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Face Rejuvenation

With Fat Transfer

By

Doctor/Presenter

Your Name Here

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© 2015 All Rights Reserved United States Copyright 2015 Published by Mini Books Express

Without limiting the rights under the copyright above, no part of this publication may be reproduced, stored in or introduced into a retrieval system, or transmitted in any form or by any means (electronic, mechanical, photocopying, recording, or otherwise) without the prior written permission of the publisher of this book.

Cover: Art design by R.L. Comstock

Disclaimer

The information presented in this book is not intended to replace the medical advice of your personal physician or any surgeon performing cosmetic surgery. In addition, the information expressed by the author in this book is the opinion of the author based on experiences in performing these procedures.

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Table of Contents Part One The Amazing Fat Grafting ......................................... 7 Chapter 1 Fat Transfer Today .................................................... 8 Chapter 2 Body Fat Cells ........................................................... 16

Part Two The Method of Fat Extraction and Preparation ....... 20 Chapter 3 Gentle Liposuction .................................................... 21 Chapter 4 Cell Isolation and Sterile Preparation ...................... 25 Chapter 5 Fat Injections ............................................................. 27 Chapter 6 Consultation with the Surgeon .................................. 30

Part Three Fat Grafting Face Procedures ............................... 33 Chapter 7 Overview of Face Fat Grafting ................................. 34 Chapter 8 Forehead and Brow ................................................... 39 Chapter 9 Eyelid Fat .................................................................. 41 Chapter 10 Tear Trough............................................................. 43 Chapter 11 Cheek Fat Grafting .................................................. 45 Chapter 12 Nasolabial Folds ..................................................... 48 Chapter 13 Fat Grafting Lips ..................................................... 50 Chapter 14 Jowls and Jaw Fat Grafting .................................... 52 Chapter 15 Chin Fat Grafting .................................................... 54 Chapter 16 Scars and Depression Corrections .......................... 55

Part Four Recovery and Possible Complications ..................... 57 Chapter 17 Recovery from Fat Grafting .................................... 58 Chapter 18 Rare Potential Complications ................................. 63 Chapter 19 Summary of Face Fat Injections ............................. 67

Glossary .................................................................................... 68 Storing Fat Cells for Future Injections .................................. 72 Frequently Asked Questions ................................................... 75 About the Doctor/Presenter .................................................... 78

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Part One The Amazing Fat Grafting

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Fat Transfer Today The new fat grafting technique has ushered in an age of facial contouring procedures. Autologous fat, which is fat harvested from the patient's own body, has become the most effective and safest long-term method of face fill substances currently used among cosmetic surgeons across the country. With today’s best methods of liposuction and fat grafting, the procedure dominates the face rejuvenation field. The latest methods performed by experienced doctors are especially good for facial contouring and enhancement. With highly-developed innovations, fat is harvested from the hip, stomach, or other areas of the body where there is sufficient unneeded fat and is re-injected into the brow, cheeks, lips, jaw line, nasolabial folds, and even acne pits, scars, and other areas of the face, and it is used to smooth out deep lines. Wherever there is loss of volume in the face, it is possible, with the new fat transplant procedure, to augment the sagging, hollow appearance. Liposuction, which is a technique of salvaging the fat, most carefully removes it. This offers doctors a method of obtaining the fill material needed to correct the appearance of the aging face and loss of volume in the cheeks, brows, and regions of the eyes.

Your own fat offers a safe, unique advantage and creates an entirely new approach without any foreign material being injected into the face. The new advances in harvesting, purifying, and

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injecting have made it a very desirable option in facial restoration and anti-aging. Autologous fat (your own fat) is especially suited for facial contouring, even though in some cases the procedure may need to be repeated in order to build up volume and to compensate for a small amount of the fat being absorbed by the body; even so, using autologous fat is a long-lasting option.

Before

After

Appearance of Your Face One of the most important components in the initial appeal or attraction that people have for one another is a smooth, fresh face. However, after the initial impression, other factors tend to replace appearance in determining the type of relationship that ultimately

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develops. Still, the first impression is very important and leads to self-confidence.

Regardless, self-image is a significant factor that may even determine income and psychosocial success in today’s society. It is a fact of our social order that physical appearance has an impact on our self-image and on how others perceive us. A more youthful face, well-developed breasts, a flat stomach, and a full head of hair are visible and important, but ultimately, it is the importance of the facial appearance that matters most. The face is the central point of a more youthful appearance. Balanced, fresh, and alive, the face tends to be the first item addressed in cosmetic appearance.

For centuries, medical doctors have tried relentlessly to improve facial appearance in their patients and to offer a more youthful look. Today, modern technology has been able to slow down or correct changes that occur due to normal aging. We now live in a nation that is made up of more and more people displaying fuller cheeks and less wrinkles and lines as they age, which would not be possible except for the latest methods of filling out the hollow, gaunt look.

Fat Grafting Treatment Fat grafting can be done on almost all areas of the face and body. This is possible if the site being treated has good blood circulation and enough capillaries and large blood vessels for the injected fat cells to have the nourishment they need to survive. Living fat tends to form its own blood supply. This is a key factor in getting the best and longest-lasting results.

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Advantages of Fat Transfer over Traditional Facial Fillers

• Long-lasting results: Fat cells transferred to your face do not dissipate like fillers. Therefore, there is often no need for re-injection of fat.

• Cost-effective: There is no limit on the volume. For instance, 1 ml of a traditional filler costs the same as

5ml of fat transferred to your face. • There is excellent correction of facial imperfections

with fat. • Fat from one’s own body is safe, so there is no risk of

allergic reaction or rejection.

As part of the natural aging process, the skin and muscles of the lower face lose elasticity, resulting in jowls with poor contour. It is true that facelifts and other rejuvenation procedures restore a more youthful appearance to the face, but there are alternatives to facelifts to achieve a fresh look.

The aging process is gradual, creating almost imperceptible changes that involve several components of the face. The facial skin is the key to the aging process. As the face slowly ages over time, there is loss of elasticity, dehydration, and atrophy. Increasing laxity lines, such as fine lines and wrinkles, can cause the skin’s outer layer to appear tired and aging.

The deep wrinkles of the skin are most apparent in the forehead, between the eyebrows (glabella frown lines), at the outer corners of the eyes (“crow’s feet”), and at the junction between the upper lip and cheek (nasolabial folds). If you look closely, finer wrinkles and etching of the skin can be seen throughout the face. For most people, there is often a host of changes that take place

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with aging skin. The upper lip gets thinner and less full and the lower lip tends to lose volume.

Hopefully, the more pronounced signs of aging may not occur until very late in life. Yet, younger people moving into their middle years can have visible aging components of the face. Today there are methods for dealing with aging without a serious surgical solution and this is why fat grafting has risen to become the most effective method to achieve a fresh, vibrant face.

Many people in their middle years look in the mirror and detect some imperfection or age-related change that they would like improved, but many still think that it is too difficult to achieve the success of obtaining a more youthful, pleasant appearance without having a major medical procedure. We procrastinate seeking any real help. The truth is that until recently, most treatments have been too invasive, too costly, and too much of a radical change, and include excessive downtime. Some have turned to so-called solutions such as salon treatments and highly-promoted creams and lotions, hoping to avoid invasive surgery and to have no downtime. These methods are often short on results.

