We still don’t totally get fat grafting.
We get that it works. We get that it is awesome. We get that we are replacing your facial volume loss of fat with your own body fat. We get that stem cells in the fat actually improve the histologic quality of your skin.
This study was in the Aesthetic Surgery Journal April 2022. It used the Vectra 3D camera to analyze volume, and they looked at the short and long term results. They do a Coleman technique (centrifuge) and similar to mine (micro fat and nanofat). There were some differences, which I will clarify later.
WHAT did they find?
- 29 women were analyzed
- 3 fat parcel sizes were used: deep fat with a 2mm cannula, more superficial fat with a 1mm cannula, and nanofat, where the fat was injected with a needle into the skin.
- Data was analyzed by age <55 or >55
- TREND: initial volume loss Months 1-7, followed by an increase in Months 8-19.
- This rebound happened regardless of amount of fat injected.
- Volume improvement was greater in patients less than age 55 (54%—>75%)
- In those over age 55, volume gradually decreased. (60% —>30%)
- No statistically significant influence of weight change throughout the study
When looking at the details of the study, I was struck by the measurement rollercoaster. I tend to see people at 6 weeks and 3 months for photos. I know 3 months is not an ideal time for photos, as patients do have “rebound.” When I see people at 9 months or a year, the stem cell effect has taken better hold, and it seems from this study, they also have rebound of the volume for those under age 55.
When they look, they found postop volume improvement for all ages:
- 1- 3months = 56%
- 4-7months = 32%
- 8-13months = 46%
- 14-19months = 52%
When they separated patients based on age, they found those under age 55 troughed at 6 months and then ended up at 75%. They found the older patients had a linear decay, starting at 60% and ending up at 30%.
Discussion:
They indicate that those under the age of 55 may show such rebound because the fat may be nourishing the surrounding tissues. It may help reverse tissue and bone atrophy which occurs with aging, at least for a period of time “reconstructing youthful tissues.” So you have the fat rebounding in addition to the stem cell effect and improved vascularity which helped the bone and surrounding tissues.
Why is there a rebound? This is not a new concept. Years ago, Yoshimura discussed graft replacement theory. Essentially it was that the fat which was grafted died, but left progenitor cells- baby cells which then later grew. The fat cells die, and are replace by adipose derived stem cells.
They postulate the older patients have issues with cell division, with telomeres shortened to a critical length. Age, inflammation, stress, senescence, and the quality of the fat are all potential issues in older patients.
My thoughts?
This paper was written by people who have stock in a Lipocube, so I always take that with a grain of salt.
But what they advocate here is what I do. I do not use such large fat deposits (2mm). I do almost all of mine with 1mm or smaller. I think the smaller size helps avoid issues of fat necrosis and irregularity. I love nanofat, as it is not to add volume but to get the stem cells in the skin. They call nanofat “skin regeneration with no augmentation effects.” I agree, and it is awesome.
I have a Vectra 3D camera, and I have not figured out how to assess the volumetric change. I will have to explore how they are able to do that.
This is also the first study which showed a clear age difference for fat survival. Given that many of my patients are over age 55, I will have to look into this more. I don’t feel like I see a linear decline in the older patient group, and prior studies did not show a discrete correlation of fat survival with age. But all of these studies are small, and the length of time in the months to a few years. Is the 55 because of menopause changes? cell senescence? And we all know as we get older all 55 year olds are not the same. Some seem old with a host of medical issues, and some still look 40.
All good questions.