Overview of Autologous Fat Grafting for Facial Rejuvenation
Fat grafting is a process where fat is taken from one part of the body and injected underneath the skin in another part. It is used to repair areas affected by injury, cancer, or birth defects, and can even be used for cosmetic reasons like making your face look more youthful. When the fat used for this process comes from the person who is receiving the treatment, this is known as “autologous fat grafting”. This is the most common way the procedure is done. Many experts think of autologous fat as the best filler material for making the face look more youthful. This is because it fits perfectly with your body, delivers a soft and natural outcome, and could potentially last forever. This summary focuses on how this procedure can be used to renew the appearance of the face.
Anatomy and Physiology of Autologous Fat Grafting for Facial Rejuvenation
As we get older, our face undergoes several changes. Gravity pulls down the soft tissues of the face, which can lead to folds and shadows, such as lines from the nose to the mouth (nasolabial folds), under-eye hollows (tear troughs), and lines around the mouth (marionette lines). All of these contribute to an older-looking face. With time, we also lose volume in our face due to thinning skin, muscle shrinkage, fat loss, and reduced bone thickness.
Surgeries like face-lifts and brow-lifts are traditionally used to counteract the effects of gravity. However, a loss of facial volume can be improved using fillers, which can in some cases give similar results to surgical procedures. This is why fat grafting and dermal fillers are becoming more popular options to rejuvenate the face.
Fat grafting involves taking fat from one part of your body, like the side of your body (flank), inner thigh, or belly, and injecting it into specific areas on your face. This can restore lost volume and shape. It’s important to know the facial anatomy and understand where and how much fat to inject to get good results and avoid complications.
The face has several compartments where fat is stored, divided into superficial (near the surface) and deep spaces. These spaces each have different sections that can receive the fat transfer. The superficial space includes areas like the cheek, forehead, and around the mouth and eyes. The deep space includes areas under and around the eye and the cheek, and in the mouth area. Understanding these areas helps doctors decide where to transfer the fat, how much to transfer, and the best methods and tools to use.
Why do People Need Autologous Fat Grafting for Facial Rejuvenation
Autologous fat grafting is a procedure used to make the face look younger by adding volume to it and by improving the skin’s tone and texture. This procedure, often used for making aesthetic improvements, is minimally invasive and is also used in various reconstructive medical procedures.
The procedure involves taking fat from one part of the person’s body and injecting it into their face to address various age-related changes including:
- Sunken forehead
- Deep wrinkles, especially on the forehead and between the eyebrows
- Indentations on the side or above the eyes
- A longer lower eyelid due to loss of fat
- Indented lines from the corner of the eye to the side of the nose (tear trough deformity) or deep lines in the cheek area
- Swelling in the cheek (malar bags)
- Creasing lines from the nostrils to the corners of the mouth (nasolabial folds)
- Creasing lines from the corners of the mouth down the chin (marionette lines)
- Changes or sagging in the jawline
- Thin lips
- A chin that seems to have shifted back into the face
Aside from making the face look younger, autologous fat grafting can also correct several other issues such as:
- Unevenness or irregular contours of the nose
- Scars
- Burns
- Skin damage due to radiation treatment
- Loss of fat in the face associated with HIV
- Facial abnormalities that someone is born with, has developed, or as a result of an injury
- Unequal facial features
- Adding volume to a surgically created flap or fold of tissue
This procedure can be applied independently, or together with other treatments designed to make the face look younger.
When a Person Should Avoid Autologous Fat Grafting for Facial Rejuvenation
There are several situations where using a person’s own fat to help rejuvenate or shape their body could be unsafe. This is especially true if the person has to undergo general anesthesia for the procedure.
Transferring one’s own fat, a procedure also known as autologous fat grafting, might not be recommended if there’s a good chance the fat will change in size. This can happen if a person is planning to lose weight or if they’re gaining weight. Also, if someone has had their own fat transferred before and it was all or mostly absorbed back into their body, this method might not work well for them.
People having fat injected into their breasts to rebuild or reshape them should know that the fat might form hard lumps or areas of hardened tissue (calcifications) that could look like cancer on future imaging tests.
People with diseases or conditions that may affect blood flow or wound healing can risk developing complications or not getting the best results from fat grafting. These conditions could include extensive burn scars, having had radiation treatment, a type of deep scar called a keloid, conditions that affect how the blood clots, needing to take medicine that reduces the body’s immune response, and other ongoing diseases or conditions.
