Posts Tagged ‘fat graft’

Understanding Fat Grafting: Is It Reliable?

With the New Year upon us, many will resolve to exercise more or start a diet in order to lose those excess pounds or fat we’ve accumulated over the years. Too much fat in the wrong place leads to a flabby tummy, ‘love handles,’ full thighs, a fatty neck, etc. But fat isn’t always a negative thing. In fact, in the right amount, fat makes our face have a youthful richness, helps give fullness to a woman’s breast, and produces a youthful, round bottom. With fat, just like real estate, it’s about location, location, location.

At the Emory Aesthetic Center, we offer a technique called autologous fat transfer or fat grafting to help improve appearance, address early aging, and just make you feel better about yourself. Below are some common questions to help you make an informed decision if you are considering undergoing this type of procedure.

What is Autologous Fat Grafting?

Fat grafting is a relatively new technique that is growing in popularity each year due to the beautiful, natural results it produces. A fat grafting procedure transfers fat from areas in which you have excess fat, and injects it into areas that may be lacking in volume. People who are dissatisfied with the volume and contour of the buttocks, face, hips, breasts, or abdomen can have their own fat transferred to these areas, improving the appearance of both areas in the process.

What are the Common Areas on the Body for Fat Grafting?

The most common areas for fat transfer are the face, breast, buttocks and hands. In the face, fat transfer can be done alone or combined with chemical peels or excisional techniques such as a facelift. Fat is typically placed in the cheeks, nasolabial folds (smile lines), and even hollowed temples. Very little volume is needed to improve these deficient areas. Fat can also be used instead of implants to augment the breast or buttocks. These procedures require larger volumes of fat grafts and in some cases, require more than one surgical stage to get the desired result.

How is a Fat Graft Performed?

First, the fat has to be harvested and depending on where we are planning to graft the fat, the harvesting method is different. For the eyelids or face, we use tiny little cannulas or tubes to remove the fat. For areas such as the breast and buttocks, the tubes are much larger. The second step involves preparing the fat. Generally we use a sieve or strainer so that the supernatant fluid – the clear fluid that separates from the fat after the settling – is drained and the fat itself is left for grafting. That fat, we call micro-fat. The fat is then carefully injected in multiple tissue planes of the targeted area so that it receives plenty of oxygen and nutrients so it can develop a new blood supply. The fat that survives provides the soft tissue volume to address areas of need. The fat that does not survive is absorbed.

How Reliable are Fat Grafts?

The most challenging part of fat grafting is the ability to predict how much of the grafted fat the tissue will take. How much do we inject? How much will be retained? Because it is much easier and more convenient to reinject than it is to remove over-grafted fat, I tend to over correct by a very small amount, about 20 to 30 percent, knowing that not all the grafted fat will take. With experience, a qualified cosmetic surgeon will know that within his or her hands, how much of that fat will survive, so it’s less likely that a patient will have to come back for a second time of re-grafting.

Emory Aesthetic Center

If you look in the mirror, and see fat that you wish were somewhere else, fat grafting may be a great procedure for you. Come meet with one of the expert cosmetic surgeons of the Emory Aesthetic Center. We can discuss your goals and see if fat grafting alone or in combination with other procedures is right for you.

About Dr. Nahai

Foad Nahai, M.D., F.A.C.S., Maurice J. Jurkiewicz chair in Plastic Surgery and Professor of Surgery at the Emory University School of Medicine, has taught for over forty years. He is certified by the American Board of Plastic Surgery where he served as a director of the board for six years.

Not only Dr. Nahai’s patients, but also his peers, benefit from his incomparable wealth of experience. His contributions to the field of plastic surgery make him a highly sought-after presenter, both domestically and internationally. He has developed and implemented many procedures, some of which he has been invited to demonstrate live.

 

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Blepharoplasty: Eyelid Surgery and Recovery Explained

Blepharoplasty, or eyelid surgery, can make you look years younger. Nonsurgical options include hyaluronic acid and fat injections.People often refer to eyes as windows to the soul. In fact, our eyes do provide lots of information about our emotional state. According to Psychology Today, we can tell a genuine from a fake smile by looking at a person’s eyes. The mouth shape of a smile is easy to fake—we do it all the time out of politeness. But our eyes are usually the giveaway.

The area around our eyes (the periocular area) also plays a crucial role in how we express ourselves and communicate with others. Aging in this area can change how others see us and can mean the difference between being seen as “bright-eyed” or tired.

As we get older, our eyelid tissues become thinner and our skin loses elasticity. We may also notice more puffiness around our eyes, as well as dark circles and wrinkles. The good news is there are several options for rejuvenating the periocular area:

  • Blepharoplasty (eyelid surgery)
  • Hyaluronic acid fillers
  • Fat grafting

Eyelid surgery for a younger, fresher look

Eyelid surgery, or blepharoplasty, is a common procedure that can refresh the area around your eyes. Making tiny incisions along your eyelids (in the natural creases so the scars are hidden), your surgeon will remove any excess skin or fat from your upper and/or lower eyelids, and tighten the tissues.