Fat Grafting Fat grafting is also called facial fat rejuvenation, fat transfer, free fat transfer, autologous fat grafting or transfer, micro-lipoinjection, and fat injections. We call it fat grafting.

Fat grafting is the process of taking small amounts of fat from one part of the body and re-implanting them elsewhere. It is minimally invasive and can help correct the small areas of your face that distress you.

As an injectable filler, your own fat is the safest, most long-lasting, and rejection-free of any foreign substance face fillers. It is soft and feels natural, it doesn’t cause immune problems, and best

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of all, there is the added benefit of having extra fat removed from elsewhere, which allows for a more sculptured body.

The main downside to fat grafting is that your body tends to absorb the fat to some degree, nothing like chemical fillers. The amount of fat that is implanted and then absorbed by your body varies depending on the method of extraction and injection into your face. A great deal of the success of fat fillers that are not absorbed into the body involves the doctor following the latest methods of fat removal and injection. The major reason that fat grafting has become more accepted today is technology. Advances in harvesting methods and processing the fat cells are the two main areas of improvement. Any qualified fat grafting surgeon is aware of the need to be extremely careful in obtaining the fat from your body, which must be done very softly and carefully. He/she must extract the fat and then purify it by not allowing any contamination before slowly injecting the fat with a series of small punches to preserve and not damage the fat as it is plumping up hollow cheek, lines, wrinkles, and other essential corrections to the face. Fat grafting, with its best extraction and purification techniques and skillful placement in the face, is now the best method of face rejuvenation without major surgery.

The cells are harvested, prepared, and then injected into the treatment site in many small crisscrossed tunnels. The fat cells survive and keep their volume if and when the new blood vessels grow in to feed them. It is a race between hooking the fat cells back up to a nourishing blood supply and the cells dying due to lack of nutrition.

Fat transfers performed as an outpatient procedure less expensive than treatment in-a hospital. The cost of the procedure will also depend on the geographical area where you will have the treatment done. Fat transfer costs may range from $600 to $8000,

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depending on what is involved in the procedure to correct the contours of the face. Before After

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There is little question today that the most sought-after face filler is the newly-revised and carefully performed procedure of removing fat from one area of a patient’s body and injecting it smoothly into the face for a much more youthful appearance.

Before

After

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Body Fat Cells Your facial skin and body fat are very involved in the fat grafting process, and one aspect that has occurred in the process of fat grafting is a wider acceptance and usage of stem cells. The realization that high concentrations of stem cells reside in fat has raised the potential that they can be used for better volume preservation and even to promote healing in difficult wounds. Autogenous fat grafting continues to have tremendous appeal due to its ease of harvest, ample donor sites (in most patients), and its ability to be injected. But no matter how it is done, the fate of the injected graft can be unpredictable if not properly extracted.

Fat is clearly much more diverse than once thought. Fat as a biologic tissue is far more complex than just a storage site for needed energy. Fat is clearly much more diverse than once thought.

It is interlaced with numerous cell types and it functions in some ways as an endocrine organ.

Fat cells develop from less-specialized cells called fibroblasts: a type of flattened cell that is abundant in your body.

As part of tissue maintenance, fibroblasts can develop into fat cells or other connective tissue types to suit the needs of your body. Once created, they remain in your body unless surgically removed, although the size of the cell can change as the fat droplet inside the cell grows or shrinks.

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This depicts a cluster of fat cells that can be extracted Fat cells develop from less-specialized cells called

fibroblasts: a type of flattened cell that is abundant in your body. As part of tissue maintenance, fibroblasts can develop into fat cells or other connective tissue types to suit the needs of your body. Once created, they remain in your body unless surgically removed. Even those with great bodies in excellent shape have enough fat to harvest, sufficient to supply the needed fat for face rejuvenation. There are thousands of fat cells in the body.

Fat cells develop from less-specialized cells called fibroblasts: a type of flattened cell that is abundant in your body. As part of tissue maintenance, fibroblasts can develop into fat cells or other connective tissue types to suit the needs of your body. Once created, they remain in your body unless surgically removed, although the size of the cell can change as the fat droplet inside the cell grows or shrinks. Even those with great looking bodies in excellent shape have enough fat to harvest, sufficient to supply the needed fat for face rejuvenation. There are literally thousands of fat cells in the body.

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Most fat cells have the appearance, under a microscope, of round, fat cells. The fat cells lack tissue stain and appear white when observed in a lab. Each adipose (fat) cell has within it a single large droplet of fat that takes up the majority of the cell’s space. At the end of the cell is a flattened section of the cell’s membrane. The fat cells are numerous and are found in various tissues of the body, such as the skin, bone, and around some vital organs. However, when it comes to fat extraction, most surgeons use the abdomen because it is an excellent supply of fat cells. The fat is rich of stem cells. An average rate of fat stem cells in adipose tissue is one of every 50 normal fat cells (compared to bone marrow that contains 1 for 10000). Stem Cells in Fat The stem cells play a part in the longevity of cell retention in the face. Stem cells were once not known to be a major part of the fat cell, but it is now debated whether or not they are the secret to sustained cell life in the face.

Fat has the greatest number of stem cells of any tissue in the adult human body. This makes it a potentially powerful tool in grafting. How the stem cells in fat grafts may contribute to better volume preservation is not clearly understood, yet it exists. Early on, revascularization may play a role in helping some of the mature and intact fat cells survive the transplantation process. Stem cell conversion undoubtedly plays a significant role in the transplanted fat. Blood supply to feed the fat cell is absolutely essential, and during the injection process, the surgeon needs to be aware of crisscrossing the injected fat to get the best results. With today’s methods of fat transfer and injection, some damage can be done to the fat cells either during the extraction process or in the purifying of them, but by far, the greater part of the extracted fat is suitable for transplanting where there is tissue.

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As one surgeon said, “We are not putting in the best material possible. We are simply putting in the best material available that is easiest and relatively harmless to get.” This is true!

Upper lip lines removed

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Part Two

The Method of Fat Extraction

and Preparation

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3 Gentle Liposuction

This step has two equally important purposes: first, to collect the fat that will be transferred to your face; second and most important, to contour the area being suctioned. The liposuction procedure that extracts fat will result in improved appearance in the area of the body where the fat was extracted. A careful surgeon does not simply harvest fat; rather, he/she treats the area with the same precision as he/she would in a normal liposuction procedure, except that it is much gentler than simply doing a body sculpting procedure.

Liposuction involves the removal of fat cells by suction through a metal tube—no bigger around than a narrow pencil—called a cannula, or by a syringe. Through the process, fat cells will be slowly and very carefully sucked out to protect the cells from damage. With current methods of harvesting fat, there is more than one way to do this. Some surgeons use the Water Jet technique and others the Internal Ultrasonic Liposuction method, which involves the liquefaction of the fat with sound waves prior to fat cell removal. Both methods have received high approval by surgeons performing liposuction.

Fat harvesting with liposuction can be performed on most areas of the body, including in the fat deposits under the chin, in the neck, the abdomen, the chest and upper arms, the hips, thighs, knees, calves, and ankles. In some cases, liposuction may be combined with customary surgical procedures that stretch and

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remove excess skin and fatty tissue, such as a tummy tuck (abdominoplasty).

