Dr. Coleman uses an 18-gauge cannula which he says is designed to reduce clogging and trauma to the parcels of fatty tissue. The distal end is blunt and the cannula is connected to a 1 mL or a 3 mL syringe filled with refined fatty tissue. One of the keys to Dr. Coleman’s procedure is multiple passes for fat placement.
Explore This IssueMay 2006
To make fat survive in the face and to really give a smooth and viable result, you need at least 30 passes to put in 1 mL, Dr. Coleman said. When you get near the eye, you need at least 50 passes to put in 1 mL.
Another method of fat transfer has been developed by French surgeon Roger Amar, MD, who has a clinic in Marabella, Spain. Noting that survival of fat transplants depends mainly on the vascularity of the host tissue and less on harvesting and reinjection methods, Dr. Amar places larger volumes of harvested fat tissue deep into the vascular muscle bed and under the periosteum of the skull.
The Future for Fat
I think more physicians are starting to do fat grafting, Dr. Tzikas said. I’ve been lecturing at academy meetings over the last six years and a lot of people have converted to this procedure. One problem, however, is the high learning curve; it takes a few years for someone to become proficient.
Dr. Lam said he thinks too many physicians are ignorant of fat. They don’t know how to use it, they don’t think it will last, or they are worried about the artistry involved.
The author of a new how-to book, Complementary Fat Grafting (Lippincott Williams & Wilkins 2006), Dr. Lam said the procedure can be learned in a day, but it’s perfected over a year as physicians move from empiric knowledge to refined technique and advanced skills.
While fat grafting has been gaining popularity with patients and surgeons alike, it may attract even more attention in the near future if research with fat stem cells proves benefits beyond plumped-up faces.
I’ve noticed for 25 years that when we inject someone with fat, their pores get smaller, their pigmentation gets lighter, even women who were subject to adult acne stopped having outbreaks, said Dr. Ellenbogen. We didn’t know what caused this, but recently we’ve learned it comes from the stem cells within fat. This is what has made people’s skin so wonderful after fat transfer.