Posts Tagged ‘fat transfer surgery’

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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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.


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.