Versatility of Fat Transfer

Most patients interested in cosmetic enhancement understand how important fat transfer has become in the past 10 years. In fact, after eyelid rejuvenation surgery, Lipo-transfer has become the second most common surgical procedure in my practice. Because Lipo-transfer addresses the deflation part of the aging process, I often combine it with Ultherapy, thread lifting, or eyelid surgery for added synergistic effect. Lipo-transfer is an essential part of any facelifting procedure I perform. Finally most patients undergoing Lipo suctioning also usually receive Lipo-transfer, if not to the face, to other areas of the body including breasts, buttocks, and hands. I don’t think there are any nay sayers amongst Cosmetic Surgeons about how powerful Lipo-transfer can be for both its volume restoring effect as well as the rejuvenative effect from the adipocyte derived stem cells in the stromal part of the fat matrix.

For most patients transferring 20cc to 40cc of harvested fat will address all the fat compartments of the face in terms of restoring the lost volume and contouring the face back to more youthful days. This amount can be harvested even from thin patients whose body mass index (BMI) borders on being close to “underweight” category. Another words, nearly anyone can be a candidate for Lipo-transfer. Skillful Lipo-transfer surgeon has to have not only the technical expertise, but true artist’s eye to understand how to re-volumize the deflated zones as close to the patient’s younger years. To this end seeing patient’s pictures from younger days is important, but perhaps more important is Surgeon’s innate sense of how much fat to replace into which zones. Another words, every patient needs to have all the fat compartments addressed, but in different proportions. I always tell my patients that while sculptors work with stones to sculpture “out” works of art, I use fat to sculpture “in” works of art. You can truly appreciate the artistry behind the Plastic Surgeon when he/she is able to naturally wind back the clock simply with transferring fat to the face. At the time of the consultation, by talking to your surgeon and looking at the portfolio, you should really get a sense whether your surgeon’s visual sense matches yours.

Very often at the time of Lipo-transfer to the face, many patients also receive Lipo-transfer to other deflated parts of the body including the:

1. Deflated dorsum (top) of the hands

2. Deflated portion of the breast

3. Deflated portion of the buttock

1. Deflated dorsum of the hands

As the patients enter into their mid 40’s, many begin to note thinning of the top of their hands with greater show of their veins, tendons, and even the bony outline. This is due to deflation of the subdermal fat that provided youthful curvature as well as greater “bounce” to the overlying skin. At the time of Lipo-transfer to the face, additional fat is harvested. Roughly 10 to 20cc is transferred into the subdermal space using the blunt cannula technique. The subdermal space is a plane which readily opens up to receive the fat, and the fat can be easily molded in and around the vessels and the subdermal structures, thereby softening their appearance and providing a more youthful tone and bounce to the dorsum of your hands. Added benefit with the fat is the rejuvenative effect due to the adipocyte derived stem cells, providing more youthful appearance to the skin. I prefer to place topical anesthetic over the hands which minimizes any discomfort. Usually there is minimal to no bruising. Swelling can be mild to moderate so patients are asked to make a few days available to rest as they would for face Lipo-transfer; but, patients are usually able to get on about the following day with usually full function of their hands. Most patients find it quiet acceptable to return to work in a few days, but just like any Lipo-transfer procedure, it takes weeks for entire swelling to resolve.

2. Deflated portion of the Breast

In our practice some of the patients, especially after giving birth a few times, note significant sagging of their breast tissue, creating a contour hollow with a deflated appearance most prominently noted at 9 to 12 o’clock on the right breast and 12 to 3 o’clock on the left breast. In reality the deflated areas are devoid of any significant breast tissue as the breast tissue has sagged downwards in a pendulum fashion. By adding as little as 50cc to 150cc to the deflated zone, optically, the breast appears much more round and lifted in appearance. Lipo-transfer is actually not directed into the breast tissue to minimize any chance of future micro-calcification from occurring. This concept is very similar to achieving liquid lift to the face using Lipo-transfer. Once again blunt micro cannula technique is utilized obviating any suturing of the entrance points. There is usually no bruising and the added swelling immediately after surgery is usually welcomed by most patients. Recovery time is in days and most patient move on about pretty much right away.

3. Deflated portion of the Buttocks.

Have you taken a look at your behind recently? It is truly an intricate meeting of curves from your spine curvature to where your waist ends and your hip starts, to where your buttocks begins to curve outward and back inwards for your thighs to define the upper part of your legs. As we age, the unwanted fat pouches in your flank and thigh area seem to join up with your buttock which itself begins to sag and deflate, rendering what we affectionally term “sponge bob square” look especially for those with baseline flat buttocks.

Most of our patients are not interested in a Brazilian butt lift, which requires at a minimum 500 cc to 1000cc of fat into each of the buttocks. However many patients who have baseline flat buttocks or a degree of contour depression especially along the outer part of the buttock experience sagging and worsening of their buttock contour as they age. For these patients wishing to restore their buttock contour to younger days or perhaps even enhancing the natural curvature of the buttocks, can usually achieve their goals with as little as 75cc to 200cc of Lipo-transfer into each buttock. Once again, blunt micro cannula technique is used obviating suture closure of the entrance site. There is usually mild bruising and moderate swelling. Most patients require at minimum two to three days to recover and during this time, they are asked not to sit in the same position for a prolonged period to minimize pressure effect to the fat graft.

As alluded to earlier, if you think you belong to the group with “sponge bob square” look to your behind, at the time of Lipo-transfer, we highly recommend that you first undergo liposuction of the fat overlying the buttocks in the flank area as well as the fat in the outer thigh (saddlebag) and the banana roll which together represents the unwanted “fat” framework around the buttocks, to achieve a better definition and greater contour of the buttock. As a bonus, from improving the dragging down of your outer-lower limits of your buttock and getting rid of the saddlebag in the upper-outer thigh area, your upper legs will appear optically longer which is a very important gain for many patients who observe their legs no longer as lean looking wearing their pants as they used to. The removed fat is then harvested and processed to be used as fat graft for the contour enhancement of their buttocks.

In conclusion, when we were younger, fat happens to be in all the right places….but as we age, fat begins to disappear from these right places and appear in all the wrong places…. however don’t despair….. Consult with your Plastic Surgeon if the fat can be “globally” removed from all the unwanted places and then transferred into all the depleted places along with its adipocyte-derived stem cells to act as your very own source of “fountain of youth”!

#Eyelid surgery #lipo-transfer #rejuvenate #Thread lifting #Ultherapy

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