Adipose Tissue Transfer
3 December 2019 onur
During the aging process, an “adipose tissue distribution disorder” occurs on our face. The medical name for this condition is “Senile Facial Lipodystrophy”.
When you put a person’s photographs in their 40s and 20s side by side, one of the most striking changes will be how much the total volume of the face has decreased. As we age, the fat tissues in the face gradually decrease. This decrease is so regular and so slow that you cannot notice the change even though you see your face in the mirror every day. More interestingly, while some areas of the face lose volume, the volume of fat tissues increases in some areas (e.g. under-eye bags and under-chin fat pad).
Adipose tissue transfer is one of the most effective methods available in the treatment of volume loss during aging. As the name suggests, adipose tissue transfer requires taking the adipose or fat tissue from one part of the body and transferring it to another part of the body. In this process, fat is taken from a certain part of the body using special cannulas (a kind of liposuction), then it is passed through various processes and given to the desired area by means of small cannulas. You can imagine a cannula as a blunt needle. Therefore, adipose tissue transfer is almost like an injection process and is also known as “fat injection”.
Since the fat harvested in the adipose tissue transfer process is removed from their natural environment, a significant part of the cells die during fat harvesting. Cells that are still alive after the injection will also survive if they can find a vein to feed themselves in their new home and cling to it, and those that cannot find such veins die. Therefore, in adipose tissue transfer, a significant part of the transferred volume will be absorbed and only a small portion will persist. The extent of the transferred adipose tissue to survive depends on many factors. The percentage of survival varies according to the internal structure and diameter of the cannulas used for fat harvesting and delivery, the areas where the fat is harvested and injected, the medication used, the intermediate steps used in fat separation (filtering, centrifuging, nanofilter, etc.) and the injection technique.
In adipose tissue transfers, the size of the transferred fat particles and their survival rate decrease proportionally. For instance, survival rate in structural fat grafts is 25-50%, while the rate drops to 10-30% in microfat transfer and 5-10% in nanofat transfer. Despite this decrease in survival rate, we prefer small particle transfers in some special cases. For example, in areas where the skin is very thin, such as around the eyes or where the injection will be applied superficially, small particles are preferred because they create a smoother contour.
Another point is the application technique. In adipose tissue transfer, the cannula acts like a sewing machine inside the tissue. We get a three-dimensional pattern by delivering a very small volume inside a thin tunnel, almost as if we are knitting a braid at each crossing. It is essential that the cannulas enter and exit the tissue and be in motion continuously. Such a procedure inevitably creates a marked edema and bruising in tissues. In other words, even if we did not transfer any fat but only inserted and took out the cannulas, swelling would be inevitable and continue for a few weeks.
Due to the reasons I mentioned above, the actual volume in the early period after tissue transfer is perhaps 10 times more than the targeted final volume. Patients are usually uncomfortable with swelling in the early days, and the swelling caused by this procedure is really uncomfortable. Around 10-14 days after the procedure, swelling from tissue trauma decreases considerably and the volume of the injected fat remains. The volume we see between 10-14 days will also decrease with the removal of the dead fat by the body and the regression of the remaining edema in the following 6 weeks, resulting in the emergence of the final volume.
It is important for you to know these because our patients who have undergone adipose tissue transfer and are not adequately informed get upset, thinking “The fat has disappeared. I could not get the result I desired.” They may also be reluctant about follow-up sessions since they are disappointed. But we can reach the targeted volume typically in 3-4 sessions. If we deliver high volumes in one go to reach the target volume, the patient will have to stay away from social life for weeks due to excessive swelling and bruising in the early period. There are other risks of applying a high volume at once. The adipose tissue is “alive” and has a unique character. More than an expected amount of the delivered fat may survive at times. That’s when the problems start.
It is better for the fat to survive less than more, because if it survives less, it can be supplemented later, but if it is delivered too much, leading to irregularities due to the injected fat, a surgical operation may even be considered to remove such fat. The best example of this is adipose tissue transfers around the eyes. If a large amount of adipose tissue transfer, particularly in large particles, is performed around the eyes and if the fat survives at a higher percentage than expected in that person, new bags and visible fat cysts may emerge under the thin eyelid skin. When this becomes permanent, we can only surgically remove such fat.
Another issue in adipose tissue transfers is that the fat is delivered to a single area and cannot be distributed well enough. In that case, a swelling or a bump is formed in the given location and an abnormal, unnatural contour may occur. To prevent this, as I mentioned at the beginning, cannulas have to penetrate multiple times and deliver the fat cells into tissues.
Adipose tissue transfer is one of the most powerful applications in modern plastic surgery. It is a key procedure in facial rejuvenation. However, this procedure, like every other medical procedure, has its own limitations. Before the procedure, talk to your doctor about the estimated number of sessions that will take you to your goals, the individual and total cost of sessions, the technique to be used and the way to deal with possible complications.
For detailed information on adipose tissue transfer and to find out whether this procedure is suitable for you, feel free to contact us.
Take good care… of yourself and your beauty.