The latest Aesthetic Surgery Journal had an article about fat grafting around the eye. This is a super common area to fat graft to, as the tear trough area makes people look “tired” all the time. The trickiness with this area is the skin around the eye is very thin. Very thin skin means you can see everything under it (think of your bed. You can hide all sorts of things under a comforter. Under a thin sheet? You see everything.)
So.
The article was in the January 2020 Journal, “Properly Diluted Fat (PDF): An Easy and Safe Approach to Periocular Fat Grafting.”
I do a ton of fat grafting—including facial fat transfer—and I must say I was intrigued by the whole concept of “properly” diluted fat. So I read on.
The gist of it all:
- They did a retrospective study on 200 patients.
- They harvested the fat with a 0.5mm cannula, centrifuged it, and then injected it with a 1.2mm cannula.
- The “properly diluted fat” meant they used an injection solution of 70% fat and 30% intranatant fluid and saline.
- They injected with a 1.2mm cannula.
- They then followed up at 6 months and 1 year.
- Findings? only 3 patients had contour irregularities.
- Conclusion? “Preparation and periocular delivery of PDF yields good contour with low risk of irregularities.”
My thoughts?
So I harvest with a slightly larger cannula. I centrifuge the fat. I get rid of all the fluid that is separated and visible as a separate layer after centrifuge (though I am sure there is still some fluid in my fat). I then use smaller injecting cannulas to place the fat, using a 0.7mm cannula for anything superficial in the skin. I spread the fat out over a broad area, being very particular and careful in the placement.
My findings? I can’t think of a patient with visible contour irregularities.
So my thoughts? I think common sense wins here. When you are fat grafting to a tricky area like the under eye where the skin is thin, you need good technique: even fat size, small fat globule size, small amounts injected per pass, constant movement and placement of the fat where needed, and small cannulas to inject. I don’t know how much mixing the fat with fluid helps.
If this fluid somehow increased fat survival, that is something I would like to know.