JOURNAL TIME!
You know how I love science. This is an article out of the August 2013 issue of Plastic & Reconstructive Surgery Journal. The title really caught my eye, “Comparison of Harvest and Processing Techniques for Fat Grafting and Adipose Stem Cell Isolation.” In English- how can we harvest fat and process it to maximize how much fat survives when we transfer it?
Currently there is no standard in fat harvesting. Some use traditional liposuction only, some use ultrasonic liposuction, some use a “wet technique.” Then to process: some do nothing, some centrifuge, some filter it, and some roll it on cotton guaze.
So, this team out of Pittsburgh decided to do an experiment to try to get some science between the different techniques. Is there a best way to do fat graft and transfer?
Study: This was out of Pittsburgh, where one of the leading fat transfer plastic surgeons is Dr. Rubin. The study did include two people who are involved in the technolgies studied, so I will keep that in mind. They harvested fat from a single patient for each phase (to keep the fat consistent within each phase). For each variable the fat was injected into 5 mice. There were two phases.
- Phase 1: fat was harvested
- using traditional liposuction only VS. ultrasonic harvesting (laser has already been shown to hurt the fat so it can’t be used for transfer. ultrasonic is different).
- This fat was then filtered using two different pore sizes
- graft material was analyzed for average size, relative oil/fat/aqueous fractions, and stromal vascular fraction yield
- These were then injected into mice.
- Phase 2: Using fat harvest by traditional liposuction alone, the fat was processed by
- centrifuge
- filtration
- cotton gauze rolling
- This fat was then studied in a similar manner to phase 1.
FINDINGS?
- Ultrasound and suction assisted aspiration of fat yielded similar retention of fat grafts
- Processing with the cotton gauze rolling had the highest yield (though this is tough to do for larger amounts, so seems best suited to “grafting cosmetically sensitive areas of the body in which optimarl retention is critical and lower total graft volumes are needed.”)
- Filtration and centrifuge both effectively removed fluid and resulted in comparable graft retention.
When reading the article, it appears filtrated fat did better than centrifuged fat- very slight, but better. One of the investigators is aligned with a filtration system for fat transfer.
Interesting study. Small scale, but it clearly shows some processing of the harvested fat increases fat survival. Rolling fat on cotton pads is not realistic for large transfer (breast, buttock), but may be realistic for face. In the study patient 1 had a fat survival of 75%, in phase 2, different patient, average retention 56%. This highlights how patients have different rates of fat survival, no matter how it is processed.
Will keep reading and trying to improve. I am a huge fan of fat transfer and fat grafting as many of you know.