In addition, liposuction surgery can be performed on any person who is in reasonably good physical condition who may have localized, unwanted fat. Large volumes of fat removal can be dangerous and is often performed as staged procedures in a series of liposuction surgeries.

Liposuction and Tightening and Lifting Skin Liposuction can be a good tool for tightening the skin. The removal of quantities of fat from under the skin allows the elastic skin to retract to its genetically predetermined position and sometimes become even smaller. Good examples of this effect are seen after liposuction to the arms, stomach area, and breasts.

The level of skin retraction following liposuction is also determined by the age of the patient as well as the quality of the skin, the presence of underlying disease or smoking, and the presence of previous skin damage, such as that caused by childbirth and surgery. Liposuction techniques such as subdermal undermining using a small cannula can stimulate further skin

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retraction. While subdermal undermining may help the skin contract, patients with severe elasticity loss and heavy stretch marks prior to liposculpture may require the removal of redundant skin by surgical means after liposculpture. Usually this can be performed after six months.

While performing a fat transfer procedure, surgeons often perform the suctioning phase in about 30-60 minutes. It is a slower process than simply removing fat for body sculpting. The fat cells have to be harvested to preserve their integrity. In review, following is what you can expect:

• An antibiotic will be given either about an hour before the procedure or afterwards

• The targeted areas are marked on the body while the candidate is in a standing position

• Sometimes pictures will be taken of the area to be treated so that the patient will have before and after photos

• In the operating room, a sterilizing solution such as Betadine is applied to the relevant areas

• The patient is sedated with twilight sleep the liposuction procedure is preferred, by general anesthetic (not sure what is meant here)

Once the harvesting begins, the goal is to harvest the fat as gently as possible in order to ensure that most of it is kept viable. With today’s latest methods, liposuction is the primary means of harvesting fat for micrografting purposes. In the early years of liposuction, the technique for sculpting the body was the use of high negative pressure suction, with the result that many, if not all, of the fat cells were destroyed in the process and cast away. Not so with the best method of harvesting fat for grafting.

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The key to maximum fat viability during the harvesting process is to perform the technique with low negative pressure liposuction. This can be accomplished either by machine or by a small syringe vacuum. The gentle method of extracting the fat needed uses half of the pressure that is normally required. For extracting smaller volumes of fat, the small syringe liposuction works well. This method of extraction usually requires a 10cc syringe while applying the plunger halfway. This method avoids using the excess negative pressure that can damage the fat cells. Those patients who require a greater volume of implantable fat often use the low negative pressure machine vacuum. It is more efficient. Many surgeons employ the Body-jet® liposuction device set at low negative pressure. Body-jet® uses a pulsing water jet to gently dislodge the fat. It is considered to be the most gentle of the machine harvesting methods with demonstrated end results of 80 to 90% viability of the fat. The Body-jet® method facilitates the next step, which is referred to as washing. This is done when the Body-Jet® fat extraction is performed. The next phase of the procedure involves a process of isolation and sterile preparation of the fat cells.

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Fat Cell Isolation and Sterile Preparation

Once the harvesting (liposuction) is complete, the fat is transferred sterilely through multiple syringes using the tulip connections to 1-ml tuberculin syringes. The liquid part of the graft is gently washed free of oil, lidocaine, and blood as part of the purification process.

The aspiration stage of cleaning the fat is done with the layers of fat in the container. The top layer is “free oil” from ruptured fat cells. The surgeon will decant (gently blot) the oil. The middle layer of extracted fat consists of fat cells for grafting. The surgeon must be gentle with this layer. The fat must be treated to remove blood and other fluids as well as any damaged fat cells. Whole, healthy fat cells are best used for re-implantation to maximize the chance for success. The surgeon may manually aspirate the fat to be grafted, which is then spun in a centrifuge machine to remove excess fluids and damaged fat cells, which are separated out. The fat, which looks like a yellowish liquid in the syringe, is then injected using a separate, smaller hypodermic needle.

Vigorous washing or straining may damage the fragile cells and decrease the viability of the graft. The bottom layer of accumulated fat contains variable amounts of tumescent fluid and blood and is drained off.

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There are other methods employed by surgeons, but the ones listed above are the most acceptable.

Fluids used for fat suspension are normal saline or lactated Ringer solution. Serum-free culture medium is also available. Some surgeons use heparin, insulin, vitamin E, and non-steroidal anabolic hormones.

Many surgeons who anticipate the need for additional adipocytes (fat cells) in the future will freeze the tissue to -30°C and reuse it later to be injected into the patient’s breasts, should the patient want additional enlargement (change to face?) where some of the fat, after the first injections, has died off. A high number of viable cells exist even after defrosting. Slow freezing and thawing is currently the best method to retain the maximum number of live cells.

If the surgeon uses a syringe to remove the fat, the same syringe is not used to inject the fat during the breast enlargement procedure (it is new). The fat must be treated to remove blood and other fluids as well as any damaged fat cells.

The fat is prepared to be concentrated and purified and is thereby rich in ADIPOSE DERIVED STROMAL/STEM CELLS (ADSC). This system, which minimizes the chance of contamination, adds an extra safety feature which is vital for face.

Once the cleansing phase is complete, it is ready for the next phase, which is the injection of the fat into the face.

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Fat Injections Injecting one’s own fat into the face is certainly gaining in popularity. The structural fat for grafting to the face for correcting flaws or reconstruction defects has become widely practiced throughout the world with excellent results. The artistic skill of the surgeon makes all the difference in the results. The injection process is most often done with syringes.

Once loaded into syringes, the pure fat is ready for injection into the targeted areas of the face. Surgeons who are skilled in the procedure of injecting fat use a specially-designed injection cannula or syringe to transfer the fat to the face. It’s critical here to apply a number of injections of very small amounts of fat to achieve the best results.

Using excessively large injections of fat into various areas of the face is discouraged. Using small amounts of fat throughout carefully predetermined areas of the face is the best approach to achieving a sculpted shape and fill. This artistic shaping takes more time but improves the fat survival rate and ultimately offers a better, more natural result. Don’t worry about scarring of the face. The fat injections can be done through tiny needle punctures that leave no visible scars.

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A syringe filled with fat prepared for injecting into the face

Volume of Fat With the fat transfer procedure, it is difficult to determine the exact volume of enlargement that you will achieve in the desired face enhancement. The fat has to be delicately placed throughout the muscle so that it can receive an adequate blood supply and be positioned to give the best results.

Repeat procedures may be required as transplanted fat is partially reabsorbed by the body. The length of time that these final

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results will take can vary significantly between patients. And of course, as we’ve mentioned, the results are also dependent on the area treated and the skill of the doctor injecting the fat. With the best surgeon employing the correct methods and amount of injected fat, as much as 80% of injected fat is retained.

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Consultation with the Surgeon

Most likely, prior to meeting with your surgeon, you will be asked to fill out some forms. Answer each question on the form in detail. Your surgeon or surgeon’s coordinator will discuss the answers with you. If you smoke, you may be asked to temporarily stop. Smokers tend to have a longer recovery time and may have problems with their wounds healing, especially in larger fat injections. Avoid anti-inflammatory drugs prior to surgery. This helps to prevent increased bleeding. Go over the list below.

Discuss with your doctor any health conditions that you have, including any pre-existing problems or the risk that you may have for developing problems.

When consulting with the surgeon, bring a list of current medications that you may be taking. In addition, bring any results of recent surgery and the date that the surgery was performed. The surgeon needs to know of any health conditions that you may have.

