Is Fat grafting a dermal-filler replacement?

Fat grafting (aka fat transfer or lipofilling) is not exactly new. Fat grafting as a procedure has been around for as long as liposuction has been available. Fats removed during liposuction were cleaned and re-injected back to areas that needed augmentation. Fat grafting has for a long time been used on the breasts, the buttocks, the back the hands, and various areas on the face.

Recent advancement in fat grafting technology now allows us to separate the fat cells of various sizes, and use them as a replacement to dermal fillers on the face. Great news for all those who are averse to having a foreign material injected into the body. The fat graft is totally your own cells. In medical jargon, it is “autologous fat”.

These advancements in fat grating technologies also allow us to shrink the fat cells into small particles, which can be re-injected using a fine cannula. As such, the procedure of fat grafting is not that much different from a multi-syringe filler injection procedure, both in terms of the comfort during the procedure and the recovery time.

 

• Milli-fat grafting, using the largest of the fat particles, can replace fillers of higher gel-density like Juvederm Volux, Juvederm Voluma, Belotero Intense and Retylane Lyft. By grafting fat into the fat pads that have begun to shrink, we can restore the tension in the layer under the skin which is comprised of the various fat pads arranged adjacent to each other. This particular technique of lifting a sagging face has been published in the Prime International Journal of Aesthetic and Anti-Ageing Medicine by Dr David Loh in 2018.

 

• Micro-fat grafting can be used to replace softer fillers like Juvederm Volift, Juvederm Vobella, Belotero Volume, and Belotero Soft. While there is currently a movement by aesthetic doctors all over the world not to over-fill patients, you cannot escape the fact the some volume replacement often goes a long way towards adding youthfulness to the face. Particularly areas like the cheek hollows and the temples.

 

• Nano-fat grafting comprising the smallest particles of fat cells, can be used to replace skin boosters or skin hydration fillers like Juvederm Volite and Restylane Vital. Or even Rejuran, a treatment which involves injecting salmon (yes, the fish) DNA fragments. Nano-fat grafting gives textural changes like reduction in wrinkles and fine lines, which can be explained by the filler effect of the nano-fat grafts. A youthful glow to the skin has also been reported by some researchers, and this they have attributed to the stem cells in adipose tissue. [https://doi.org/10.1093/asj/sjx183]

 

So why hasn’t fat grafting caused the demise of filler companies, by completely replacing it?

The answer is that fat grafting needs to be done in a practice with the proper setup, including staffing, equipment and facility, for a small area liposuction. The doctors also need to be trained and accredited to perform small area liposuction. For this reason, fat grafting is a select procedure which only a few clinics can provide.

And of course there will be people who would prefer having a foreign material injected, to a surgical procedure, albeit a minimally invasive one.

The other reason is that there are areas where fillers are still better than fat grafting. Areas like the lips and the nose. “Fat should only go where fat belongs” Dr David Loh quotes his mentor Dr Pierre Fournier, under whom Dr Loh was trained to perform liposuction and fat grafting. What Dr Fournier meant was that fat would look strange in areas which should not normally have fat.

So for areas like the lips and nose where there is naturally no overlying fat pad, many doctors like Dr David Loh prefer to use fillers rather than fat grafting.

 

What is the process of fat grafting like?

 

Fat grafting is a one to two-hour long procedure in the clinic or day surgery. Sedation by an anaesthetist may be requested for those who are nervous. Otherwise, local anaesthetic will usually provide enough comfort for the whole procedure.

The first step is to extract a palm sized area of fat cells (100mls or so) from the abdomen or inner thighs.

The fat cells are then processed in a close circuit system to minimize contamination. Once ready, they are re-injected back to the necessary areas using a cannula and according to a published method described by the 2 doctors.

Recovery usually involves a bit of soreness and bruising to the donor area. The face will be slightly swollen and there may be some bruises especially for the first few days. Swelling usually peaks by the 4^th day and completely goes away by the 2^nd week.

Not all the grafted fat cells will survive the transplantation process. A portion will die and be absorbed by the body. The fat cells that survive will last for the long term as a living cells. In the past about 60% will remain for the long term. Recent advancements in fat grafting technology now allows us to micronize (shrink) the cells. “Smaller cells” means that oxygen can diffuse more easily into the cells, hence we are getting improved fat graft survival rates.

The final results will be evident from the 2^nd month onwards. The remaining fat cells will expand and contract respectively to weight gain and weight loss.