Authors of section

Authors

Scott Bartlett, Michael Ehrenfeld, Gerson Mast, Adrian Sugar

Executive Editor

Edward Ellis III

General Editor

Daniel Buchbinder

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Fat grafting for soft tissue corrections

1. Introduction

Smaller deficiencies respond to serial fat grafting. Large soft tissue deficiencies may require micro vascular free tissue transfer.

Fat grafting by injection has been increasingly used for the treatment of congenital and acquired facial deformities in which there is failure of development or loss of facial soft tissue.

fat grafting for soft tissue corrections

2. Anesthesia

Depending on the size of the area to be treated and the amount of fat to be injected, regional or general anesthesia may be required.

3. Autologous fat transfer: Harvesting

The goal is to obtain maximally viable fat cells with minimum trauma to the cells. This is typically accomplished by a specially designed cannulas and syringes not larger than 10 cc (larger syringes produces too much negative suction damaging the fat cells).

Fat can be harvested from any body's site in which there is abundance (abdomen, thighs, buttocks, etc.).

Some surgeons prefer a dry technique without pre-injection of fluid. Some infiltrate the area with a diluted solution of local anesthesia with epinephrine.

fat grafting for soft tissue corrections

4. Autologous fat transfer: Processing

Harvested fat can be refined by either centrifugation or straining through sterile gauze. The purpose of this is to remove oil, blood and local anesthetic to get a more pure product.

After this refinement, the fat is loaded into 1-3 cc syringes for injection.

fat grafting for soft tissue corrections

The picture shows harvested fat being processed on a sterile gauze.

fat grafting for soft tissue corrections

The picture shows refined harvested fat after processing.

fat grafting for soft tissue corrections

The picture shows the fat as harvested (left), through processing (middle), and "pure" once blood and serum have been removed (right).

fat grafting for soft tissue corrections

The picture shows the "pure" fat being loaded into a smaller syringe in preparation for injection.

fat grafting for soft tissue corrections

5. Autologous fat transfer: Placement

The fat must be uniformly distributed from bone to dermis to simulate the deficient tissues. Specially designed cannulas are available for this or large bore needles can also be used.

fat grafting for soft tissue corrections

The goal is to place very small droplets of fat (0.02-0.1 cc) in a "Swiss cheese" fashion.

Note: Care should be taken to avoid intravascular injection by the use of blunt cannulas or withdrawing of the needle as the fat is injected.

Note: Do not over graft an area. Each fat droplet should be surrounded by well vascularized tissue otherwise fat necrosis will occur.

fat grafting for soft tissue corrections

For large defects serial fat grafting in two, three, or more times might be required.

Fat should be harvested, processed and reinjected in as short time as possible to prevent loss of viability of the transferred fat.

6. Aftercare

The fat should not be molded or manipulated after placement. Deep massage should be avoided in the first weeks after grafting.