During the consultation, you will be asked what it is that you wish to achieve by undergoing face fat injections. Be frank about your goal. What shape do you hope to achieve and what is possible? Your surgeon will have answers for you in an effort to guide you as to what is possible and what is not. He/she will determine your facial size, fat distribution, and the amount of fat

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present. These are all part of the optimal plan to give you the best result.

The more revealing you are with your surgeon, the better the outcome. He/she can’t divine your wishes, so you have to let him/her know what you want to achieve.

In some cases, a full history and physical examination will be conducted prior to the procedure. Your surgeon may take pre-procedure photographs and you will be required to sign an informed consent acknowledgement.

Make certain you follow all pre-surgical instructions and be prepared to make financial arrangements for the full cost of the procedure. Be open with the surgeon as you discuss costs and what you can reasonably afford. Many surgeons offer assistance in getting financing to cover much of the costs. However, most surgeons request advance payment of the fat transfer procedure.

At some point, the surgeon will explain how the stages of removing the fat, purifying it, and injecting it into your face will work.

Advanced Preparation for Your Surgery Your surgeon will give you instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. In addition, while explaining your surgical procedure, your plastic surgeon will discuss anesthesia, the recovery process, and your obligations as a patient.

You should also discuss where your procedure will be performed. You will be asked to sign consent forms to ensure that you fully understand the procedure that you will undergo as well as any risks and potential complications of your surgery. There may be a waiting period of several days or weeks from the time of your commitment to the day of the surgery. While making preparations,

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be sure to arrange for someone to drive you home after your surgery and to help you for a few days if needed.

No anticoagulants should be taken for two weeks prior to surgery. If general anesthesia or sedation is to be involved, the surgery will usually be in the morning, and fasting from midnight the night before is required. If only local anesthesia is to be administered, fasting is not required. Smoking must be avoided for about two months prior to surgery, as nicotine interferes with circulation and can result in the loss of tissue.

Items to Consider before Scheduled Surgery There are items to be checked off prior to face fat transfer surgery that will ease the experience and allow for greater success:

• No aspirin or anti-inflammatory medications before the procedure (your doctor can provide you with a list of OTC medications to avoid).

• Make arrangements to have someone drive you to and from the operation.

• Arrange for someone to care for you during the first 24-72 hours after surgery. Fill prescriptions (especially pain medications and antibiotics) before surgery.

The preoperative instructions are important to follow if you wish to maximize the results of fat transfer for face rejuvenation, as well as to avoid any complications. At times, face fat transfer surgery may be cancelled, although rarely. There may be a need to hold off on performing the surgery; this could happen should you fail to follow the precautionary measures that are required in order to avoid complications.

Proper planning is a must for the best results and in order to achieve improved, balanced, and increased size of your breasts (change to face?) for a more attractive you.

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Part Three

Fat Grafting Face Procedures

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7

Surgeon’s Overview of

Face Fat Grafting

Everyone, without exception, experiences the human process of losing facial fat. Facial fat is a noticeable element in maintaining a youthful, vibrant appearance and healthy look. The common goal of these indications is to produce a more harmonious and aesthetically appealing proportion of the face. As we age and lose the fullness of youth, the face literally gets smaller. The skin remains the same size, but without the underlying tissue structure, the skin retreats into wrinkles. As the missing structure under the skin is restored with natural fat, the wrinkles diminish. Enhancing Facial Proportion With aging, the cheeks, chin, jaw, and forehead not only decrease in size, but the fat, muscle, and connective tissues that atrophy or waste away leave behind unsupported skin, resulting in a hollowness. As the support underlying the skin wastes away, the skin develops wrinkles and folds. While the cheeks become smaller, bags under the eyes become more prominent.

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As the jaw line and chin lose their prominence, jowls appear. The result is the loss of a more youthful fullness.

Since shrinkage of the subcutaneous tissues is the primary manifestation of aging, replacement of the atrophied tissue with the structural microfat grafting technique offers a marvelous rejuvenation. By diffusely augmenting the structure of the forehead, cheeks, mouth, chin, and jaw line, all can be restored to a fullness of youth. Traditional plastic surgery has identified the signs of aging: wrinkles, bags, jowls, and folds. Most cosmetic surgeries have tried to remove these signs of aging with a host of fills, implants, and even lotions. Unfortunately, they do not take into account how people looked when they were younger. Therefore, the end result of a facelift or eye tuck without filling in the lost fullness often results in a tight, non-youthful appearance that is distressing to the patient. The procedure is often called volumetric restoration of the face and body with a living filler (your own fat), correcting

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asymmetry and restoring the fullness of youth. It is the most natural of all fillers. Some common facial areas for fat transfer are forehead creases and plumping of the temples, sunken areas beneath the eyes, the deep wrinkles next to the mouth, the labial folds, and other regions of the face. Fat grafting is also used for cheek and lip augmentation. Alterations of these facial parts can give an individual sought-after face rejuvenation results. Facial fat transfer procedures are one of the newest facial rejuvenation processes nowadays. There are several facial features which can be injected with the patient’s own fat. As with any face rejuvenation procedure, patients need to give it time to show lasting results. Using fine needles, the fillers are injected into the skin under each depression or wrinkle. The filler pushes the depressed wrinkle forward and makes it less visible. There is temporary discomfort associated with the injection. The use of ice or an anesthetic cream can numb the area, making the injections painless. Most fat grafting cases are performed comfortably using local anesthesia in a surgeon’s office. Many patients wanting facial fat grafting are most often lightly sedated and feel no pain. At times, it may be necessary to administer a general anesthesia and therefore, in those cases, the procedure is usually performed in a surgical center or hospital. The results of facial fat grafting are permanent. Since it is a living graft, the fat achieves a blood supply in the same way that a skin graft or hair graft does. Once the process of neo-vascularization (new blood supply) has been established, the fat grafts not only survive in their new environment, they thrive. This process can take several months to be effective. The first two to three months can be the lowest point of fat grafting. As with any

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face rejuvenation procedure, patients need to give it time to show lasting results. Need for a Touch-up Touch-up fat grafting is uncommon. A growing number of patients seek out the more experienced fat grafting surgeons who have learned how to keep the transferred fat alive and nourished with blood. If a touch-up is needed, it means that more fat is required to completely achieve the desired result. Have patience for at least six months. After six months to a year, if the desired level of fat grafted into areas of the face has become less acceptable, then it is possible to do a touch-up with one’s own fat once again. Keep in mind, though, that the patient will still have an enhanced look with the increase of fat that has already been grafted. Once the blood supply is firmly established, within three to six months, the fat begins to take hold and thrive. Usually within a year, the result of the fat grafting process is well-established. Why No Over-Injections It is very important in the process that the fat graft relies on each “grafted” fat cell being near a blood vessel or other cells where it can borrow from them for a time. As mentioned, small amounts of fat are placed in different layers of the skin and muscle to increase the chances that each fat cell is close to another cell to borrow from. The more this takes place, the better the overall success rate.

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The following are general guidelines only. Variations are common.

Surgery length:

One to two hours

Location: Office or hospital outpatient surgery suite Anesthesia: Light sedation Dressings: Self-dissolving sutures and bandages where fat is

removed; no dressings where fat is injected Pain discomfort:

Mild discomfort at the fat removal site and slight discomfort caused mainly by swelling at the injection sites. May or may not require pain medication. Ice packs recommended to speed recovery at injection sites.

