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Fat Transplantation
Overview
Filling soft tissue deficits such as
wrinkles, laugh lines, sunken areas around the eyes, and cheeks
has been a frustrating problem. This frustration has been
shared by both plastic surgeons and their patients who want
something that works well and lasts. Many substances have
been used. Some have been successful but last only a short
time such as collagen. Others are permanent but are hard to the touch and have an
unnatural feel like silicone implants. Still, others have
been fraught with infection and lumpiness like liquid silicone. We have not come up with the perfect soft tissue filler yet. There is an amazing work being done in the field of stem cell
research. In the future we will be able to take your own blood
and grow your own collagen which will be permanent. That day
is at least 20 years away and the cost will be very high.
Recently, fat transplantation has become
very close to what could be considered the ideal soft
tissue filler. Many pioneers in plastic surgeons such
as Dr. Cruise are using it with outstanding results. After
all, it is your own fat that is being used. The benefit of
fat transplantation is that the majority of the fat transplanted
lives forever. Meaning, the result is permanent. This is
a major step forward. Also, the touch and feel of fat is perfect
because it is your own tissue.
The idea of fat transplantation is not
a new one. It has been attempted since the early '70s but
the results were not reliable. The reason for this was because
the adipocytes, or fat cells, were destroyed when the fat
was harvested during liposuction. With newer techniques such
as gentle handling, filtering, and chemical alteration it
has been found that the majority of adipocytes can and do
survive.
For decades, plastic surgeons have been
actively looking for something to act as a soft tissue filler. Until these new techniques were devised, the search included
such substances as silicone, fascia, tendon, bone, and many
other artificial foreign bodies. None could provide the soft,
squeezable feel that one's own tissue has. Fat is the best
soft tissue filler that we currently have available.
The importance of fat transplantation
was not thoroughly recognized until plastic surgeons started
seriously evaluating what causes facial aging. It was once
thought that aging was caused by stretching of the skin. With more recent developments it is clear that this is only
a small part of facial aging. The majority of facial aging
can be attributed to fat and muscle descent as well as loss
of facial fat. With the advent of successful fat transplantation,
significant strides have been made in recapturing one's youthful
appearance. This is done by replacing the fat, which has been
lost with age, or has fallen down the face leaving sunken
eyes with circles, deep cheek folds, etc.
The importance of facial fat can be best
seen in that of a baby. Look at the cheeks of an infant. You will see a tremendous amount of fat. When you look at
successful models, all of them have high cheekbones with a
lot of fat within the cheeks. As we age the fat either falls
downward or goes away exposing an aged, sunken in appearance. By replacing this fat a more youthful appearance can be obtained
without even making incisions. This is a very attractive
idea to most people, and this is why fat transplantation has
become so popular among experienced plastic surgeons.
Fat loss is mostly noticed around the
eyes and within the cheeks. The loss of fat around the eyes
creates a sunken in appearance. Another characteristic is
that the facial skeleton becomes more and more apparent. Deep circles and bags become obvious as the fat either drifts
downward or goes away. By replacing the fat these processes
can be reversed.
 Dr. Cruise's philosophy regarding Fat Transplantation
 Fat transplantation is the treatment of choice for permanent soft tissue filling about the face. I have been doing it for quite some time and have found that by gentle harvesting of the fat, usually from the abdomen, and proper transfer well over 60 per cent of the fat survives forever. It is an excellent option to enhance cheeks without implants. I have found that when I fill in areas around the cheeks and eyes it acts like filling up a balloon with water. As the balloon fills it becomes very smooth and tight. The same happens when fat is added to the loose skin around the eyes. The small wrinkles and even some of the larger ones go way or are diminished markedly.
The nice thing about fat transplantation is that it can be repeated until the desired effect is obtained. Because fat is continually lost and/or descends down the face with aging it is a good idea to replace it approximately every 5 to 7 years with fat transplantation. This way, the results are not as dramatic that everyone notices and it effectively replaces the much needed fat that gives us a healthy, youthful appearance. In addition, face lifting can be avoided or delayed significantly.
I feel that continual fat replacement every so often is better than trying to do it all at once. The reason is because the results are much more predictable and you can only augment so much at one time with fat. You cannot augment more than 3 mm at any one time because fat requires the surrounding tissue to supply it with blood. If you put more than 3 mm of fat in, the surrounding tissues are unable to supply the middle with adequate blood leaving it to die and then be reabsorbed.
Benefits
The biggest benefit that fat transplantation
has to offer is that it is your own tissue. You are replacing
fat lost because of the aging process with fat from other
parts of the body. Here is a summary of fat transplantation
benefits.
- Your
own tissue is used.
- You
get the additional benefit of liposuction.
- There
is no better replacement of fat than fat itself.
- Fills
in the tear trough crease underneath the eyes.
- Dramatically
improves or eliminates circles under the eyes.
- Corrects
the sunken in look seen around the eyes as we age.
- Corrects
the sunken in look within the temple region common with
aging.
- Dramatically
helps corrects crow's feet.
- Is
able to re-create full, high cheeks seen in the youthful
face.
- Can
fill in other soft tissue defects and divots all over the
body.
- The
fat that successfully survives is permanent.
- The
procedure can be done under local anesthesia.
