Fat grafting, also known as fat injections or fat transfer, is a cosmetic surgical procedure that involves fat transfer from one area of the body (donor site) to another, either to improve or augment the area of interest. The procedure involves extraction of adipose fat by liposuction technique followed by fat processing for purification and then transfer or re-injection of purified fat into the area that needs augmentation or improvement.

Since the 1990’s, Plastic Surgeons have extensively employed fat grafting to enhance the cosmetic appearance of breast, buttocks, face, hands, hips and feet. In the recent years, cosmetic surgeons have published the clinical applicability, therapeutic and reconstructive benefits of fat grafting procedure in wound healing, scar treatment, in addition to repairing damaged breast tissue in cancer patients who undergone radiation therapy.

History of Fat Grafting

Fat grafting is actually a century-old medical technique. The first fat grafting was performed by German Plastic Surgeon, Gustav Neuber (1850-1932) in 1893. He grafted the fat obtained from the patient’s arm to the orbital area to treat scars that formed due to osteomyelitis (bone infection).

After the first-ever fat transplantation event, fat grafting has not gained steam for the next 100 years due to procedure-related complications. Until 1990’s, no reliable liposuction techniques was developed or standardized for fat purification and processing. Due to this limitation, the extracted fat was of inconsistent quality and the therapeutic outcomes were poor.

In the 1990’s, a New York City-based Plastic Surgeon Dr. Sydney Coleman has developed and standardized reliable analytic techniques for fat graft harvesting, processing and transfer of fat into the recipient site. After he published his findings in reputed academic medical journals, the fat grafting procedure gained popularity, and it being used extensively for a variety of therapeutic and reconstructive purposes. Dr R Sadove has been performing fat grafting since the 1990’s.

Who performs Fat Grafting and where?

Fat grafting procedure involves liposuction as a preliminary step, and therefore the procedure is generally performed by trained Plastic Surgeons. Dr R Sadove is trained to maintain the standards of care during liposuction procedure as well to manage the procedure-related adverse events/complications.

Fat Grafting process

Fat transfer involves three main steps:

• Liposuction – extraction of adipose fat from the donor area

• Processing or purification – Seperation, decanting and processing of the extracted fat

• Fat Grafting – Grafting or re-injection of the purified/processed fat into the recipient area that needs to be improved or treated.

The first step of fat grafting involves extraction of fat cells (lipocytes) from the donor area by employing standardized liposuction methods. Manual techniques are the preferred choice of method, in which, thin liposuction cannulas are inserted through the small holes to extract fat from the donor site. Ultrasonic or laser liposuction should be avoided as it can potentially destroy the lipocytes.

After extraction, the fat is processed by leaving the extracted fat in sterile saline solution to decant under gravity, followed by washing to isolate the viable fat cells from debris, dead cells and excess fluid. The obtained isolate (fat cells) should be washed again with a sterile saline solution. The discarded fat cells are usually unviable cells that are unlikely to survive if transplanted. In certain cases, these cells can harm the good cells and hence it should be discarded.

Finally, the purified fat is re-injected in small droplets into the subcutaneous tissues of recipient areas that need reconstruction/treatment. In this way, adequate blood supply to the transplanted fat cells and their survival (post-procedural) can be ensured. Plastic Surgeons employ anaerobic transfer method to avoid undesirable exposure of harvested fat to air which may lead to contamination.

The amount of injectable fat is generally measured in cc’s which varies from one patient to another, depending on patient’s medical condition/requirement and the recipient site.

Types of Anesthesia Used

Fat grafting procedure is performed by employing a variety of anesthetic drugs and the choice of anesthetic drug depends on the volume of fat that needs to be extracted by liposuction technique. Small volumes of fat can be conveniently harvested under the influence of local anesthesia. However, extraction of fat >500cc always require patient sedation with General or IV anesthesia.

As local anesthesia administration is not complicated, it can be performed by Dr Sadove. However, General anesthesia or IV anesthesia should be administered by a CRNA (Certified Registered Nurse Anesthetist), or preferably by a Board Certified Anesthesiologist.

Common areas of Fat Grafting

Some of the common fat grafting applications and respective volumes of fat injections are listed below:

a. Face

• Requires 10cc – 100cc of injectable purified fat in total.
• Efficiently repairs scar tissues including traumatic scars
• Restores youthful appearance by filling-in the hollow cheeks, temples and orbital area
• Corrects wrinkled areas including nasolabial folds and area below the eye(s).
• Enhances the appearance and texture of the skin.