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Interest rising in transfer of fat for facial rejuvenation

Article-Interest rising in transfer of fat for facial rejuvenation

Key iconKey Points

  • Adipose Accentuation treatment shifts fullness from one area of face to another using one's own fat.
  • The technique is designed for someone not seeking immediate, surgery-free enhancement.
  • It is recognized as an organic anti-aging procedure.

Dr. Hakki
INTRODUCTION Over the last few years, there has been growing interest in the transfer of fat for facial rejuvenation. This interest is closely linked to the recognition that there is a significant volumetric component to restoring youthful facial aesthetics. Originally described by Neuber in 1893, then decades later by Ellenbogen who, in 1987, wrote on the subject (along with many others), it was not until the early 1990s that an effective way to graft fat was developed. Coleman, in 1995, gave a presentation to the staff at a suburban hospital in Bethesda, Md., that described his technique for fat transfer. The technique that I have developed, Adipose Accentuation, is an adaptation of these previously described techniques that emphasizes a minimally invasive approach, simplified handling of fat and creates lasting reproducible results.

Adipose Accentuation can best be described as a treatment that shifts fullness from one area to another using one's own fat. Commonly practiced in the face or buttock region, Adipose Accentuation is the ideal filler for someone not seeking immediate and surgery-free enhancement. It is the latest trend in organic anti-aging procedures. For plastic surgery to be transcendent, three things must occur: the result must be less plastic and more natural, the intervention must be minimal with fewer incisions, and the result must be long lasting.

During Adipose Accentuation, a portion of the fat removed from one part of the body is reintroduced to a different site. This also transfers some stem cells into those areas. Stem cells mimic all cells they come into contact with and actually create new fat, bone and skin cells. As a result, the fullness of the cheeks, lips or buttock region of the patient is brought back to their youthful appearance naturally. The fat transfer results not only in fullness, but also in rejuvenation of the skin on a cellular and microscopic level.


1. The donor site is infiltrated with a combination of saline and epinephrine.

2. The fat is harvested with a 2 mm cannula using 1 g of suction and clear tubing.

3. The fat is then poured into a standing 60 cc syringe and allowed to settle and separate by gravity.

4. The top fatty layer is wicked away with a gauze sponge and most of the bottom serous layer is strained off.

5. The interface between the fatty layer and the serous layer is preserved.

6. The remains are shaken and introduced into the mid-face into the purple areas depicted in the photo (right), using a blunt-tipped Coleman infiltrator.

METHODS & RESULTS In my practice, we conducted a retrospective review of this technique to evaluate patient satisfaction and need for revision (submittal for publication pending). All procedures were performed by a single surgeon from January 2000 to June 2009. During this time, 104 procedures were performed on 104 patients. Patient satisfaction was measured by a written survey. Of the 104 surveys sent out, 68 were completed and returned. Of the completed surveyed patients, 59 indicated that they were very satisfied, five were satisfied, and only two patients were not satisfied. Of the 104 patients treated, five required revision, three of which were extractive and two additive.

42-year-old patient is show before (left) and two months after (right) Adipose Accentuation technique. Photo credit: Ayman Hakki, M.D., F.A.C.S.
DISCUSSION Central fullness and peripheral slenderness are the hallmarks of youth. This concept was demonstrated in the nineties with a 3-D analysis of mothers and daughters. CT studies showed that the sagging and jowling experienced by the mothers was not due to skin surface increase; it was caused primarily by volumetric fat loss.

To correct this loss, first, fat is harvested with cannulas that vary in diameter; second, fat is allowed to settle; and third, the middle third of the (noncentrifuged) fat is introduced through specialized cannulas that match the diameter of the suction cannula. The revision rate is low for this technique, and actually, more subtractive revisions than additive revisions were performed.

The fat is neither strained nor centrifuged nor are any components added to it. It is efficiently harvested (under low barometric settings) and allowed to settle in an upright syringe; the upper third of the sediment is wicked off and then the lower third is strained away. The goal is to minimize cell manipulation.

CONCLUSION This technique has been shown to be a reliable way to transfer fat with a high rate of patient satisfaction and a fairly low revision rate.

Ayman Hakki, M.D., F.A.C.S., is a board-certified plastic surgeon practicing in Waldorf, Md.

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