I like fat. Autologous fat transfer is a technique that has allowed me to expand my repertoire for soft tissue augmentation. For many patients, a few cc’s of filler is not enough to repair mid-face ptosis or diminish nasolabial creases. Using fat, I can offer these patients the opportunity to have truly remarkable results using minimally invasive techniques. For those cosmetic dermatologists already doing liposuction, the addition of fat transfer is fairly simple. For dermatologists not presently doing liposuction, you should consult with and learn the technique of fat harvesting from a colleague that is skilled in this area. Harvesting the Fat The harvesting of fat begins by selecting a donor area. One site that I frequently select is the upper buttock in the midline. When this area is not suitable, I will look to the hips or flanks. If you do use one of these areas, keep in mind that you have to take equal amounts from both sides. Using standard Klein anesthetic technique, I anesthetize the donor area. I then use a 30-cc syringe with a Coleman aspiration cannula and a metal stopper that keeps the syringe withdrawn to harvest. Using a fanning technique when harvesting, I take care to avoid asymmetry and dimples. When I obtain fat from two areas, I make sure that I obtain the same amounts from each side. The amount of fat aspirated should be about three times what you anticipate using in a given session so that you can freeze material for later use. It’s important when storing material to write the patient’s name and the date on the syringe as well as on an autoclave bag — perform both of these activities in full view of the patient so they understand that there is no room for confusion of specimens. Before storing or injecting the fat, I wash it with cool isotonic saline several times. While I do not centrifuge the fat, I do know of several skilled practitioners that do. Injecting the Fat Once the fat is obtained, you are ready to inject. When injecting, it is important for the patient to be seated almost upright (reclining too much will mask the descent that needs to be corrected). Anesthesia for the procedure is obtained with nerve blocks. Valium (administered by mouth) is also helpful. For injection, make an incision with an 11 blade. Typically, this is done at about the corners of the mouth. Using a Coleman injection needle (available at Byron), I create a tunnel in the nasolabial crease. I then fill the nasolabial crease while withdrawing the needle (minimizing the risk of fat embolism). Depending on the person’s anatomy, I can usually use this same insertion point for correction of the corners of the mouth. For correction of mid-face descent, I use several injection points to obtain an even dispersion of the fat. Again, it is crucial to inject while withdrawing. Areas to Inject I will inject lips in patients needing more volume than one can realistically deliver with some fillers, although I suspect that with Restylane, Perlane, Hylaform and other fillers, the need to perform fat injections in the lip will diminish. I like the fact that the exogenous fillers are uniform sized and textured molecules. In an area, such as the lip, I think this fact is of critical importance. The final area that I like fat for is the dorsum of the hands. Fat transplantation is a great way to rejuvenate hands that are stringy due to lack of connective tissue. One area that I have not injected is the eyelid. Though I have seen several of these done by other physicians, I am not convinced that the heterogenous nature of fat globules is well suited for filling an area with very thin skin and little tolerance for variability. Points to Remember When injecting fat, be aware that the procedure is typically performed several times in a year because there is about a 25% to 33% survival of the fat that is transplanted. Do not lead patients to believe that one treatment is enough. Be sure to educate them to the fact that this is a process rather than a discrete procedure. It’s important that patients have realistic expectations about the timeline and results they should see. When beginning to perform fat transfers, seek out help from someone that has done them. Also read the literature about fat transplantation — it’s actually quite interesting, as the procedure was used during war times to change the appearance of spies. In summary, fat transfer is a technique that I think should be familiar to cosmetic dermatologists. It is relatively easy to learn, requires simple equipment and is fun to do.
The Benefits of Fat
I like fat. Autologous fat transfer is a technique that has allowed me to expand my repertoire for soft tissue augmentation. For many patients, a few cc’s of filler is not enough to repair mid-face ptosis or diminish nasolabial creases. Using fat, I can offer these patients the opportunity to have truly remarkable results using minimally invasive techniques. For those cosmetic dermatologists already doing liposuction, the addition of fat transfer is fairly simple. For dermatologists not presently doing liposuction, you should consult with and learn the technique of fat harvesting from a colleague that is skilled in this area. Harvesting the Fat The harvesting of fat begins by selecting a donor area. One site that I frequently select is the upper buttock in the midline. When this area is not suitable, I will look to the hips or flanks. If you do use one of these areas, keep in mind that you have to take equal amounts from both sides. Using standard Klein anesthetic technique, I anesthetize the donor area. I then use a 30-cc syringe with a Coleman aspiration cannula and a metal stopper that keeps the syringe withdrawn to harvest. Using a fanning technique when harvesting, I take care to avoid asymmetry and dimples. When I obtain fat from two areas, I make sure that I obtain the same amounts from each side. The amount of fat aspirated should be about three times what you anticipate using in a given session so that you can freeze material for later use. It’s important when storing material to write the patient’s name and the date on the syringe as well as on an autoclave bag — perform both of these activities in full view of the patient so they understand that there is no room for confusion of specimens. Before storing or injecting the fat, I wash it with cool isotonic saline several times. While I do not centrifuge the fat, I do know of several skilled practitioners that do. Injecting the Fat Once the fat is obtained, you are ready to inject. When injecting, it is important for the patient to be seated almost upright (reclining too much will mask the descent that needs to be corrected). Anesthesia for the procedure is obtained with nerve blocks. Valium (administered by mouth) is also helpful. For injection, make an incision with