Blepharoplasty is an outpatient surgery usually done under local anesthesia with sedation. This involves numbing the area around your eyes to prevent any feeling of pain during your procedure in combination with medicine to calm you. In some cases, your surgeon may recommend general anesthesia instead.
Either way, you can go home the same day.

Typically, you can expect a complete recovery in about two weeks. You will experience some bruising and swelling for a few days after your surgery, so you may not want to plan any major social events during that time frame. Use ice and anti-inflammatories (such as ibuprofen) to help with your swelling or any discomfort. You may also need to have stitches removed a few days after your procedure.

Nonsurgical options

If you can’t or don’t want to have surgery, you still have options for refreshing your look. For hollowed eyelids (or deep, dark circles), hyaluronic acid fillers or fat grafting are effective, nonsurgical methods for plumping up the tissue around your eyes.

Hyaluronic acid fillers are temporary, but can be repeated as needed. Our specialists provide hyaluronic acid injections in the office using topical anesthetic to numb the area around your eyes.

Fat grafting is a more permanent solution, but since fat is partially reabsorbed, you may need more than one injection session. In this procedure, fat is taken from another area of your body and injected into hollow or drooping areas around your eyes. Because it’s your own tissue, your body won’t reject it – it’s your own natural filler. Fat grafting requires local anesthesia to numb the area where the fat is harvested and where it will be injected.

You can go home immediately after both procedures. There may be some bruising and swelling for a few days following your injection or grafting procedure, but you should experience a quick recovery. Ice is recommended to help with swelling and Ibuprofen can be used to help with any discomfort.

Emory Aesthetic Center

If you’re ready to refresh your eye area, the expert cosmetic surgeons at the Emory Aesthetic Center can help you determine the best treatment option for you.

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Ask the Doctor: How Do Fat Transfers Work?

Fat TransfersPatients often ask “How do fat transfers work, and do they last?” It is a very good question, and pertinent, too, because fat transfers have become very common in cosmetic surgery over the past several years. Fat transfers have assumed an important role in facial rejuvenation, breast augmentation surgery, buttock enhancement, and the secondary treatment of body contouring deformities, so it is important to understand what is going on.

Fat transfer is a lot like the old real estate saying: It’s all about location, location, location. Most of us have extra fat in areas we don’t want, and the beauty of the fat transfer is that we can remove some of this unwanted fat and relocate it to where we want to enhance volume. Even though this concept is quite simple, the actual way the procedure is performed has taken cosmetic surgeons many years to develop. We are still constantly improving and enhancing our techniques as we get a better understanding of how these techniques affect the survival of the fat in the new location.

The first step in fat transfer is to collect the fat from the donor site. The most common location where we harvest fat is the tummy, but we can use many potential sites, including the love handles, the thighs, and the back of the arms. The fat is collected by liposuction, either using a syringe system or a system with a fat collection chamber. The fluid obtained during liposuction (the aspirate) is then treated to remove excess fluid from damaged fat cells so that concentrated fat is ready to inject. There is significant variability in how surgeons prepare the fat for transplantation. This prepatory step can be as simple as gently straining the aspirate, may involve washing the fat, or may involve centrifuging the aspirate. The prepared fat is then loaded into syringes for injection.

The injection of the fat cells into its new “home” is done using fat grafting cannulas, these are generally small and designed to be gentle on the fat cells. The surgeon injects the fat into many tunnels and layers, as you want the fat to be widely dispersed in the tissues and not to “pool” in one area. Pooling leads to a decreased “take” of the transplanted fat. To explain this further, I like to use the analogy of planting seeds. Like seeds, the fat grafts need to get nutrients from the bed in which they are planted in order to survive. If you plant a full bag of seeds into a single hole in the ground, the seeds in the middle of the “pool” would not be able to get their roots into the dirt and would eventually die. That’s how it works with transplanted fat – if you put too much in one place, the cells in the middle will die and will be absorbed by the body.

When fat cells survive in their new location, they are there forever, and will be of stable size (unless you gain or loose a lot of weight). Cosmetic surgeons love to argue sometimes about the best way to harvest, prepare, and transplant the fat in order to optimize graft survival, and although we’ve made tremendous progress (fat transplantation is now highly effective and reliable – probably in the range of 70% survival), I don’t think we know all the answers yet. Be cautious if you feel you are being sold a “magic solution” for fat grafting, as these are often not backed up by good clinical evidence, at least currently.

One more word of warning relates to “stem cell fat grafts.” Stem cells are a current hot topic in medicine, and indeed stem cell science has tremendous potential to change the way medicine will be in the future. All tissues – including fat harvested for transfer – have stem cells anyway. However there is currently no compelling science to support the clinical claims of any special stem cell fat transplantation techniques in aesthetic surgery, and there is a lot of deceptive advertising to entice unknowing patients. In fact, both the American Society for Aesthetic Surgery and the American Society of Plastic Surgeons have issued a joint statement emphasizing this point.