- The
procedure can be repeated over and over until the desired
results are obtained.
Possible complications
In Dr. Cruise's hands, the complications are quite rare. The most common complication with fat transplantation is inadequate volume. This, however, may not be a complication as it may be necessary to do it twice to obtain the desired volume. Other possible complications are asymmetry, skin irregularities, infection, and fluid or blood collections.
Are
you a good candidate?
Most people who have fat transplantation
are those who don't quite need a face lift or eyelid surgery
but want something to significantly improve the look around
their eyes and temples, and to increase the height of their
cheek bones. Often, it is done in conjunction with other
procedures. Outlined below are other good indications for
fat transplantation.
- Deep
tear trough crease underneath the eyes.
- Circles under the eyes.
- Sunken-in appearance around the eyes.
- Sunken in temples.
- Deep folds above the upper lip.
- Small cheeks.
- Chicks where fat has fallen downward.
- Fine wrinkles around the eyes and
crow's feet region.
- Soft tissue divot anywhere on the
body.
Prior to surgery
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Medications. Certain medications thin your blood and should not be
taken within 3 weeks of surgery. The most notable is
aspirin and aspirin containing products. Vitamin E and
many herbal products also thin the blood and should not
be used within 3 weeks of surgery. Dr. Cruise will go
over this more thoroughly prior to the procedure.
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Sleep. It is important to get a good night's rest prior to the
procedure. If you think this may be a problem, please,
do not hesitate to ask Dr. Cruise for something to help
to sleep.
-
Smoking. Please do not smoke within 3 weeks before and
after surgery. Smoking has a profound effect on reducing
wound healing capabilities. It significantly increases
the likelihood for infection, wound healing problems,
and scar formation. It also affects your airway, therefore,
makes anesthesia much more difficult.
-
Eating. Do not eat within 8 hours of surgery and do not drink
within 6 hours of surgery. It is OK to take medications
with a sip of water. Please discuss all medications with
Dr. Cruise and the anesthesiologist.
-
Washing. It is
a good idea to wash the surgical area thoroughly the night
before and the morning of surgery. If the abdomen is
being used to harvest the fat, please be sure to wash
the belly button. Do not apply any make up.
-
State of mind. Remember,
this should be a happy and exciting time. A certain amount
of nervousness is normal but you should not be overly
concerned. Dr. Cruise and ICRS are well trained and experienced. Excessive worrying can actually be detrimental and you
should discuss this with Dr. Cruise prior to surgery so
that something can be prescribed to make sure you remain
calm.
Anesthesia
ICRS only uses board certified anesthesiologists
to make sure you have the best anesthesia possible. The anesthesiologist
will discuss with you what type of anesthesia is best for
you. He/she will take into consideration your medical history,
the procedure, and your personal wishes.
Normally, fat transplantation is performed
under local anesthesia. It may be done under general anesthesia
or with sedation but this is usually when it is done with
other procedures.
After
the procedure
Immediately. If only fat transplantation is being done the procedure normally
takes about 1 to 2 hours. After which, you may have tape
applied to the areas where the fat has been injected to hold
it in place. You will be encouraged to walk around immediately. It is important that you have someone else drive you home. Do not touch the areas where the fat has been transplanted. It takes about 3 days before the fat is revascularized by
the surrounding tissues. If there is a lot of movement within
the transplanted area revascularization may not occur and
the fat will die. Dr. Cruise is a strong advocate of good
pain relief so you will be given as much pain medication as
necessary both immediately after the operation and for the
postoperative period. There will be some swelling and bruising
but there is surprisingly little pain. You must sleep sitting
up or at least with your head elevated on 2 ore 3 pillows
for the first week so that swelling is minimized.
That evening. It is recommended that you take it easy. You can walk around,
eat, but not too much more. You must sit and lay with your
head up on at least 3 pillows. You should take as much pain
medication as necessary and try to go to sleep early. Do
not apply ice to the fat transplantation site as this may
diminish blood flow and inhibit revascularization of the fat
cells. You will be given medication to help keep the swelling
down as well as to prevent infection.
First
week. You can take a body shower the day after surgery. Let cool water run over your face. Do not wash. Dab dry. Keep
the tape on for as long as it will stay on. If it starts to
peel off, gently cut off the portion that is lifting. Just
be gentle. You will see Dr. Cruise in his office 1 week after
surgery.
First
month. Begin gentle massage with a vitamin E cream
1 week after surgery. Gently massage your skin from
your nose to the side of the face to encourage lymphatic drainage. This will help bring the swelling down. At 2 weeks after surgery
you can begin to massage a little more firmly. Massage at
least every 4 hours for 2 minutes.
Beyond. Swelling will not completely resolve for about 6months but,
as mentioned above, the majority of it will be gone by 2 weeks. The final result will become evident at 3 to 6 months.
Recovery
time
Resolution of the swelling and bruising
is variable. Some people do not bruise at all while others
have bruising for 2 weeks. People with sedentary jobs go
back to work after 2 weeks. If you work at home or are not
self-conscious about the swelling then you can return after
4 days. If your job, however, requires strenuous activity
then it may take as long as 3 to 4 weeks to return to work. Most people return to work within 2 weeks.
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