Fat Filling: Lipostructure

Areas of volume loss are frequently filled with fat. The fat not only provides volume for filling depressions, but, because fat is the richest source of adult stem cells (100 times more stem cells per gram of tissue in fat than in bone marrow), skin rejuvenation occurs as well. While the research into fat derived stem cells is still in its infancy, it is thought that these stem cells and associated growth factors help stimulate the formation of cells which can then renew collagen, elastin and other proteins necessary for a youthful skin. Science aside, there is certainly a visible improvement in the quality of the skin following a fat filling procedure where some of the fat is placed superficially under the skin.

The areas treated with fat grafts (pink) may include the following:

> lower lids (tear troughs, etc)
> lips
> nasolabial fold
> marionette lines from the mouth down
> temples
> frown
> chin crease
> crease below the chin
> depression in front of the jowls

The hands can also be treated to reduce the signs of aging. Other usese of structural fat grafts are for breast augmentation, buttock augmenation and to fill defects after previous liposuction.

The fat is your own fat, harvested with liposuction. When I perform a facial rejuvenation, the usual donor sites for the fat are the neck and possibly the face if the lipo is carried on to the face. These areas usually supply enough fat for adequate filling although in patients with thin faces I may have to harvest fat from other areas (tummy, inner thigh, etc) so as to obtain enough fat for volumetric correction.

The harvested fat is then treated (with centrifuge, a technique popularised by Sidney Coleman from NY (www.lipostructure.com). The oil and fluid layers are discarded and the middle, fat layer is used for fat grafting). The treated fat is transferred to small (1 ml) syringes and injected using specialised blunt needles called cannulae. I am very particular about the cannulae I use. Since using the Byron Tulip range of cannulae (I have no financial interest in the company), I have seen very little in the way of irregularities and my fat graft survival seems better. The cannulae are inserted through small incisions made simply with a needle. These incisions are not sutured and heal without any noticeable scarring. Multiple incisions are used and tiny quantities of fat are injected in each pass to slowly and artistically build up the depression or fill the area.

The fat is transferred as a graft (a non-vascularised tissue transfer). For the fat to survive in its new site, it needs to pick up a blood supply. This takes a few weeks, but generally the appearance of the fat at 6 months is likely to be permanent. It is traditionally said that there is an element of unpredictability to fat grafting and that serial grafting - a repeat procedure some months later - may be be required. In my experience this is rarely necessary. Asymmetry and lumpiness or depressions are also possible, but this is not common.

Following a fat grafting procedure, there will be some bruising and swelling which will last a week or two. Once this resolves, the effect will be soft and natural without any of the stigmata of surgery such as scars. For me, fat grafting has replaced the need for other graft material such as dermis. Sometimes an alternative to fat is filler, although I prefer to use filler for fine lines