Slim and reshape your body, perfectly: Many individuals find that certain areas of their body do not respond to a reasonable level of fitness and exercise. Despite a healthy diet these patients continue to have “stubborn” areas of fat deposits and disproportionate body contours. This is often due to heredity or family traits. The judicious use of liposuction can improve your body contour and proportion by selectively removing localized or regional fat deposits.
Before and After Photos
Liposuction uses a variety of techniques. One of these, the tumescent technique infuses the fatty tissue with sterile normal saline and a vasoconstricting agent to minimize blood loss as well as a local anesthetic before suctioning the fatty tissue out. Another technique is known as ultrasound-assisted lipoplasty, or UAL. This method uses an ultrasound probe to break up the fat cells before they are suctioned out of the body. In PAL, or power-assisted liposuction, a vibrating probe is used to break up the fatty architecture and assist in the ease of suctioning the fat.
Not all the fat removed is thrown away. Often patients have unwanted areas of depression and hollowness or flattening that are easily addressed with fat transfer and grafting at the time of liposuction. The harvested fat is prepared for grafting in a sterile fashion and is re-injected in areas of fat loss such as the face, cheeks, and buttocks. These techniques have been refined in the last several decades so the transferred fat has a reasonable chance of grafting with good long-term results.
Fat Grafting or Fat Transfer
Fat grafting has become popular in the past several years due to the marketing of the “Brazilian Butt Lift” or “BBL”. This is essentially liposuctioned fat of the mid-section and waist transferred to the buttock region to augment the size of the buttocks.
Historically, fat grafting has been in the Plastic Surgical literature and performed by plastic surgeons since the nineties with reports that date back to the late 19th century. Fat grafting has both a cosmetic indication as well as a reconstructive one.
How Does Fat Grafting Work?
Fat grafting for cosmetic and reconstructive indications both involve the harvesting of fat. Harvesting is performed by special liposuction cannulas that do not damage the fat cells. The harvested fat is then transferred to special sterile canisters in a closed system that does not expose the harvested fat cells to the operating room atmosphere. It is then allowed to sit as gravity separates the cellular portion from the heavier serous or fluid portion of the harvested fat. This separation is enhanced by passing the separated fat through a fine mesh and the fat is arranged in 3 to 10 cc. syringes and injected into the areas that need additional fat.
Cosmetic Fat Grafting
The most common areas for cosmetic fat grafting in my practice are for the cheeks for one’s face as an adjunct to a facelift, at the temples should there be hollows as well as the naso-jugal grooves (depressions along the inner corners of the lower eyelids and nose junction).
Other popular places where fat is injected are the upper portions of the buttocks to enhance buttock projection.
Fat grafting is also used to correct areas of aggressive liposuction where too much fat was removed; in women sometimes, we see the hip and inner thigh regions with divots that are correctible with fat grafting for a more feminine and attractive proportions. In trans-women, the harvested fat from the waist and lower back is transferred to the hip regions and the upper buttocks to achieve a feminine hourglass body shape.
Fat Grafting for Men
For men, a common area for fat grafting are the buttocks for a rounder buttock contour and care is taken not to feminize the appearance. For men as for women, the face, cheeks, jawline and chin areas are also popular places for fat grafting. In addition, in patients with Poland Syndrome, if the chest defect is minimal and does not warrant placement of a custom-made chest implant, fat grafting has resulted in excellent outcomes in my practice.
Reconstructive Fat Grafting
In the reconstructive arena, the most common areas for fat transfer are to the reconstructed breasts, especially to areas of the breast and chest wall due to the shrinkage of the soft tissues and atrophy of the subcutaneous fat as a result of the radiation treatment to these areas. Fat grafting can be performed around both autologous as well as implant-based breast reconstruction to improve the symmetry, fullness, and appearance of the reconstructed breast.
Factors That Affect Fat Grafting
In all fat grafting procedures judicious care and experience dictates the amount of fat that is grafted to an area. There are important variables that are considered to optimize fat take (long-term fat survival). Some of these variables are the nature of the tissue bed that the fat is being transferred into, such as the blood supply and compliance of the tissues, the degree of pliability that the tissue possesses, and the fine points in techniques of how the fat transfer is performed, the types of cannulas used to inject the fat with, and the quantity of injected fat per area among many other considerations.
Fat transfer, when performed in a proper and tasteful fashion enhances the aesthetic appearance and proportions without being grotesque or even evident. It has essentially replaced the need for buttock silicone implants in my practice and is a procedure that has evolved through the years with improving techniques and outcomes.