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Injectable Dermal Fillers - Fat Grafting

 

Lip augmentation using a fat transfer is an outpatient surgical procedure that involves removing fat from one are on the body to the lips and also as a dermal filler for a patient who has lost facial volume as they have aged.

 

The fat is harvested using the procedure of liposuction on one area of the body:

  • buttocks

  • abdomen

  • hips

  • inner knee

  • saddle bags

 

Most surgeons are very particular about the location of the fat and the formation of the fat pockets.  To have successful fat grafting, the surgeon needs to be able to remove the fat cells fully intact and minimize any damage - the location of where the fat is being harvested is very important - and the texture of the fat.  All of these key issues are important in order to have a successful fat grafting.

 

 

Fat grafting has two major indications:

  • increase the volume of the target area 

  • to improve the quality of the skin

 

Fat grafting as a successful procedure will impart a natural fullness and plumpness to the skin or lip area.

 

 

 

 

 

 

 

Injected fat stimulates a process called "neovascularization" - by increasing the vessels net and blood supply which can help quickly repair and restore the target area that needs volumization.

Stem cells are full of "growth factors" and are considered the most valuable constituents of the fat tissue aspirate, because they contribute to the complex role in tissue reconstruction.

 

It is important that the fat is carefully harvested, processed, refined and prepared so as to avoid washing out these vital "growth factors".

 

Once the fat is harvested it is carefully prepared for injection into the lips. The fat is removed using a small cannula that has limited suction in order not to damage the fat cells.  This same procedure is used for fat grafting to the facial area as well.

 

                               Fat Grafting Procedure and Injection

                                                  Licensed image for CosmeticSurgeryForums.com

 

Most surgeons will then spin the fat in a centrifuge to remove the excess fluids and the damaged fat cells. Only the whole undamaged fat cells are injected. Once the fat is prepared it is injected into the lip area using a blunt needle or a syringe. 

Incisions are made less than 0.2 centimeters in diameter in the corner of the mouth, and normally the fat is delivered in “Micro-droplet Technique”.

Another method of fat grafting to the lips involves tiny incisions that are made inside each corner of the mouth, and a tunnel is created under the skin of the lips and then the fat is injected this way.

Although some physicians believe that fat grafting is permanent, it really does depend on the patient and their own absorption rate. Fat grafting is highly technique dependent, and most physicians will have an average re-absorption rate of approximately 50%.

To counter what the patient might lose during recovery and the body absorbing some of the fat, most physicians will overfill the area to compensate for this occurring.  Physicians who are specialized in fat grafting tend to have a lower absorption rate due to their technique. Fat grafting tends to last longer in the areas of the face that has less movement and also if the area being treated is around muscle and a good blood supply.

Fat grafting is performed on an outpatient basis and normally takes approximately an hour and a half. The results from lip augmentation with fat transfer can last from six months to several years and can range in price from $1,500 - $5,000.

 

                                                            Fat Grafting Instruments

                                                            Cannula and Syringes used with Fat Grafting

                                                               Cannula and Syringes

 

 

ADVANTAGES:

The advantages of fat grafting to the lips or face is that you are using your own tissue, so there is no chance of an allergic reaction occurring.

Many plastic surgeons agree that there is no other product which can improve the quality of the skin as autologous fat. 

The fat aspirate has the ability to enhance the blood supply of the skin, improve the color, thickness, elasticity and texture naturally.

 

DISADVANTAGES:

The downside of fat grafting is that it requires another procedure to harvest the fat, which is more invasive than injections alone. The procedure can be time consuming for the patient with the recovery period. It also can be more costly because of procedure and time it takes to harvest the fat. The less movement the treated area gets, the more fat cells survive. There are forewarnings and uncertainties too with this procedure.

The biggest problem is that only a percentage of the injected fat takes hold in the treated area. Additionally, this percentage may vary widely: from about 10% to 50% depending on a variety of factors. Many surgeons have their favorite harvesting and injection techniques and claim higher than average clinical longevity of the grafts.

 

 

 

Indications:  lip augmentation - facial contouring - wrinkles - lines - nasolabial folds - cheeks - under eyes

Composition:  The fat is harvested from your own body (such as from the abdominal area or waist).  The fat is processed by spinning the fat down and then re-injected into the area.

Allergy Testing:  Not Required

Longevity:  Several months or years

Cost:  $1500 - $5000 per 3.0 cc

 

 

                            Harvested fat ready for injection into the facial area

                                            Licensed image for CosmeticSurgeryForums.com

 

                                                           Facial Fat Grafting

 

                            Harvested fat spun down and drawn up into a syringe for injection to the facial area.

                                        Licensed image for CosmeticSurgeryForums.com

 

 

 

The Cosmetic Dermatologic Surgery, Darmstadt, Germany - Reviewed the effectiveness of fat injections in an article published in Dermatologic Surgery Journal.

They concluded that:

Clinical longevity of correction after autologous fat transfer is determined by the degree of augmentation resulting from the amount of fibrosis induced and the number of viable fat cells. Survival of aspirated fat cell grafts depends mainly on the anatomic site, the mobility and vascularity of the recipient tissue, or underlying causes and diseases, and less on harvesting and re-injection methods.

Swelling is expected after the fat graft and is dependent on the physician’s technique and the patient’s tolerability. Swelling can last from two to several weeks after the procedure. Bruising may be apparent and possible scarring of the fat donor site.

As with any surgical procedure, there are drawbacks to lip augmentation fat transfer surgery. Part of the fat that is injected into the lips is subject to necrosis (tissue death) as a result of the procedure. Also, excess scar tissue can form inside the lips from having this procedure done.

 

 

 

Autologous Fat  Grafting:  Long-Term Evidence of its Efficacy in Mid-Facial Rejuvenation

By: Meier JD, Glasgold RA, Glasgold MJ

OBJECTIVE: To provide quantitative objective data demonstrating the longevity and amount of volume augmentation in the mid-face obtained with autologous fat grafting.

METHODS: A prospective analysis of all patients who underwent autologous fat transfer to the midface region at our private practice and were followed up for at least 1 year. Three-dimensional imaging was performed with a Canfield Scientific Vectra camera and software, with quantitative volume measurements evaluating the amount of postoperative volume change.

RESULTS: Thirty-three patients (66 hemiface-mid-face regions) were included in the study. The mean follow-up time was 16 months. The mean amount of autologous fat injected into each mid-face region was 10.1 mL. Overall, the mean absolute volume augmentation measured at their last postoperative visit was 3.3 mL (31.8% take). There was variability between patients in the volume amount and percentage that remained. Touch-up procedures were performed in 8 patients.

CONCLUSIONS: To our knowledge, this study is the first clinical quantification of autologous fat transfer and/or grafting in the literature that provides definitive evidence on the amount as well as the resultant longevity in the mid-face. Autologous fat transfer to the mid-face has definite long-term volume augmentation results. On average, approximately 32% of the injected volume remains at 16 months. However, some variability exists in the percentage of volume that remains that may require a touch-up procedure.

 

 

 

 

 

 

 

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