The medical community continues its exploration of fat grafting.
Fat grafting is once again a popular topic of conversation at meetings of plastic surgeons and other specialists who offer cosmetic surgical and non-surgical treatments. Using fat to restore volume and as a source of stem cells has created a resurgence of interest in this often maligned tissue.
The importance of volume loss, or specifically fat loss, as part of the changes that occur with aging is no longer in dispute. Fat loss or thinning contributes to many features of aging in the face and body. Loss of skin tone and tissue thickness combine to cause the face, breasts and many other body parts to sink and sag. Skin tone and excess skin is best treated with modern plastic surgery procedures, but the optimal treatment to restore lost volume is still not clear. One option involves carefully harvesting fat cells from one part of the body, then transplanting these cells into another area that needs to be “plumped up.” Our own fat cells would seem like the perfect solution to this common problem. Firstly, fat is fairly abundant and accessible in most of us. Furthermore, using our own tissue rather than something foreign eliminates the worry of “rejection.”
Patients are only too eager to offer up their extra and unwanted fat . I am regularly asked, “Dr. Mosher, can you take the fat from my hips and put it into my breasts and lips?” My answer is almost always the same: “Yes, I can do that, but the results are not yet as predictable as we would like.” Plastic surgeons and dermatologists have been trying to perfect this procedure for more than 25 years. There have been some great improvements and a better understanding of where and when using your own fat will work. Precise and relatively atraumatic harvesting of the fat using liposuction techniques has proven to be the easiest step. Getting this fat to survive when placed back into the body or face is another story.
During Aesthetic Surgery Fellowship training in Southern California, I had the privilege of training with one of the foremost experts in facial fat grafting, Dr. Val Lambros. He and several others were trying to perfect fat grafting, particularly for treating the aging face and to correct the severe facial fat loss common to patients living with AIDS. Precise techniques that involved transplanting microscopic droplets and tunnels of a patient’s own fat cells resulted in a beautiful restoration of volume and shape to many patients. Most fat transplanted with their careful surgical techniques was shown to survive and provided a lasting and living solution for lost fat volume. These early experiences led to the development of fat grafting techniques for many other parts of the body.
Unfortunately, however, the amount of fat that survived when transplanted proved to be unpredictable at times. Surgeons had to perform multiple procedures to achieve optimal filling. Many elected to “over-correct” an area in anticipation of a less than 100 percent survival of the transplanted cells. This approach led to numerous disastrous outcomes when too much fat died or too much fat survived. Infections, scarring and disappointments were common. When fat grafting works, there is no better alternative. However, it requires very skilled techniques, is expensive to perform, and remains unpredictable even in very experienced hands.
Pharmaceutical and medical device companies rapidly developed “off the shelf” temporary and semi-permanent fillers to meet the demand to fill and plump the slowly deflating faces of baby boomers. Today, the most popular of these materials include a variety of hyaluronic acid gel fillers that, when injected, can last six to 12 months or longer. Their predictable filling effect, proven safety, adjustability and convenience has made injectable dermal fillers one of the most popular cosmetic treatments in the world. In skilled and experienced hands, facial volume loss can be safely restored with a simple office-based treatment.
Another exciting feature of fat that is reviving our interest in grafting techniques is in the area of stem cell rich treatments. Fat has the highest percentage of multi-potential stem cells of any tissue in the body. The previously unknown easy access to stem cells is driving research and development of treatments and potential cures for many degenerative and age-related diseases. We may learn that fat is not just an annoyance, but may prove to be an unrecognized solution for many of the cosmetic and medical challenges we face.
Originally published in Fresh Vancouver Magazine.