draw on the experience of some of the best surgeons who perform these procedures. Dr. Jose Guerrerosantos has long advocated fat grafting around the facial area, and has repeatedly demonstrated beautiful results at meetings over the years. I have personally observed his work. Dr. Sydney Coleman and Dr. Val Lambros have had great results and tend to use larger volume replacements than many of us do.

It seems obvious, when you look at the faces of younger people, that fat simply is, first and foremost, the key to rejuvenation of the face. In the aging face, there is fat atrophy around the perioral area, sometimes in the mid-cheek areas, and along the nasojugal groove. In addition, there is hypertrophy of existing fatty tissue adjacent to the nasolabial fold, in the jowl area and in the submental area. By manipulating or removing the excess fat and by performing volume replacement in the atrophied areas, one can "turn the clock back" to a greater extent than by doing only a facelift or resurfacing procedure.

Fat grafting in these areas can be simple and straightforward and still obtain good results. Also, fat grafting can be used in combination with other fillers and Botox. It is not uncommon for me in perioral rejuvenation to use fat grafts deep, underlift the lateral chin and perioral creases, and place collagen in the fine lines and Botox in the perioral muscles of the upper lip and lateral mouth area.

Many studies show greater than 50 percent "take" of fat grafts at 12 months, but this is variable from author to author. A variety of methods are currently being used. Possibly this may be the time to standardize the technique to a greater degree, based on various surgeons' successful results. Obviously, long-term follow-up is the key to evaluating the success of these grafts.

Fat grafting has the advantage of a low complication rate, but, as with all procedures, there are minor problems with it. Fat can be stored in the freezer for up to several months, to be easily drawn out and used for "touch-up" procedures in follow-up to the original fat grafting.

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