Swelling & bruising:

Minor swelling and some bruising where fat is removed. Moderate swelling and little to no bruising at the injection sites, with swelling resolving in three to four days. Bruising at the removal site typically fades in 10 to 14 days.

Suture removal:

Dissolvable sutures are commonly used, requiring no removal

Return to work:

Within a week or less

Resume exercise:

Two weeks for gentle exercise; six weeks for strenuous exercise

Initial results: Immediate, once swelling diminishes Final results: Within a week Permanence: Properly injected, the fat remains a lifetime

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8

Forehead and Brow

A specific fullness of the brow, upper eyelid, and the temple region is fundamental to a healthy appearance. Fullness characterizes the young brow, cheek, and temple. Aging is seen in the upper face that displays the skull and the rims around the eyes. When many blood vessels are no longer concealed by youthful fullness, they become more visible. The eyebrow descends with loss of fullness from the forehead, temple, and brow.

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What to Expect You will experience a slight pressure to the forehead as the injections of fat are sent into carefully selected regions of the skin. The volume of fat injected ranges from 0.8 ml to 4.5 ml per orbit, which means that not a great deal of fat will be injected into the area of the forehead to fill out any hollow space or to assist in removing lines and wrinkles. It is a short procedure and you will be allowed to resume your normal activities the day after injections.

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Eyelid Fat Grafting

Hollowness at the eyelid (that is, beginning just beneath the rim of the bony socket) requires enlisting an experienced and careful surgeon to be safe and get the best results. The area is sometimes referred to as upper cheek fat loss with secondary sagging of the cheek's upper muscles ("midface descent") and/or inadequate development and forward projection of the bone of the upper cheek (for bony features, microfat injections are excellent to improve hollowness). What to Expect

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Many patients are satisfied after one session of fat grafting to eye region. However, it is best to prepare for two treatments in case the patient wants to see more volume in the respective region. When properly done, you can expect a softening of your eyelids’ appearance. Fat grafting of this area of the face requires aesthetic skills as well as technical knowledge on the part of the doctor.

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Tear Trough Grafting

Tear trough grafting deals with the part of the face where the eyelids meet the cheeks. Often with age, this region of the face becomes what is called an Anatomic Indentation, and when it becomes noticeably deepened, there is dissatisfaction. Here again, when properly injected, you can expect a softening of your entire eyelid appearance.

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What to Expect With careful attention to the sort of appearance the patient wants to project, the doctor will take time to make certain that the fat is properly placed in order to receive the supply of blood that usually attaches to the fat cells within weeks. Although many patients are satisfied after one session of fat grafting, I always prepare our patients for two treatments in case they want to see more volume in the respective region. In my opinion, fat injections in the lower lid can do wonders. When smiling, there is an accentuated demarcation between the eyelid and the upper cheek. The eyelid’s muscle contracts and draws the skin just above the orbital bone. It pulls inward so that the transition is easier to see. The area above the red dots in the picture above is considered to be part of the eyelids. Deep orbital volumes of fat influence the fullness in only this area. The area at and below the red dots is considered the cheek. Orbital volume does not influence the fullness of the cheeks.

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Cheek Fat Grafting

Fat transfer involving the cheeks is one of the most sought-after procedures of facial fat transfer. This procedure is more often preferred than other cheek augmentation method. Other cheek augmentation procedures use artificially prepared materials that can cause risks and other complications of the procedure. The cheek fat transfer has the least---almost non-existent---risks because it uses only a natural material extracted from the person’s body.

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What to Expect The purified fat will be injected into your cheeks. It can be injected either into your cheekbones or into your hollow cheeks, or both. The heightened cheekbones will make you look younger and filling your hollow cheeks will take some years off your age. Upper Cheek Fat Transfers A facial structure known as the malar fat pad exists high in the face, normally attached to the cheek bones. This is what gives some people the attractive appearance of prominent cheekbones. As with most sagging parts of the body, the fat pad and the skin around the cheek begin to sag and cause an older appearance. The muscles for smiling are connected to the mouth. The act of smiling forms a line on the face from the nose to the mouth along the nasolabial line. Smiling creates a more prominent nasolabial line. Lower Cheeks This procedure is a great alternative to artificial implant materials and injectable fillers. The results of your cheek fat transfer can be long-lasting, if not permanent, since the cheek and the cheekbone areas are not subjected to excessive movement. If the fat isn’t absorbed by your body over the next few months or years, there is no need for a follow-up treatment. The cheek fat transfer is considered one of the many forms of a mini-facelift because it can lessen or eliminate the current wrinkles, as well as fill in some of the acne scars on your face. By choosing a cheek fat transfer procedure over other cheek augmentation methods, you are not endangering yourself

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with any possible allergic reactions or other complications associated with unnatural substances being inserted into your body. Fat injections can enhance the volume of the cheeks and help to avoid the appearance of sunken cheeks. Cheek augmentation with fat grafting creates a natural and attractive proportion in facial aesthetics. The best option is to replace fat to the cheek to restore soft tissue and to fill in the face. Descent of the cheek fat pad can extend to the corners of the mouth and the marionette lines. Fat grafting and can alleviate this condition. Fat grafting to the cheek relies on adding more volume to key areas of the cheeks, which improves the signs of aging.

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Nasolabial Folds

Nasolabial folds are primarily caused by the contraction and pull of the facial smile muscles. These muscles don’t change, but with the minor plumping of the cheek, folds form. Along with marionette grooves, these folds convey emotions. Aging can result in negative and fixed changes to facial expressions. As the skin surrounding the mouth loses its fullness, the unsupported skin sinks into folds, wrinkles, and creases. The resulting negative facial appearance can and often does become permanent.

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With fat transfer, nasolabial folds and marionette grooves can be altered. It is possible to reverse the negative appearance with fat grafting to this area. Fat grafting through injections of your own fat can improve the support to the facial structures. What to Expect The nasolabial folds are primarily caused by the contraction and pull of the facial smile muscles, which of course continue to work and pull after the facelift. Fortunately, filler injections of Perlane or Radiesse can plump the cheek further and help lessen, but not eliminate, the nasolabial fold appearance. Of course, you will need to wait two to three months to see the final results of the grafts.

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Fat Grafting Lips

The goal of lip augmentation is to create attractive, pouty lips. The lip fat grafting technique enables doctors to increase the surface area of the lip. The changes that happen with the aging of the lip can be dramatic. Along with the shrinkage in volume of the lips, wrinkling of the upper lip is particularly distressing. Restoring lip fullness with fat filler will result in a more youthful appearance. During the injection of fat technique, the doctor must be aware of lip contours. There are certain contours that must be respected and enhanced in order to create aesthetically appealing changes in shape and volume.

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The primary indication for lip augmentation is the patient’s desire for a correction for a more acceptable facial appearance. Fat grafting sends the depressed wrinkle forward and makes for less-visible lines on the face. The lips are one of today’s most sought-after signs of beauty. Fortunately, women born with thin lips or whose lips have lost their plumpness due to aging now have options for obtaining the lips that they desire. Fat adds volume to the lips. As with other facial enhancements using fat injections, the lips may be over-filled for a few days. This compensates for absorption of some of the fat cells, but when the fat settles in with an adequate supply of blood that tends to attach itself to the stem cells, the result can be a more refined, full lip appearance.

