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Selecting for fat transfer success

Article-Selecting for fat transfer success

Sewickley, Pa. — A novel study on fat augmentation is attempting to answer a long debated question: Does fat survive upon transplantation?

Dr. Obagi
Early results indicate that the fat is not only surviving, but thriving after augmenting the malar region and intraorbital areas, according to Suzan Obagi, M.D., assistant professor of dermatology, director, The Cosmetic Surgery and Skin Health Center, University of Pittsburgh Medical Center, Sewickley, Pa.

"My three-month data shows 90 percent retention of the transplanted fat in 45- to 55 -year-old female patients. While the six -month data is incomplete, preliminary results show similar retention. Yet, a successful fat transfer tends to primarily occur in those patients with a normal-to-higher body mass index," Dr. Obagi says. "We're finding purely through clinical application that thin patients don't do as well as someone who is heavier."

With fat augmentation emerging throughout the last decade as a preferred technique due to sophisticated studies proving (undesirable cosmetic appearance may be due to) volume loss in the malar fat region over time rather than muscle fiber elongation, cosmetic surgeons are better able to analyze and correct their transfer technique — as well as which patients will benefit most.

"Thin patients need two to three (fat transfer) procedures to achieve what one treatment would accomplish in a heavier patient," Dr. Obagi tells Cosmetic Surgery Times.

Proper candidacy, lasting augmentation

While thinner patients may reap the most benefits from fat transfer to reverse their midface volume loss, clinical application is proving that the most success does not occur in this patient group, according to Dr. Obagi.

"The most gratifying patient (for fat transfer) is a woman in her early forties to fifties who's had two or three pregnancies and has achieved her pre-pregnancy weight, but her face has lost volume," Dr. Obagi says. "They typically hold more fat somewhere on the body, making it easier to harvest and transfer to their face. The results are amazing, with the laxity restored and many patients looking as if they've had cheek implants."

Fat augmentation in the midface can be accomplished in patients ages 60 and older, yet multiple procedures are required to gain the same result as the younger patient. The reason may be linked to the metabolic changes that fat cells, like all cells in the body, undergo over time. After fat augmentation, the long-term result may be due to survival of the grafted tissue but may also be due, in larger part, to the transfer of preadipocyte (fat stem cells) which then differentiate into fat, muscle or bone depending on where they are placed. In older individuals, the stem cells may have less ability to differentiate into the mature cells. There are some small studies to support this, but larger studies are needed to qualify the decline that occurs with age, Dr. Obagi says.

"I also will not perform fat transfer on a patient who smokes," Dr. Obagi says. "Fat is fragile and you don't need to add it to an environment that prevents the creation of its own blood supply. We know that nicotine inhibits angiogenesis, and just as we have concerns about performing a full facelift on a smoker due to the potential for skin flaps not being able to revascularize, there are similar concerns in fat transfer. If you don't give the fat every opportunity to survive it's not going to."

Fine tuned technique

In addition to proper patient selection, a precise technique is required for successful fat transfer.

While there is a plethora of ways to extract, prepare and transplant fat, many problems occur from the different techniques currently used, and cosmetic surgeons can modify and improve their approaches by analyzing their patients' results, according to Dr. Obagi.

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