The physicians at the Emory Aesthetic Center keep up with the latest developments in fat transplantation, and we’d be happy to help you figure out how they can work for you.

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About Dr. Eaves

Felmont Eaves, MDDr. Eaves recently returned to Atlanta, Georgia, to head the Emory Aesthetic Center as Medical Director, having previously completed his plastic surgery residency as well as a fellowship in endoscopic and minimally invasive plastic surgery at Emory University, The Emory Clinic, and associated hospitals. Before joining the Emory Aesthetic Center, Dr. Eaves was a partner in Charlotte Plastic Surgery for more than fifteen years and served as group president from 2010-2012.

His professional and institutional committee memberships and offices include an impressive list of national, international and local plastic surgery organizations, societies, boards, task forces, advisory councils, coalitions and foundations, including having served as President of the American Society for Aesthetic Plastic Surgery (ASAPS) from 2010-2011 and Trustee (2011-Present).

Dr. Eaves’ primary areas of academic inquiry have been in minimally-invasive and endoscopic aesthetic surgery, patient safety, system and process improvement in plastic surgery, evidence-based medicine applied to plastic surgery and recontouring surgery after massive weight loss. He has received several patents for new medical devices he developed, and has made major clinical service contributions to his field. Dr. Eaves has published more than 100 articles, book chapters and book reviews on plastic surgery in peer reviewed publications, as well as manuals, videos, computer programs and other teaching aids and has coauthored the first textbook on the topic of endoscopic plastic surgery.

Fat Grafting: How Your Own Fat Can Be Transferred to Give You the Look and Shape You Want

Body GraftingBody fat…we love to hate it. We try so hard to make it go away. Too much fat in the wrong place leads to a flabby tummy, ‘love handles,’ full thighs, a fatty neck, and in men, feminine appearing breasts. However fat has another side…a positive side. Yes, I said it – a positive side. Fat, in the right amount, makes our face have a youthful fullness, helps give fullness to a woman’s breast, and produces a youthful, round bottom. With fat, just like real estate, it’s about location, location, location.

As our faces age, we can develop somewhat sunken temples, flat cheeks, thin lips, and more hollowed eyes, all related to a loss of soft tissue volume. Not only does this loss of volume affect contours, but it also contributes to making the skin look looser. As women age, they sometimes lose volume in the breast, which also can make the breasts appear droopy (ptosis). In the buttock area, sometimes we are born with flat bottoms, but sometimes bottoms flatten with aging or weight loss.

Over the past several years, cosmetic surgeons have developed better and better techniques for fat transfer. In a fat transfer, or “fat graft” procedure, fat is harvested from the body by means of liposuction. The fat is gently prepared for injection back into the body, and then is “grafted” into position using small cannulas or needles. The fat is placed in the appropriate position and tissue plane so that it gets plenty of oxygen and nutrients as it develops a new blood supply. The fat that survives the transfer process and grows a new blood supply will survive long term to provide the soft fill needed to correct volume deficiencies. The part of the fat that doesn’t survive is simply reabsorbed.

The most common areas for fat transfer are the face, breast and buttocks, although sometimes fat is placed into aging hands. In the face, fat transfer can be done alone or it can be combined with excisional procedures such a facelift, blepharoplasty (eye-lid tuck), or brow lift. Fat is most commonly used to fill out a flattened cheek, deep nasolabial lines (run from nose toward corner of mouth), the groove underneath the eyes, or sunken temples. In the face, only small amounts are generally needed to get the right result. On the other hand, buttock augmentation with fat grafts, often referred to as the “Brazilian Butt Lift,” requires larger volumes, and in some instances, may require more than one surgical stage to get the full, desired result. One area where fat has proven particularly helpful is in the correction of contour irregularities that sometimes occur after previous liposuction procedures. In these instances, moving the fat around to fill in the depressions is a powerful improvement tool.

Recovery after a fat graft procedure is generally rapid, although this depends on if any other procedures were performed at the same time. For instance, facial fat grafts in combination with a full face-neck lift will take longer to settle than facial fat grafts alone. Typically after an isolated fat graft procedure you might experience a week or two of swelling, perhaps a little bruising (but often not), and the injected areas may feel firm for a few days. Since incisions are very small, after the swelling and bruising subside you can usually be up and working out in relatively short time. Complications like infection can occur but this is very rare with fat grafting procedures. Another potential complication is “loss” of the fat graft. In this instance, the transferred fat simply doesn’t seem to grow its new blood supply and hence melts away over several weeks. A good rule of thumb is that whatever volume that you have present at three months after surgery is the volume that you’re going to keep.

Of course everybody is different, and every BODY is different. Let the physicians at the Emory Aesthetic Center talk with you about your goals, your unique situation, and create a plan to fit your specific needs.

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