Fat Transfer

What is Lipo-Filling?

Lipofilling, fat transfer or fat grafting is a technique that uses fat to address a number of clinical and cosmetic problems. There is a long history of “fat grafting”, or the transfer of fat from one part of the body to another. Modern fat grafting started in the mid nineteen nineties and involves the careful transfer of fat by gentle liposuction of sites which have spare fat, such as the abdomen and thighs. The key is to maintain the viability of fat. The living fat cells are then injected with fine cannulae (tubes) in to subcutaneous areas of fat deficit. The injection of fat requires a careful technique such that the fat is deposited in small volumes in different planes to improve their survival rate after transfer. This process is called lipofilling and can be carried out under local anaesthetic with or without sedation and most procedures will be carried out as day cases.

Indications

The indications of lipofilling have increased as its clinical effectiveness in a number of conditions has become established. Contour defects or deficits of soft tissue under the skin can be corrected with lipofilling. So post-traumatic defects and congenital problems such as Treacher Collins and Rhombergs syndromes (where patients are born with very little soft tissue in the cheeks) can be treated. Breast asymmetry and lack of volume can also be addressed from quite major deficits to cosmetic breast augmentation in selected cases. Lipofilling can be used for iatrogenic problems (medically or surgically induced), such as irregularities as a result of poorly performed liposuction.

There are a number of cosmetic applications. Fat is a natural “filler” and therefore can be used to enhance cheeks, which also allows gentle lifting and rejuvenation. It can be used to augment lips and reduce facial creases such as the naso-labial, glabella (root of nose) and the grove that can develop between the upper cheek and the lower eyelids. Lipo-filling is often used as an adjunct to cosmetic surgical procedures such as face lift. The technique is evolving with the development of finer cannulae and more refined methods so that more subtle and minor problems can be addressed.

The properties of fat have also been found to have some affects on the surrounding tissue. Fat contains stem cells, which can transform into other types of tissue such as blood vessels and fibroblasts (which produce new collagen). Therefore, lipofilling has found uses in improving the nature of surgical and post-traumatic scars. It has even been discovered to improve the quality of skin in areas, which have had radiotherapy.

Complications

The results from Lipofilling are undoubtedly multi-factorial, but technique, experience and selection are major factors. In most cases there is some regression (shrinkage) of the fat after transfer and this can range from 0% to 40% in some cases. Over-correction is sometimes necessary in the primary procedure to compensate for future regression. Serious complications are rare but they include, under-correction, over-correction, bruising, infection, bleeding and total regression of the fat transfer as well as some very uncommon unwanted skin changes. For larger volume defects serial lipofilling is required.

Summary

In conclusion, lipofilling is a powerful technique with a number of applications. It has become major part of the armamentarium for cosmetic, plastic reconstructive surgeons. The procedures are safe and complications rare. The vast majority of cases can be carried out as day case procedures. These include those listed below:

  • Augmentation Cheeks and Lips
  • Correction of soft tissue defects (congenital or acquired)
  • Natural filler for facial creases
  • Breast asymmetry
  • Breast augmentation
  • Improvement of scars
  • Adjunct to other cosmetic surgical procedures

Frequently Asked Questions (FAQs) View all

Can I decide where on my body I want the fat taken from, for breast augmentation?

Yes. As long as there is fat in the location requested then we do our best to harvest from the area of the body the patient requests. This is not always possible but I will discuss that with you during consultation.

My friend had to go to the surgeon several times to have her breasts enlarged with fat transfer, how many procedures does it take?

The number of procedures depends on the degree of augmentation needed. It is not unusual to need several lipo-filling procedures to achieve a desired breast volume. Two or three times, or even more, is not unusual and done safely under local anaesthetic with sedation.

Can fat transfer be used to plump up lips?

Yes, lipo-filling is a good way to plump up lips

My cheeks are quite sallow, I want to plump up my cheeks so I have apples – is lipo-filling a better option than botox?

Yes, lipo-filling is a better option as Botox will not make cheeks bigger/more plump.

In placing the implants under the muscle, does this damage the muscle in any way? What happens to the muscle if the implants need to removed for any reason?

This is a good question. The reasons for any muscle changing in function if it is not used for any reason, injured, the nerves been damaged or the muscle length and therefore its tension has changed. Initially the muscle is damaged because we have to incise it partially to get the implant under it. This is why sub-muscular implants are more painful postoperatively than implants placed directly under the breast. Also initially because it is stretched the muscle will function slightly differently, but nature is forgiving because the muscle will learn to behave as normal after a period of recovery.

I have not detected any long term functional problems with the muscle (called the pectoralis major muscle). However, if you were a professional swimmer, tennis player, athlete (such as a javelin thrower, gymnast) I would not recommend any sub muscular implants to be inserted. For “normal people” in the long term, I do not think that there should be any impediment to sporting activities and every day life. Long term the muscle, I believe, fully recovers.

If the implant is removed the muscle will function as before but I suspect that there will be a relatively short period of full functionally recovery as the muscle gets used to the decreased length and tension after the implants have been removed.

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