Equipment used for Autologous Fat Grafting for Facial Rejuvenation
Autologous fat grafting is a procedure where fat is taken from one part of your body and transferred to another area. This process requires a number of different tools and equipment, including:
Firstly, a solution made from saline, lidocaine (a local anesthetic), and epinephrine is used to prepare the area where the fat will be harvested. The same type of local anesthesia will also be used at the cannula (sort of a needle) entry sites. The cannula is a slim tube that allows for the fat to be collected and then re-injected.
For collecting and injecting the fat, the most commonly used cannula is a Coleman type 2, which has a side-port design. The size of the cannula varies, depending on where the fat is being grafted, and the injector’s experience and preferences. For facial injections, a cannula that is 5 to 9 cm in length is generally used.
The surgery uses large syringes (10 mL or 20 mL) for collecting the fat and then smaller 1 mL syringes for injecting the fat into the desired area.
If a large amount of fat is being harvested, a suction machine could be used instead of syringes. Fat extracted in this method should be low power suction to minimize damage to the fats’ integrity. To ensure everything is safe and sterile, tools like a scalpel (for creating access for the cannula), sterile skin markers, gauze, and a compression garment are used.
There may also be additional equipment required based on how the fat is processed, such as absorbent materials, commercial fat grafting preparation kits, strainers, saline, and a centrifuge. The centrifuge works by spinning around rapidly, which separates the collected fat from other particles, causing minimal trauma to the cells.
Who is needed to perform Autologous Fat Grafting for Facial Rejuvenation?
The process of skin grafting involves a group of medical professionals, including:
– A surgeon, such as a plastic surgeon, facial plastic surgeon, ear, nose, and throat doctor (also known as an otolaryngologist), or even a skin specialist (dermatologist).
– An anesthesia provider, who is responsible for giving you medication that makes you sleep or numb to ensure you don’t feel any pain during the procedure.
– The nursing staff, who supports the medical team and looks after you during the procedure.
– Operating room technicians who take care of the technical details and maintain the surgical instruments and equipment during the procedure.
Each of these professionals play a crucial role in ensuring the grafting procedure is safe and successful.
Preparing for Autologous Fat Grafting for Facial Rejuvenation
Before having any kind of surgery, you’ll need to give your written agreement or ‘informed consent’. This means that you fully understand the procedure, its risks, benefits, and any alternatives. It’s vital to ask any questions you may have, and understand what the surgery involves. You should also know whether you might need further treatment down the line. For example, in some operations involving fat injections, you might need additional procedures as some of the injected fat may be reabsorbed by your body.
Before your surgery, you’ll have a consultation with your doctor to make sure you’re ready for the procedure. They will discuss any health conditions that might affect the surgery, like bleeding disorders or anemia. They might ask you to stop medicines like ‘non-steroidal anti-inflammatory drugs’ (NSAIDs, like pain relievers) and blood-thinning drugs, as these can interfere with the outcome of the procedure. If you’re taking any of these medications, your doctors may ask you not to take them for two weeks before the operation.
Prior to surgery, your doctor will take before-and-after photographs, and discuss where they’ll take the fat from for your operation. They’ll also carefully check the area where the fat is to be injected and calculate how much fat is needed.
Your doctor will then prepare the areas for the operation. For men, this may include shaving facial hair to see better. All areas of ‘adherence’—regions where fat is stickier or harder to remove— should be avoided to prevent damage and irregularities on the skin surface; these regions will be marked out to steer clear during the operation.
The majority of these procedures are performed under general anesthesia (you are put to sleep), but in some cases, a local anesthetic (numbing only the area to be operated on) might be used. If local anesthesia is used, nerve blocking is preferred because a drug called lidocaine can make the harvested fat less viable or healthy, as well as increase the volume of the treated area, making it harder for the doctor to measure the injections of fat accurately.
How is Autologous Fat Grafting for Facial Rejuvenation performed
Fat grafting is a medical process that involves three stages: harvesting fat, processing fat, and transferring fat.
Fat Harvesting:
The first step is to collect fat from parts of the body that have an abundance of it. Common areas include the stomach, around the belly button, the buttocks, and the thighs. In some cases, if neck fat is available, this might be used instead. To prepare the area and get the fat ready for removal, a wet solution is injected into the fat-rich part of the body.
