What is autologous fat grafting used for?
Fat grafting, also called lipofilling, is used by plastic surgeons for augmentation and restoration of soft tissue in reconstructive and aesthetic surgery as it is a natural, regenerative method. Numerous approaches have been developed over the years, varying in adipose tissue collection sites as well as techniques for collection, processing, and injection.
Types of fat for autologous fat grafting
Different types of fat are used in autologous fat grafting, each suitable for different applications.
Macrofat
Macrofat, consisting of 2mm to 4mm fat particles, is ideal for treating larger areas of the body such as the breasts and buttocks.
Millifat
Millifat, consisting of 2 mm fat particles, is used to fill deep fat deposits on the face or other sensitive areas.
Microfat
Microfat, consisting of 1 mm fat particles, serves as a natural filler for superficial fatty tissue areas in the cheeks as well as around the eyelids, eyebrows, nose, temples, nasolabial folds, marionette lines, lips and hands.
Nanofat
Nanofat, which consists of 0.5 mm fat particles, contains fat stem cells and growth factors that promote tissue regeneration but do not replace larger volumes. This makes it ideal for treating scars, chronic wounds, osteoarthritis and skin rejuvenation.
Fat harvesting
Harvesting areas
First, I will carefully examine you to determine available fat deposits for extraction. Surprisingly, even slim patients often have enough reserves for facial fat transfer, breast enlargement or smaller buttock fat grafting procedures. Common harvesting sites include the flank, abdomen, thigh and knee for smaller volumes, while the entire body is used for larger volumes.
Harvesting techniques
Various harvesting techniques such as manual aspiration and standard liposuction are commonly used, although the pressure and equipment used vary. Liposuction can be assisted by technologies such as ultrasound (VASER®) and mechanical vibration (MicroAire®). The size of the cannula affects the size and viability of the removed fat. Removal with larger diameter cannulas helps ensure that fewer cells are destroyed in the process and the architecture of the fatty tissue is preserved. However, larger fat particles are more difficult to inject, are more likely to cause irregularities, and the fat’s ability to survive may be limited due to the lack of oxygen supply to the center of the fat particle. Harvesting can be done either with a tumescent method, in which a larger amount of anesthetic fluid is infiltrated into the donor site, or with smaller infiltration volumes, primarily for manual harvesting.
Fat processing
Common procedures used to prepare fat grafts include sedimentation, filtration, washing, and centrifugation. These procedures are often essential to remove connective tissue fibers, blood, and debris that could cause inflammation at the recipient site and compromise the fat graft. Coleman introduced a processing method that has since been widely adopted and incorporated into many clinical protocols. In this method, the fat removed in syringes is centrifuged, creating three separating layers: the upper layer contains oil from destroyed fat cells, the middle layer consists of viable fat cells, and the lower layer contains blood and infiltration fluid. Implementing an optimal processing method is crucial to increase the number of viable cells, resulting in improved graft uptake.
LipoCube™ Nano
Designed specifically for small volume fat grafting, LipoCube™ Nano is a single-use mechanical device that processes autologous adipose tissue into milli-, micro- and nanofat tailored to the specific application.
LipoCube™ SVF
LipoCube™ SVF is a similar device that helps mechanically isolate the Stromal Vascular Fraction (SVF) from the patient’s autologous fat. Find out more about SVF in this Blog.
Transplantation
Autologous fat grafting (transplantation) is performed under different types of anesthesia, which usually depend on the harvest volume and the recipient area. Smaller volumes can be comfortably treated under local anesthesia, while larger volumes typically require monitored intravenous (twilight) sedation or general anesthesia for your comfort and safety. The fat graft is gently injected into the desired tissue level via small skin incisions or simple needle holes. The use of blunt, small caliber cannulas minimises trauma to the recipient site and reduces the risk of bleeding, bruising, swelling and irregularities. Since revascularisation is not immediate and begins in the periphery, the central part of the graft faces some difficulties in oxygenation. Therefore, the fat must be treated with the greatest care and the absorption capacity of the recipient tissue must be respected. Depending on individual needs, nanofat can be introduced through sharp cannulas using the SNIF technique (Sharp-Needle Intradermal Fat Grafting), subcutaneously with a blunt cannula and through microneedling.
BRAVA®-Technik
The BRAVA® technique (Brava® Breast Enhancement and Shaping System) can be used to increase volume during breast reconstruction and breast enlargement. BRAVA® is a special bra that combines plastic domes with silicone edges that patients wear for several weeks before fat grafting. This approach offers several advantages. The negative pressure exerted by the BRAVA® system causes the tissue envelope to expand, creating more space for the fat graft. In addition, the negative pressure promotes increased vascularization of the breast tissue, which leads to better graft survival. In addition, studies indicate that local growth factors and stem cells are activated after BRAVA® treatment.
Expansion Vibration Lipofilling
Expansion vibration lipofilling (EVL) is a technique that can be used to transfer larger amounts of fat. After liposuction with vibrating cannulas, the fat is injected into the recipient site through a closed system using the same vibrating cannulas and a roller pump. This method is primarily used for buttock enlargement and buttocks contouring.
Applications
Breast augmentation
Autologous fat grafting is an excellent technique for natural breast augmentationand correction of breast asymmetries. Further advantages include the aesthetic improvement of the donor region, the natural behavior and the minimal scars. Unfortunately, fat grafting is not suitable if you need or desire a larger volume unless it is performed in multiple treatment sessions. However, it can improve the results of breast enlargement with silicone implants in a hybrid technique, especially in the cleavage area.
Butt augmentation
Buttock augmentation with your own fat, often referred to as BBL (Brazilian butt lift), is a combination of liposuction and lipofilling all around and on the buttocks. When performed by experienced plastic surgeons under ultrasound guidance, it is safe and results not only in buttock enlargement but also in improved waist shape.
Facial rejuvenation
Fat grafting is an important aspect of facial rejuvenation as it provides natural volume replacement and long-lasting improvements. Fat grafting allows the restoration of lost volume in areas not reached with traditional facelift techniques. Methods such as micro- and nanofat grafting have been developed to improve lines, wrinkles and skin quality. There are legal restrictions in Switzerland on the use of certain products made from human cells and autologous tissue transplants. I would be happy to discuss this with you in a consultation.
Are you interested in fat grafting and want to know how it can help you? I cordially invite you to book a consultation!