Plumping Up

Created on 10th September 2009

Consultant plastic surgeon Mr Sanjay Azad explains the increasingly popular procedure of fat transfer and its many benefits in fighting the ageing process

There has been an explosion in the medical aesthetic market with a lot more patients asking for dermal fillers and Botox. These are attractive, quick fix procedures and in the right hands will yield good short-term results. The concept is popular, as one is avoiding a major surgical procedure at a very reasonable cost.

Fillers can be either synthetic or from the body itself (autologous). Synthetic fillers can have a temporary effect or can stay in the body permanently.

The number of synthetic fillers abound with more being added each day. They are typically injected in superficial locations on the face and different manufacturers will expound on their advantages. In my experience, this category of fillers needs to be used very carefully. There can be issues with fillers being palpable, infected, extruded. Any problems such as these are difficult to treat.

The other disadvantage of synthetic fillers is that they lack the ability to really rejuvenate tissues. Some of the hyaluronic acid fillers have some rejuvenating effect, but this can be enhanced even further with fat transfer.

Fat transfer is a versatile technique which is becoming increasingly popular. It was first described more than a decade ago and basically involves using the fat in one's body to fill and rejuvenate different areas.

Fat cells are delicate and need a good blood supply to survive. They also have among them ‘stem cells' which have the ability to regenerate and rejuvenate tissues. Research over the last ten years has shown that fat transferred into different parts of the body can fill and improve tissue quality. Most importantly the results, with proper technique, are permanent.

The technique of fat transfer can be done under local anaesthetic, but general anaesthetic is preferred. The area of interest is firstly marked and the area of fat harvest is infiltrated with a dilute solution of local anaesthetic. The fat is harvested from any area of the body with excess fatty tissue, like the lower abdomen and upper thighs.

The harvesting is done very gently using 10 ml syringes through a small skin stab incision, and is quite unlike the forceful techniques of liposuction. Gentle harvest is critical to preserve the fat cells.
Once the fat cells are removed they are placed in a centrifuge.

Centrifugation helps the fat cells to be separated out from oil and water. At the end of this process, we have pure undamaged fat cells which are then transferred to small syringes (1-3 ml). Special cannulae are used to inject the fat into the area for filling.

The injection technique is a key, as fat needs to be placed in multiple tissue planes, depositing a ‘string of pearls' in each area only. Too large an amount of injected fat in one area will lack the ability to get a future blood supply and will basically dissolve away. About 30-40 per cent of the fat injected will not ‘take', but with good technique and proper training about 50-60 per cent of the fat will then last long term. The result, visible at three months after the procedure, should be durable.

The technique of fat transfer has numerous advantages. It uses one's own tissue so it avoids any issues relating to artificial filler materials. It is minimally invasive as only stab incisions are used for harvesting and injection.

Fat has a rejuvenating effect on tissue and can help enormously in enhancing cosmetic results of any area of the body. Fat transfer is versatile and can be used in virtually any part of body, but more so in the face, hands and breasts. The long-term results are durable and this avoids the need for repeated injections with the associated costs.

However, with any procedure there are some disadvantages. This procedure is more expensive than a simple filler injection and involves an anaesthetic, with possibly an overnight hospital stay.
Fat transfer is a versatile, simple technique of enhancing and filling areas of the body. It has the ability to rejuvenate and regenerate tissues to give a more youthful appearance to the body.
CS&AM