Liposculpture, Fat Transfer / Fat Grafting

With apologies, we have included the title “Liposculpture”, but only because it is a popular search term. It’s really just a marketing term, used to imply that a “liposculpture” surgeon performs a form of elite liposuction. By that standard, every patient we treat is getting Liposculpture!

Fat grafting Technique

Fat grafting involves the harvest (removal) of fat from an area of excess, and placing it in a new location that is deficient. This is most often performed with a blunt tube similar to a liposuction cannula. Fat grafting is an important tool though, and can improve depressions left after previous liposuction surgery. We have unfortunately noticed more need for it as other practices adopt power liposuction (e.g. ultrasonic, laser). Fat grafting can also be an effective tool for augmentation in the upper face, the buttocks, and for localized indentations (e.g. post-lumpectomy in the breasts). Fat grafting does not always result in complete ‘take’, but provided fat cells are gently handled, good survival of fat grafts can be anticipated.

Liposculpture and Fat Grafting.

Liposculpture

Liposculpture is a marketing term used to imply that the surgeon performs an elite liposuction that is more precise and artistic than normal liposuction. By that standard, every patient we treat is getting liposculpture!  Liposculpture has no useful meaning, and  I would be concerned with a practice that advertises “Liposculpture”.

Fat Grafting

Fat grafting involves the removal of fat cells typically by liposuction from one part of the body where they are in excess and injection in another part of the body which requires more fat volume.

It is a very efficient technique for augmenting soft tissue volume in areas of deficiency. 

Face: Cheeks and temples, as facial ageing typically involves a loss of volume in the upper face.

Breasts: 1/2 to one cup size increments are possible without risking complications from dead fat (see below).

Buttocks: fat grafting to the bum is called Brazilian butt lift. No actual lift takes place, although adding fat to the upper buttock makes the bum appear to sit higher. 

Indented areas: grafting is used in the restoration of volume deficits arising from trauma or surgery.

Skin restoration: effects of aging or radiation can be improved with fat grafting, even without plumping the skin.

Are you a good candidate for fat grafting?

As with most plastic surgery procedures, fat grafting is best when you are healthy and at a stable weight. You will need one to two weeks to recover from your surgery, but light activity is possible the next day. Fat grafting requires a donor site where there is cosmetically too much fat. Aside from small grafts, consideration of optimizing the contours of the donor site by completing the liposuction procedure is necessary to avoid asymmetry or contour deformity.

Alternatives to fat grafting.

Hyaluronic acid fillers are used in the face and to some extent in the body as a soft tissue filler.  They are temporary, unlike fat grafts which are permanent.  They are less complicated to use than fat grafts, and allow for very quick recovery.  Auto-augmentation by shifting local tissues (flap surgery) is a powerful and common technique in plastic surgery, but is limited by need to maintain or create a blood supply to the flap.  Implant surgery is another popular option, and a careful consideration of the relative risks and benefits relative to fat grafting is part of the planning process.

Technique

Fat grafting requires careful handling of the donor fat to prevent fat cell death, but preparation of the recipient site is also important.  If the recipient site has a poor blood supply or is contracted due to previous surgery or trauma, we will consider a first stage procedure in which any scar is released, and the bed of the future graft is pretreated to encourage the formation of new blood vessels. This step is similar to tilling soil before planting seeds.

An appropriate donor site(s) must be selected, as there must be sufficient donor fat cells and an opportunity to cosmetically improve the donor area by removing the fat.  If we are grafting in the face and only require five or 10 cc of fat then any area can be harvested as a 20 or 30 cc harvest is unlikely to create contour deformities. For large areas of augmentation like the breast or the buttocks, large volume donor sites including the hips, the medial thighs and the abdomen are considered. 

The liposuction of donor fat is usually performed at lower vacuum pressure than usual to prevent the cells from exploding. The lobules of fat cells are then separated from the free oil and liposuction fluid, and may be further separated into tiny collections of cells to allow pressure-free injection of the fat with blunt-tipped needles or cannulae into the recipient bed.  We further distribute these small parcels of fat by using a basket-tipped cannula to break up any clumps and distribute fat throughout the tissue without risk of a pressurized injection into a vulnerable area.

Successful fat grafting requires the grafted fat cells to be very close to a blood supply or the cells will die. There are surgeons who inject 500 cc and more of fat in a single session. This fatty tissue is doomed to die, as it will vastly exceed any available blood supply. Initially it may appear impressive, but the dead fat will then breakdown and either be absorbed by the body or potentially persist in the form of a cyst, which may then calcify. It requires good judgement to know how much fat can be grafted in a particular bed, whether it be the breast or butt or even the face. We can anticipate under ideal conditions that approximately 70% of the transferred fat will survive if the volume of grafting is kept under 2-300 cc

Risks and limitations. Fat grafting like other injectable techniques carries a risk of embolization. This amounts to particles of fat entering blood vessels and then showering the circulation of the lungs, or potentially the skin or eye circulation in facial fat grafting. The risk of embolization can be minimized by avoiding grafting under pressure around large blood vessels, particularly as may be present underneath the muscles. We take a number of steps to minimize the risk of these complications and have not experienced any of them in our practice. Other risks include poor survival or ‘take’ of the graft, or cyst formation with calcification of dead fat. This more commonly occurs when large volumes of fat are injected into one area and are not dispersed. Immediately after the graft, there is a dramatic increase in the volume of an area. Once swelling goes down and the fat cells that do not survive are absorbed, the volume loss can become a concern. Usually by three months, the surgical site has healed well enough that the fat cells that have survived will begin to retain triglycerides again, causing the fat cells to swell and restoring the appearance of the augmentation.

Recovery after fat grafting

The recovery process is very similar to that with liposuction, with a distinction being that efforts are made to avoid pressure on the area that was grafted. This can involve off-loading the graft site by putting foam around it and using a compression garment to control the position of the fat graft. Other things like Brazilian butt lift (BBL) pillows can be used to avoid putting pressure on the graft while seated. Bruising and swelling can compromise the early appearance, but usually by two weeks people have recovered cosmetically and are able to return to their normal activities. We would like our patients to remain available to us for at least five days after the procedure, and typically by eight or nine months the results are complete.

Long-term issues

Fat grafting provides a permanent augmentation. This also means that the fat tissue is prone to conspicuous enlargement if you experience weight gain. The fat cells from your hips continue to think that they are hip fat cells, even though they are now in your cheeks or temple. And if you gain a lot of weight after your surgery, your cheeks and temple will enlarge in size just as if they were your hips. Fortunately, it is possible to reduce areas of excess fat with subsequent liposuction.