Are fat graft results better than that of a facelift?
A facelift is designed for a different surgical purpose! Facelifts are used to lift up and tighten excess facial and neck skin, while fat grafts are more used for structure, support and volume optimization.
Nonetheless, it is the case in my view that many facelift procedures fail to address the problem of insufficient facial fat volume, and this is why there are many well-known ‘failed facelift’ photos around – some patients can just look stretched after a facelift if they have insufficient ‘padding’!
Fat grafts in my view are a great additional technique to support facelifts. They can be carried out before or after facelifts and certainly improve the outcomes. One personal observation is that many Asian patients do not have as much facial sagging as Caucasian patients. For these patients with mild facial sagging, fat grafts may often provide sufficient improvement for patients to defer their consideration of facelift surgery. So fat grafts are best considered a parallel treatment, and not as a replacement for facelift surgery.
So how much reabsorption is there, and how long does it last?
This depends on how well the surgery is executed, and how healthy the patient’s tissues are. In general one would expect a 25 – 30% reabsorption rate within the first three months. The reabsorption process has been found to be important for fat grafting as the loss of cells is a signal for the remaining fat cells to regenerate and multiply. Although there is some variability in the graft survival, the fat that survives beyond 3 months is effectively permanent. So for the majority of the patients, the results can be long lasting. The down time is minimal and thus the procedure can be repeated if necessary without too much trouble.
Is fat grafting related to PRP?
PRP (platelet rich plasma) injections are derived from the patient’s own blood, where their platelets are concentrated and injected underneath the skin. Platelets are a source of chemical messengers which are involved in wound healing and blood clotting. They are fragments of cells and are not whole cells, unlike fat grafts which utilize living cell transfers.
There is some improvement in texture of the skin after PRP injections. It is also claimed that PRP injections can stimulate delayed increase in facial volume by collagen synthesis. However, in my view, fat grafts offer superior volume rejuvenation to PRP as well as better skin texture improvement.
Is fat grafting the same as stem cell transfer?
No, although there are many advertisements that appear to suggest or label fat grafts as stem cell transfers. A stem cell transfer involves harvesting and purification of active, living stem cells which are sometimes concentrated for injection.
There are some stem cells in the fat cell colonies which are transferred with the fat cells, and these are necessary for the survival of the fat grafts. However these work differently from therapeutic stem cell transfers.
So why haven’t I heard more about fat grafts before?
Some of this is due to marketing. The biggest share of cosmetic advertising still involves injectable materials – many more doctors offer purely injected treatments as these do not involve surgery. Thus injection based treatments such as platelet rich plasma and fillers have always had a higher profile than fat grafts.
Many surgeons in this region are only now becoming more convinced about the safety and efficacy of fat graft treatments, so are now starting to include this in their practices. In fact fat grafts have been quite popular in the US and Europe, and will probably continue to increase in popularity in South East Asia.
Is it suitable for everyone?
By and large, yes. Age is not a concern provided you are fit for anaesthesia. The treatment is most suited for improving volume and restoring texture. However I would use this method cautiously in smokers as the results may be less optimal if the patient is still smoking.
So which are the best areas to treat?
Fat grafts can work in most parts of the body. I have found that it works extremely well in the hands which as you know can sometimes be a big giveaway for age! My other favourite areas are the lips and cheeks which respond well to this structuring.
Finally, there is increasing interest in fat grafting for aesthetic breast enlargement. The advantages are that there is no silicone involved, but breast enlargement usually requires more than one procedure.
What would I expect if I undergo this procedure?
Most procedures are carried out as day surgery cases. The patient is admitted to our Day Surgery Unit in the morning. The procedure usually takes less than an hour under a light anaesthetic and the patient is awake half an hour after the procedure ends. There is little or no pain, just a mild ache in the harvest site and the injection sites.
Almost all the patients can be discharged from hospital the same afternoon with no significant limitation in daily activities. I do provide a facial and head wrap to help the patient avoid accidental scratching of the face during sleep.
There are usually small incisions 1 – 2mm wide on the face which are closed with fine sutures – these are removed at a week from surgery. The recovery time is minimal and patient satisfaction is usually quite high. This is also a rather interactive procedure as the contour sculpting can be enhanced or increased in areas of the patient’s choosing, with the procedure repeated as required to obtain the results desired.
FAT Can Be your Friend (part 2)
by: Dr. Yap Lok Huei Plastic and Reconstructive Surgeon
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