For many years, liposuction
was associated with body contouring and fat removal, and was mainly in the
domain of plastic surgeons. Although the
technique has been refined in some ways, fundamentally it still involves the
removal of fat using small, often insignificant incisions, to reduce areas that
have accumulated fat deposits. We use
the term “cannula” to describe the metal tube that is passed to extract the
fat. While the details of each surgeon’s
technique may vary, most agree that nowadays it is appropriate to place fluid
(“tumescent fluid”) into the area first, in order to best prepare the site for
fat extraction and to minimize blood loss and discomfort. The ideal patient who is a candidate for liposuction
has traditionally been the patient who is close to ideal body weight and has
focal areas of excess or prominent fat.
Often, these patients note that, however hard they may work to keep
their weight at their best, certain areas “just don’t go away.”
Some of the ways that liposuction
has evolved include the development of new kinds of cannulas, the use of
different ways of aspirating the fat, and the use of different forms of energy
to break up the fat for removal. Energy
forms that have been applied to fat tissues include lasers, ultrasound and
radiofrequency. The use of
radiofrequency has even been used without any incisions or cannulas, and has
been passed directly through the skin with no incisions. In my opinion, the results achieved with that
technique have been minimal or disappointing.
It is always worth considering the fact that, whenever the surgeon
delivers any thermal energy to the tissues, the risk of scarring or
burning the tissues is a real potential danger.
Over time, interest has
grown in using fat for valuable purposes rather than discarding it as medical
waste. Although fat has been harvested
and reinjected for many years, the process has hardly been standardized and the
results have been extremely variable.
Some of the best “minds” in plastic surgery have had legitimate
disagreements on whether transfer of fat really works, and even more disagreement
on the best method(s) to use for fat transfer.
Evidence increasingly shows that fat can be transferred by injection
techniques and survive, and that fat can also be used as a source of delivering
other cells, such as stem cells, to different regions of the body. I have personally experienced very gratifying
results with fat transfer, provided certain principles were followed. Here are some guidelines that I follow in my
own practice:
1) The technique of harvesting the fat is very
important, and this includes the selection of the instruments used, the
pressure used to extract it, and the manner in which it is separated from
unnecessary fluid. This concept would
suggest that the use of newer laser-assisted or thermal systems of fat removal
may be very unappealing because they can destroy these valuable cells.
2) The technique of delivery of the fat is equally
critical, as the fat must be able to thrive in its new location and receive
adequate blood flow and nutrition.
3) Patients who are thin may be very good candidates for
specific types of fat grafting; they do not have to be overweight or carrying
pockets of donor fat.
4) Areas that are prone to constant movement, such as
the lips, are less likely to retain the volume injected when compared to areas
that do not move as frequently.
5) If you assume that some percent of the fat will be
lost over time, while the rest has a good chance of retention, you are
embracing a more realistic approach and will likely be pleased with the
results.
6) Fat grafting can be a great addition to other
surgeries that you may already be considering, such as face or neck lifting.
7) Fat has the possibility to provide long-term volume
enhancement; off-the-shelf fillers usually do not. For large areas of fat grafting, such as the
buttock area, fillers are not even a reasonable option given those that are FDA
approved in the U.S.
Fat grafting and transfer is
a growing area of interest, and you will likely see more advances on the
horizon. I will keep you posted . . .
To your health!
Saul R. Berger, MD, FACS
www.drberger.com
