What? Blasphemy? A plastic surgeon who performs liposuction regularly telling you not to get liposuction? What is going on?
Fat grafting.
Fat transfer is fat grafting. What it involves is removing fat from one area of your body (read: love handles, inner thighs, the little pooch around your belly button) and putting it in another place. Fat transfer is booming. Why?
- Much of our facial aging is due to fat volume loss. Volume loss in our face helps lead to the tired under eye circles, those parenthesis around our mouth deepening (the nasolabial folds), our jawline forming jowls.
- There are some who believe the fat nourishes the overlying skin. So perhaps some of our skin aging — the fine lines, crepey skin, larger pores and the like– is due to the fat loss as well.
- We know fat is rich in stem cells. We think stem cells may help our skin. Moving new fat cells to an area likely brings in new stem cells.
Where are we putting fat?
- Breast: I use this for breast augmentation, breast asymmetries, chest wall asymmetries, and breast cancer reconstruction.
- Buttock
- Hands
- Face: Cheek, cheekbone, lip, jawline
So why hold onto the fat?
Before you go liposuctioning all your fat away, remember we need fat to do fat transfer. You can’t borrow fat from your sister. You can’t bank it in a fat storage bank. For those really thin patients, you can’t chow down on Ben and Jerry’s and grow some when you need it. (Why no plumping up to get new fat? Some think the first fat to come when you gain weight is the first fat to go when you lose weight. Also, when you harvest fat, it is ideal to have an easily accessible pocket, which won’t have a bad cosmetic outcome when removed. If you don’t have a pocket, you need to remove a thin layer of fat from everywhere. This runs a higher risk of contour irregularities, cellulite dimpling, fine wrinkles in the skin, etc).
For certain areas, like the breast and buttock, you need a lot of fat when doing transfer. Remember when I do liposuction for fat transfer, I centrifuge the fat. This helps concentrate the fat and separate out unhealthy fat cells. This also decreases the volume of fat I have to use.
- If I centrifuge a liter of fat, after centrifuge that 1000 cc of fat may concentrate down to 500-600cc of fat.
- Split the number between two sides (breast and buttock) and the number gets smaller- now 250-300/side.
- Realize only 50-70% of fat transferred will make it, so the number gets smaller still.
- This is not as much of an issue for the face. The volume I need there is less.
So. Does this mean no liposuction? Likely not. But before doing liposuction consider if there are areas you would want to use the fat. I don’t like to throw fat away. It is becoming liquid gold, full of stem cells.