an 11 blade. Typically, this is done at about the corners of the mouth. Using a Coleman injection needle (available at Byron), I create a tunnel in the nasolabial crease. I then fill the nasolabial crease while withdrawing the needle (minimizing the risk of fat embolism). Depending on the person’s anatomy, I can usually use this same insertion point for correction of the corners of the mouth. For correction of mid-face descent, I use several injection points to obtain an even dispersion of the fat. Again, it is crucial to inject while withdrawing. Areas to Inject I will inject lips in patients needing more volume than one can realistically deliver with some fillers, although I suspect that with Restylane, Perlane, Hylaform and other fillers, the need to perform fat injections in the lip will diminish. I like the fact that the exogenous fillers are uniform sized and textured molecules. In an area, such as the lip, I think this fact is of critical importance. The final area that I like fat for is the dorsum of the hands. Fat transplantation is a great way to rejuvenate hands that are stringy due to lack of connective tissue. One area that I have not injected is the eyelid. Though I have seen several of these done by other physicians, I am not convinced that the heterogenous nature of fat globules is well suited for filling an area with very thin skin and little tolerance for variability. Points to Remember When injecting fat, be aware that the procedure is typically performed several times in a year because there is about a 25% to 33% survival of the fat that is transplanted. Do not lead patients to believe that one treatment is enough. Be sure to educate them to the fact that this is a process rather than a discrete procedure. It’s important that patients have realistic expectations about the timeline and results they should see. When beginning to perform fat transfers, seek out help from someone that has done them. Also read the literature about fat transplantation — it’s actually quite interesting, as the procedure was used during war times to change the appearance of spies. In summary, fat transfer is a technique that I think should be familiar to cosmetic dermatologists. It is relatively easy to learn, requires simple equipment and is fun to do.
I like fat. Autologous fat transfer is a technique that has allowed me to expand my repertoire for soft tissue augmentation. For many patients, a few cc’s of filler is not enough to repair mid-face ptosis or diminish nasolabial creases. Using fat, I can offer these patients the opportunity to have truly remarkable results using minimally invasive techniques. For those cosmetic dermatologists already doing liposuction, the addition of fat transfer is fairly simple. For dermatologists not presently doing liposuction, you should consult with and learn the technique of fat harvesting from a colleague that is skilled in this area. Harvesting the Fat The harvesting of fat begins by selecting a donor area. One site that I frequently select is the upper buttock in the midline. When this area is not suitable, I will look to the hips or flanks. If you do use one of these areas, keep in mind that you have to take equal amounts from both sides. Using standard Klein anesthetic technique, I anesthetize the donor area. I then use a 30-cc syringe with a Coleman aspiration cannula and a metal stopper that keeps the syringe withdrawn to harvest. Using a fanning technique when harvesting, I take care to avoid asymmetry and dimples. When I obtain fat from two areas, I make sure that I obtain the same amounts from each side. The amount of fat aspirated should be about three times what you anticipate using in a given session so that you can freeze material for later use. It’s important when storing material to write the patient’s name and the date on the syringe as well as on an autoclave bag — perform both of these activities in full view of the patient so they understand that there is no room for confusion of specimens. Before storing or injecting the fat, I wash it with cool isotonic saline several times. While I do not centrifuge the fat, I do know of several skilled practitioners that do. Injecting the Fat Once the fat is obtained, you are ready to inject. When injecting, it is important for the patient to be seated almost upright (reclining too much will mask the descent that needs to be corrected). Anesthesia for the procedure is obtained with nerve blocks. Valium (administered by mouth) is also helpful. For injection, make an incision with an 11 blade. Typically, this is done at about the corners of the mouth. Using a Coleman injection needle (available at Byron), I create a tunnel in the nasolabial crease. I then fill the nasolabial crease while withdrawing the needle (minimizing the risk of fat embolism). Depending on the person’s anatomy, I can usually use this same insertion point for correction of the corners of the mouth. For correction of mid-face descent, I use several injection points to obtain an even dispersion of the fat. Again, it is crucial to inject while withdrawing. Areas to Inject I will inject lips in patients needing more volume than one can realistically deliver with some fillers, although I suspect that with Restylane, Perlane, Hylaform and other fillers, the need to perform fat injections in the lip will diminish. I like the fact that the exogenous fillers are uniform sized and textured molecules. In an area, such as the lip, I think this fact is of critical importance. The final area that I like fat for is the dorsum of the hands. Fat transplantation is a great way to rejuvenate hands that are stringy due to lack of connective tissue. One area that I have not injected is the eyelid. Though I have seen several of these done by other physicians, I am not convinced that the heterogenous nature of fat globules is well suited for filling an area with very thin skin and little tolerance for variability. Points to Remember When injecting fat, be aware that the procedure is typically performed several times in a year because there is about a 25% to 33% survival of the fat that is transplanted. Do not lead patients to believe that one treatment is enough. Be sure to educate them to the fact that this is a process rather than a discrete procedure. It’s important that patients have realistic expectations about the timeline and results they should see. When beginning to perform fat transfers, seek out help from someone that has done them. Also read the literature about fat transplantation — it’s actually quite interesting, as the procedure was used during war times to change the appearance of spies. In summary, fat transfer is a technique that I think should be familiar to cosmetic dermatologists. It is relatively easy to learn, requires simple equipment and is fun to do.
