Chicago-based facial plastic surgeon Steven Dayan, M.D., says he hasn’t seen any of the reported problems with autologous fat use among his cosmetic patients.
“Autologous fat has been around for many years. We’ve always questioned its survival rates. And on rare occasions, when it stays, complications can occur where years later … lumps and bumps may surface, or faces can take on a distorted or bizarre look,” Dr. Dayan tells Cosmetic Surgery Times. “Those are the issues being reported, but I’m not seeing any of those, and I’ve been doing fat in large volumes for around 10 years.”
Dr. Dayan shared his approach to autologous fat transfer yesterday, during his presentation “Autologous Fat vs. Off-the-shelf Fillers,” at the Global Aesthetics Conference, in Miami Beach, Fla.
His Tips for Making Fat Transfer Work
Dr. Dayan no longer centrifuges the fat. Many doctors, he says, centrifuge autologous fat 3,000 rpms for 3 minutes.
“I strain it and stir it and get rid of all the oils and blood, transfer it to 1cc syringes, and place it right back in the face. I do it immediately. I don’t let it sit on the table,” Dr. Dayan says.
He harvests the patient’s fat from the lateral thigh or the belly.
“The main reason why I think I’m not getting complications, and this is, perhaps, counterintuitive: I use a cannula that is 2.7 mm, which is the equivalent of a 12gauge, to inject the fat back into the face. It’s a very large, blunt-tip cannula. I use it around the eyes without any difficulty, and I think I’m getting better results and less complications than using a small, narrow cannula, such as a 25-guage, a 27-gauge or a 22-guage,” he says. “I know I can’t explain it, as it seems paradoxical, but I am just not seeing the periocular lumps or distorted faces. Also, anecdotally, I believe my survival rates of the fat is near 75% or better.”
Fat vs Filler
As a general rule, Dr. Dayan uses autologous fat when patients are already scheduled for a procedure, such as laser resurfacing, a facelift, rhinoplasty or blepharoplasty.
“I do fat in the operating room because I like the sterile environment, and I like to have the patient anesthetized because I think it’s somewhat painful,” he says. “If I’m treating someone in the office, I’ll treat them with fillers.”
Dr. Dayan has started combining platelet-rich plasma (PRP) with autologous fat. He says that while he doesn’t have science to prove it works, he doesn’t see the harm in adding PRP and is impressed with patients’ skin at six months and a year after fat transfer.
“Their skin looks so rejuvenated. Their dyschromias are gone. Their skin is healthier. The dermis appears thicker. The effect is almost magical,” he says.