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Jowls and Jaw Fat Grafting

A triangle-shaped face, with the cheeks dominating the widest part of the triangle and a chin that peaks, is the most sought-after look. For most young people, the triangle is well-proportioned and full; however, aging takes its toll. In time, the cheeks lose their fullness, the chin is often slack, and the jaw is no longer well-defined. As time progresses, the jaw line becomes less apparent and often, jowls develop. When the skin loses elasticity and tone, it sags. The result is an aging, less attractive appearance.

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What to Expect By injecting fat into the center and sides of the chin, doctors can redefine the jaw line and regain that triangular look. Your face will look more youthful and a softening can become apparent. There is also a greater possibility of having a clean, full chin, which offers a strengthened appearance with a sculpted profile. There is no question that a sculpted, well-contoured jaw line is the goal of many. It is the loss of the fullness in the jaw line and chin that causes the skin to sag due to lack of underlying tissue. Actually, the skin remains the same; it simply lacks tissue support. Deflated skin tends to drape due to lack of fat. As the underlying fullness is reduced, the fat disappears. The entire lower facial structure can show aging. It is now possible to have a lasting, sculptured jaw line with fat transfer by altering the shape and allowing for a sculpted profile.

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Chin Fat Grafting

Fat injections can safely and effectively correct a small chin without surgery. Fat grafting chin augmentation will create a much more dynamic facial profile. Small chins tend to make the nose appear larger. By using fat grafting, it is possible to have a better balance of the facial features. What to Expect It possible with the structural microfat grafting technique to restrict not only the chin, but the jaw line as well. Once again, this procedure restores the fullness between the chin and the fat of the jowl, altering the profile for the better.

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Scars and Depression Corrections

With fat injections, it is now common for facial lines, depressions, folds, and depressed scars, which tend to stand out on people who have had to live with them much of their lives, to be eliminated or lessened in appearance. The face can be successfully treated with injectable fat up to a point. It is not always possible to remove all depressions, scars, and facial lines, but it is certainly feasible to remove some of them and lessen the appearance of these bothersome skin defects. What to Expect It is a fact that aging and scarring can erode the underskin structures. When underskin creates an empty or hollow look, fat can assist in minimizing the effects. In many, scars have an effect on the normal supporting foundations under the skin. The subcutaneous structures can be enhanced with fat grafting. Restructuring fat can improve this condition. With fat grafting, the surface of the skin can have a more textured appearance. The overall appearance of the face after fat grafting can be drastically improved. The fat grafting procedure is a marvelous method using a more permanent solution to aging and skin defects;

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one that millions of people across the world are taking advantage of with outstanding results. Everyone, without exception, is subject to the human process of losing facial fat. Facial fat is a noticeable element in maintaining a youthful, vibrant appearance and healthy look. The common goal of these indications is to produce a more harmonious and aesthetically appealing proportion of the face. The main reasons for adding structure to the face is to replace atrophied, lost tissues and to enhance facial elements or proportion. The common goal of both is to create a more harmonious and aesthetically appealing proportion of the face and this translates to a more youthful appearance.

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Part Four

Recovery and Possible

Complications

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Recovery from Fat Grafting

Depending on the extent of the liposuction procedure, patients are generally able to return to work in one to two weeks after surgery. A compression garment or bandage is worn for two to four weeks. If non-absorbable sutures are placed, they will be removed after five to ten days. (not applicable for fat grafting?)

Any pain is controlled by a prescription or over-the-counter medication and may last as long as two weeks, depending on the particular procedure. Bruising will fade after a few days; possibly not until as long as two weeks. Swelling will subside in anywhere from two weeks to two months, while numbness may last for several weeks. Normal activity can be resumed anywhere from several days to several weeks afterwards, depending on the procedure. The final result will be evident anywhere from one to six months after surgery, although the patient will see a noticeable difference within days or weeks as the swelling subsides.

The suctioned fat cells are permanently gone. However, if the patient does not maintain a proper diet and exercise regimen, the remaining fat cell neighbors could still enlarge, creating irregularities.

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After Fat Transfer Surgery After the procedure, you may need someone to drive you home. You may also need someone to help you with daily living activities during the time specified by your doctor. The doctor will instruct you to limit activity, including exercise, for up to three weeks after the procedure. Within two to three days after the procedure, the bandage is removed by the doctor. Patients can begin to shower after the bandage is removed. (N/A for face?)

There is typically some swelling and some bruising. The swelling may last for several weeks. However, bruising will subside within a few days. The treated area may be reddened within the first 48 hours.

Discomfort can be managed with oral medications. Scabs may form at the injection site as well. Unmanageable pain or any symptoms that are progressive or abnormal should be reported to the doctor immediately. Normal activities can often be resumed almost immediately, except that you are advised to stay out of the sun. Patients should notice a marked improvement after the procedure. However, the final results may not be evident for several months or longer. Side Effects A side effect, as opposed to a complication, is medically minor, although it can be uncomfortable, annoying, and even painful. Some possible side effects of fat grafting include the following:

• Bruising: can be painful in the short term, and should fade after a few weeks.

• Swelling: should subside gradually over a month or two. • Scars: will vary in size depending on the particular

procedure and should fade over the following weeks.

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Scarring is an individual matter, partly dependent on heredity. For some, scar healing may take as long as a year.

• Pain: should be temporary and controlled by either over-the-counter medications or by a prescription.

• Numbness: sometimes persists for a few weeks. • Limited mobility: will depend on the exact procedure. • There could be various factors limiting movement for a

short while, such as:Wearing a compression garment • Keeping the head elevated • Temporary swelling

The surgeon should advise on how soon the patient can resume normal activity. Follow-Up with the Doctor Regardless of how you feel, you must make the follow-up appointments with your surgeon. Continue the self-exam of your breasts and schedule diagnostic breast screenings as instructed by your regular doctor.

Understand that the important thing is how you feel about it. If you've set realistic goals, then the surgery is usually a success. Cleavage is one of the objectives of many women, when it is possible. The appearance of it will depend on the former shape of the breasts; however, many women have been pleased with their new cleavage.

Continue with routine mammograms following breast surgery. Mammographic technicians will use special techniques for studies in breast augmentation patients. Inform your mammogram technician that you have implants before your study.

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POST-OP VISITS AND CARE SUMMARY

Blood Clot 1. It is important to walk at least every two

hours while you're awake to prevent the blood from clotting. Do not overdo it. Right after surgery, you will be instructed to walk around every hour. 2. Pay specific attention to leg swelling. If you notice swelling on only one leg or if there is calf pain, contact the office.

Constipation 1. If you are constipated at day two, stop taking Vicodin or Darvocet. 2. Encourage walking, drinking a lot of fluids, and consider laxatives (Ex-lax or Correctol).

Fever 1. Make sure to cough and breathe deep, fever is usually in the lungs for the first three days after surgery.

Activity 1. You can take a cool shower the day after surgery. Dab dry. Make sure that you have someone helping you. 2. Walk every hour while awake for the first day and then every two hours. 3. Sleep at a 45 degree angle for the first three nights. 4. Begin massage after the first post-op visit. 5. Regarding exercise: If it hurts, don't do it. Wait for your body to tell you what you can do. 6. You can exercise areas other than your chest at two weeks. You can work out your chest at eight weeks.

