Fat Filling of Face / Lipofilling / Fat grafting
Pioneered by Sidney Coleman, it is a very versatile procedure.
The next decade in plastic surgery is touted as the “Decade of the fat”, with more and more innovative uses of fat are being discovered.
The procedure involves harvesting fat from parts of the body where it is in excess and transferring them to areas where it is required.
With more understanding of the aging process in the face we now know that it is not only the gravity pulling the skin down to cause wrinkles, there is also a over all reduction in soft tissue volume of the face associated with fat atrophy. This atrophy or shrinkage is part of a generalized process, occurring in all parts of the body.
Fat grafting aims to help transfer fat into areas of lipoatrophy to replace the volume loss and rejuvenate the area. Most commonly performed to replace volume to the face. But other areas of the body like dorsum of hands, torso, buttocks,calves & breast, are all areas where fat grafting has been tried with varying degrees of acceptance and success.
The procedure is usually done as an out patient procedure under local anaesthesia with sedation.
The fat is harvested from the abdomen, lower gluteal fold or inner thighs, etc. This is done by Liposuction cannulae but at low pressures. The harvested fat is then allowed to decant, the fluid and liquid fat separated. The concentrated fat is then injected into the areas where it is required as marked before the start of the surgery.
Out of the fat transferred, at the end of 3 months only about 60-70% fat usually survives, the rest being absorbed into the body. So, some amount of over correction is desirable though not possible in the face. Hence lipofilling is usually a multi staged procedure depending on the amount of volume increase that is sought.
Immediately following the filling there is swelling of the grafted areas which increase in the first few days and then gradually subsides. This is all the more apparent in exposed areas like the face and dorsum of hands. Gradually over the next few weeks the swelling subsides. For the final result to be known it usually takes 3 months, after which a decision to do a re fill of the area is taken.
Problems:
Problems are rare and it is a very well tolerated procedure. Usual problems of bleeding, infection and swelling are present. The amount of absorption of the grafted fat is a variable, and sometimes some of the dead fat cells can get calcified which may be felt as nodules or may show up on X Rays as calcified nodules.
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