After waiting for about 15 minutes for the anesthesia to work, a small cut is made on the skin and a blunt thin tube attached to a low-pressure suction device is used to take out the fat. The aim is to cause minimal bleeding during this procedure because blood can reduce the survival of the fat cells. It is also important to avoid any damage to the skin that might occur due to repeated movement of the tube.
Fat Processing:
Once the fat is taken out, it contains other components like oil, dead fat cells, blood, and local anesthetic. To ensure the transferred fat is successful, these extra elements need to be removed. The fat can be purified by letting it settle naturally, spinning it around at high speed in a machine or washing and filtering it. This processed fat is then transferred to small syringes, ready to be injected into the desired area.
Fat Transfer:
The final stage of fat grafting is transferring, or injecting the processed fat into the area that needs it. For this, a small cut is made into the targeted area and an 18-gauge needle is introduced. The fat is then injected in small amounts in a three-dimensional pattern to give the best aesthetic results. Interestingly, the quantity of fat injected is often a bit more than needed to account for future fat resorption.
To ensure the transferred fat survives, compression garments are usually worn for at least 2 to 3 days after the procedure. Some patients might find wearing these for a longer time more beneficial. In some cases, the patient’s own blood, processed to improve graft survival, may be injected along with the fat.
The exact quantity of fat injected and the specific areas it is injected into depend on the desired outcome and the experience of the injector. It’s important to note that each facial area, like forehead, brow, nose has a specific approach and technique for ideal results.
Possible Complications of Autologous Fat Grafting for Facial Rejuvenation
Despite careful techniques, fat grafting surgery can sometimes lead to complications:
* Common issues include bruising, swelling, and discoloration of the skin.
* Putting in too much fat might make the area look bigger than intended.
* Not putting in enough fat, or the body absorbing some of the transferred fat, might not give the desired results.
* Infections and long-lasting inflammation can sometimes result in painful, red lumps (pyogenic granulomas) and skin infection (cellulitis).
* Blisters and scars might form after the procedure.
* If injections are placed too close to the skin surface, irregular lumps or a feeling of unevenness can develop.
* Some people might notice changes in skin shape or hard lumps (nodules or calcifications).
* Pain might occur at the site where the fat was taken if it wasn’t properly numbed.
* Changes or unevenness in body shape can happen at the area where the fat was removed.
* Rarely, a blockage in the artery supplying the eye can cause loss of vision.
* In very rare cases, a blockage in the artery supplying the brain can cause a stroke.
Problems like graft loss (where the body absorbs the transplanted fat) and bruising can be limited by using techniques that minimize damage to tissue and prevent blood clot formation. Using cool compresses in the early days after surgery can reduce discoloration, but too much icing can constrict blood vessels and risk losing the graft. Heavy exercise should be avoided in the weeks following surgery.
Blindness is a very rare but serious complication. If fat enters the blood supply of the eye, it can cause a blockage and lead to blindness. Anyone with this issue would need immediate medical help. Symptoms that might point to a fat embolism (fat entering the circulation and causing a blockage) can include headaches, feeling sick, being sick, feeling dizzy, feeling numb, weakness, and changes in vital signs like blood pressure and heart rate.
Swelling and bruising of the face are also common after fat grafting. But it’s important to recognize when these are signs of cellulitis, a skin infection that can involve symptoms like fever, warmth, redness, and tenderness. Swelling will get better on its own but may last for a while due to the good blood supply to the face. This extended swelling can be treated with methods like facial lymphatic massage and ultrasound.
If fat injections have resulted in overcorrection (making the area look bigger than intended) of the treated area and the excess fat does not go away, the extra fat may need to be treated with an injection of deoxycholic acid, a substance that can help break down fat.
What Else Should I Know About Autologous Fat Grafting for Facial Rejuvenation?
Your face plays a big role in defining your identity and being comfortable with how it looks can really boost your confidence and the way others perceive you. One procedure that can help rejuvenate your facial appearance is autologous fat grafting. This is a technique where fat is taken from one part of your body and transferred to your face. This not only adds volume but also enhances the quality of your skin.
This procedure is liked by many surgeons because it uses your own body fat, matching perfectly with your body, and lasting longer compared to other substances. It also has fewer risks, it’s cost-effective, and most people are really happy with the results. It’s a wonderful option when thinking about facial rejuvenation.