Wound Care 1. Make sure that your bra is on as directed. 2. Keep the surgical area clean and dry at

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all times. 3. Two weeks after surgery, take your steri-strips off. Apply ScarLess®, allow it to dry, and then apply silicone sheet for two months.

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Rare Potential Complications

The main complications with face fat grafting are contour irregularities (lumps and bumps), poor cosmetic distribution, and poor fat take. All of these potential complications can be significantly minimized in the hands of an experienced fat grafting surgeon. The fat transfer procedure requires a surgeon who has an extremely high level of experience and artistry, as well as judgment, knowledge, and excellent technique. All of these elements combine to achieve a natural, enhancing, and enduring result.

A moderate amount of swelling is expected after the fat graft. This is usually evident for two weeks after the procedure. Some bruising may also be apparent.

Some complications of fat grafting include:

• Undercorrection: desired outcome not achieved, thus requiring a further graft to complete the correction.

• Overcorrection: too much fat is injected into the area. This prevents new blood vessels from growing to supply the graft, leading to cell death and a lumpy consistency.

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• Clumping of the graft. • Accidental damage to underlying structures, such as nerves

and blood vessels, particularly around the eye. • Bleeding: usually associated with use of sharp needles for

fat injection. • Infection. • Scarring of the donor site.

Complications from fat transfers are infrequent. The most common, but infrequent, complications of fat transfers include uneven skin texture, infection, abscess, excessive bleeding, and scarring. If fat is injected into two or more areas, patients may have asymmetry, whereby the fat appears uneven in different areas. Treatment for complications can range from oral medications to surgical intervention, depending upon the extent of the complication. Following the doctor's instructions before and after the procedure can reduce the risk of complications.

As with any surgery, there are certain risks beyond the temporary and minor side effects. The surgeon should mention them during a consultation. Careful patient selection by the surgeon minimizes their occurrence. Their likelihood is somewhat increased when treated areas are very large or numerous and a large amount of fat is removed. Allergic Reaction to Medications or Material Used During Surgery Infection: Any time the body is incised or punctured, bacteria can get in and cause an infection. During liposuction, multiple small puncture wounds are made for inserting the cannula, which can vary in size depending on the technique.

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What are the Potential Complications? The main complications are contour irregularities (lumps and bumps), poor cosmetic distribution, and poor fat take. All of these potential complications can be significantly minimized in the hands of an experienced fat grafting surgeon. Fat transfer is a procedure in which an extremely high level of judgment, knowledge, excellent technique, experience, and artistry are required to get natural and enhancing results that last. Unfortunately, most of the bad press that fat transfer has received is from surgeons who only dabble in this procedure. As a result, they lack the experience and knowledge to achieve consistent and excellent results. This is most analogous to rhinoplasty, in which a very unique set of skills and knowledge is required, and this is uncommon. There can be damage to the skin. Most surgeons work on the deeper levels of fat so as to avoid wounding the skin any more than they need to for the insertion of the cannula. Sometimes the cannula can damage the tissue beneath the skin, which may show up as a spotted appearance on the skin surface. Burns: Sometimes the movement of the cannula can cause friction burns to skin or nerves. Also, in UAL, the heat from the ultrasound device can cause injury to the skin or deeper tissue. Skin necrosis (dead skin) is a rare complication in which the skin falls off in the necrotic area. The problem can vary in degree. The resulting wound then needs to heal, typically requiring extended wound care. Puncture of an internal organ: Since the surgeon can't see the cannula, sometimes it damages an internal organ, such as the intestines, during abdominal liposuction. Such damage can be corrected surgically, although in rare cases it can be fatal. An experienced cosmetic surgeon is unlikely to puncture any internal organ.

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Contour irregularities: Sometimes the skin may look bumpy and/or withered because of uneven fat removal or poor skin elasticity. Not all patients heal in the same way, and in older patients, the healing may be slower and a bit imperfect. Sometimes a small touch-up procedure can help. Lidocaine toxicity: When the super-wet or tumescent methods are used, too much saline fluid may be injected, or the fluid may contain too high of a concentration of lidocaine. Then the lidocaine may become too much for that particular person’s system. Lidocaine poisoning at first causes tingling and numbness and eventually seizures, and then is often followed by unconsciousness and respiratory or cardiac arrest. Fluid imbalance: Since fat contains a lot of fluid and is removed in liposuction, and because the surgeon injects fluid into the fat to more efficiently perform the procedure, there is a danger of the body’s fluid balance being disturbed. This could happen after the patient is at home. If too much fluid remains in the body, the heart, lungs, and kidneys could be affected. The surgeon likely has a written list of symptoms to watch for, along with instructions for post-op self-care.

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Summary of Face Fat Injections

Fat grafting is a marvelous new medical breakthrough that has captured the world with its non-surgical method of lifting the face and plumping out hollow cheeks. Today thousands are having this less-than-an-hour procedure performed with little discomfort and with immediate recovery. Although it may take several weeks to see the effects of a more youthful face, it does offer the patient the assurance that they will have a more youthful appearance that doesn’t smack of having had a drastic facelift, which can take months to fully heal and cost considerably more. The fat has little, if any, risk since it the patient’s own fat that is transferred into the face. This alone is a marvelous method of risk-free results. The filler is not a foreign substance that will soon fade and perhaps have a reaction with the patient. Medical doctors have moved into a much safer and longer-lasting method to rejuvenate the face and erase lines and wrinkles.

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Glossary

Aspiration: The withdrawing of a fluid from the body by means of suction.

Biocompatible: Being biologically compatible by not producing a toxic, injurious, or immunological response in living tissue.

Breast Augmentation: A surgical procedure which enlarges the breast through implantation of a prosthesis.

Breast Implant: A soft, silicone envelope with various fillers that can be placed in the body for simulated breast tissue.

Breast Reconstruction: A surgical procedure that rebuilds a removed breast.

Capsular Contraction: A tightening of the scar tissue surrounding an implant.

Delayed Reconstruction: Breast reconstruction that takes place weeks, months, or years after a mastectomy.

Envelope: The outer lining of an implant which traps the inner fluids, sealing them in.

Expander/Mammary Implant: A breast implant that also acts as a tissue expander, stretching the tissues, but then also remains in place as a breast implant.

Fibrous Tissues: Connective tissues composed mostly of fibers.

Flap: A portion of tissue, which may include muscle, fat and skin, with its blood supply moved from one part of the body to another.

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Flap Reconstruction: Rebuilding of a removed breast using a flap to form the breast mound.

Glandular: Relating to a gland.

Hemorrhage: Abnormal internal or external discharge of blood.

Immediate Reconstruction: Breast reconstruction that takes place during the same surgical procedure as a mastectomy.

Inpatient Surgery: A surgical procedure in which the patient is required to stay overnight in a hospital.

Latissimus Dorsi Flap Reconstruction: Breast reconstruction that utilizes the patient's own tissue transferred from the latissimus dorsi muscle, located in the back, to build a breast mound.

Lumpectomy: Surgical removal of a cancerous tumor along with a small margin of surrounding tissue.

Lymph Nodes: Structures in the lymphatic system that act as filters, catching bacteria and cancer cells, and that contribute to the body's immune system.

Mastectomy: The removal of breast tissue due to the presence of a cancerous or precancerous growth.

Mastopexy: Breast lift to tighten the breast by removing skin that the forces of gravity and the effects of aging have caused to sag.

Milk Ducts: Tubes for the passage of secreting milk.

Modified Radical Mastectomy: Surgical removal of the breast, some fat, and most of the lymph nodes in the armpit, leaving the chest wall muscles largely intact.

Opaque: Not transparent; impenetrable by visible light rays and x-rays.

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Outpatient Surgery: A surgical procedure in which the patient is not required to stay overnight in a hospital.

Pectoralis Major: A muscle located in the upper chest which provides support for the breasts and is necessary for arm movements.

Postoperatively Adjustable Implant: An implant that allows the volume to be adjusted, after implantation, within a specified range.

Prosthesis: Any artificial body part.

Ptosis: Sagging. Breast ptosis is usually the result of normal aging and the pull of gravity or changes caused by pregnancy or weight loss.

Radical Mastectomy: Removal of the breast, underlying muscles and underarm lymph nodes.

Saline: A solution that is made up of water and a small amount of salt. Approximately 71% of an adult's body weight consists of this saltwater solution.

Sensory Nerves: The nerves that conduct afferent impulses from sensory receptors to the brain or spinal cord.

Sepsis: The presence of various microorganisms, their poisonous products, or their toxins in the blood or tissue.

Silicone: A material that is widely used in medical implants, composed primarily of silicon, carbon, hydrogen and oxygen.

Silicone Gel: Silicone produced in a semisolid, semiliquid state, used as a filling in breast implants, similar in consistency to a normal breast.

Simple Mastectomy: Removal of the breast only.

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Thrombosis: The formation or development of a blood clot.

Tissue Expander: An adjustable implant that can be inflated with salt water to stretch the tissues at the mastectomy site.

Tram Flap Reconstruction: Breast reconstruction that utilizes the patient's own lower abdominal tissue and muscle to build a breast mound.

Courtesy of Mentor

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Storing Fat Cells for Future Injections

There is a desire by some to freeze their fat CELLS FOR FUTURE USE in COSMETIC INJECTIONS. Fat works as the safest filler for nasolabial folds, cheeks, and eye hollows. Using fat tissue from your own body has the added benefit of allowing your own STEM

CELLS TO IMPROVE COLLAGEN GROWTH and blood flow, an advantage over using synthetic injectables like Juvederm and Restylane. The September issue of Bazaar reports that plastic surgeons are recommending their patients to place their fat “on ice,” particularly AFTER LIPOSUCTION. The first fat bank in the United States, BIOLIFE CELL BANK in Dallas, has had an increase in activity since late last year, with the number of people banking their fat doubling every three months.

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Meanwhile, a plastic surgeon in Orlando, Florida has also opened a “fat bank,” the Liquid Gold Center. Freezing the fat at a negative 192 Celsius degrees, it can be defrosted later for use in cosmetic injection procedures. The doctor says that his patented method of freezing fat benefits patients by making extra surgeries to harvest fat unnecessary. . The Ideal Age to Harvest Your Fat Cells Don’t wait until your 50s and 60s to harvest fat – the best age to remove and store fat cells is during your 20s, 30s, or 40s, when your stem cells are still potent. Fat is able to be banked for at least 20 years. Therefore, if you bank it at 30 years of age, you can use it for cosmetic injections when you’re 45 years old, the common age where fat loss and tissue descent happen. Thanks to new liposuction techniques, the process of harvesting fat has improved and become more reliable. New and gentler liposuction techniques used by BODY-JET and VASER break down fat into small particles and then use a low pressure vacuum to suction it out. What If You Don’t Need Liposuction? Your plastic surgeon can remove 10 or 12 ounces of fat from your thighs or buttocks -- which is enough fat to use as filler for a lifetime – within an hour and without pain.

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The Procedure and Costs After your fat is harvested, it is shipped to the bank, where it is stamped with a barcode and put into liquid-nitrogen vapor as a preservative. The fat storage costs $1,700 for the initial first year, and then $200 a year after that. All in all, the procedure can cost $2,500 and up. When it’s time to use some fat filler for a cosmetic procedure, a part of your stored fat and stem cells is divided and recombined, put into a syringe, and shipped to your doctor’s office via Fed Ex for about $2500. Although this may seem pricey, an article in Bazaar magazine reports that if you re-inject the fat in five years, it costs approximately the same as paying for Juvederm and Restylane injections twice a year for five years. To store 250 to 300 cubic centimeters of fat, the Gold Center charges $900 for the first year and $200 every year after that.

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Frequently Asked Questions

WHAT IS FAT GRAFTING? Fat grafting is a cosmetic procedure in which your own fat is used to rejuvenate the face, augment the cheeks or lips, or correct problems such as hollowness around the eyes or acne scars. Many people lose facial fat as they age and develop a hollow or gaunt look. Fat grafting can be used to correct this and give a younger, more refreshed look. Fat grafting is also referred to as free fat transfer. Some of the fat re-implanted is reabsorbed within a few months, but some of the augmentation will be permanent. AT WHAT AGE CAN FAT GRAFTING BE PERFORMED? Fat grafting can be performed at any age. For lip or cheek augmentation, it is usually done anywhere from age 20 up. It is often done on people in their 40s or 50s for correcting the hollowness that can come with age (or to correct the removal of too much facial fat in a previous cosmetic surgery). WHAT DOES A TYPICAL FAT GRAFTING CONSULTATION ENTAIL? You and your surgeon will discuss your medical history. You will have the opportunity to see photos of his/her patients to give you a realistic idea of what you might expect.

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HOW IS FAT GRAFTING PERFORMED? The fat used in fat grafting is taken from elsewhere in your body. This fat is treated to concentrate viable and whole fat cells, which are then carefully re-implanted into the treatment area. The re-implantation is done by injection with a small blunt needle. This is a simple in-office procedure in most cases and is done under local anesthesia. WHAT SHOULD I EXPECT POSTOPERATIVELY? You can expect to be swollen, a bit bruised, and a little sore both at the treatment site and the donor site. This is normal. You should keep the treatment area as still as possible for the first few days to allow proper healing. Avoid high-impact exercise or activities for the first two to three weeks, depending upon the extent of the surgery. WHEN WILL THE STITCHES BE REMOVED FROM MY DONOR SITE? Typically stitches are not used at the donor site (they are not needed). There may be a single suture at the corner of the mouth to release the attachment to the nasolabial fold. WHEN WILL I BE ABLE TO SEE THE RESULTS? You will be a bit swollen at first and it might look like you were too augmented. This is usually just due to the swelling. The swelling will subside and you will usually be able to see your true results in three to four months. At about four months, we will be able to see the final results: any volume remaining should be the result of viable (living) fat cells, which should be quite long lasting. “What you see at four months, you’ll see at four years.”

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WHAT ARE THE RISKS OF FAT GRAFTING? The risks for fat grafting include infection, asymmetry, fatty cysts, hematoma, fat embolism, seroma, and permanent discoloration from the bruises. Most complications are rare. ARE THE RESULTS PERMANENT? It depends. Fat grafting is an inexact science and it is difficult to predict precisely how much of the graft will “take” and survive. Fat grafting typically survives better in areas with little movement (under the eyes) than in areas with a great deal of movement (lips).

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