Fat stem cell grafting, also known as fat injections or fat transfer, is a procedure that involves fat stem cell transfer from one area of the body (usually a hip donor site) to another, either to improve or augment the area of interest.
The procedure involves extraction of adipose fat by liposuction technique followed by fat processing for purification and then transfer or re-injection of purified fat and stem cells into the area that needs augmentation or improvement.
Stem cells are distinguished from other cell types by two important characteristics. First, they are unspecialized cells capable of renewing themselves through cell division. Second, under certain conditions, they can be induced to become specific cells like skin or fat, for example, with special functions.
Since the 1990’s, Plastic Surgeons have extensively employed fat grafting to enhance the cosmetic appearance of breast, buttocks, face, hands, hips and feet. In the recent years, plastic surgeons have published the clinical applicability, therapeutic and reconstructive benefits of fat grafting procedure in wound healing, and scar treatment.
History of Fat Grafting
Fat grafting is actually a century-old medical technique. After the first-ever fat transplantation event, fat grafting has not gained steam for the next 100 years due to procedure-related complications. Until 1990’s, no reliable liposuction techniques was developed or standardized for fat purification and processing. Due to this limitation, the extracted fat was of inconsistent quality and the therapeutic outcomes were poor.
In the 1990’s, a New York City-based Plastic Surgeon Dr. Sydney Coleman has developed and standardized reliable analytic techniques for fat graft harvesting, processing and transfer of fat into the recipient site. After he published his findings in reputable academic medical journals, the fat grafting procedure gained popularity, and it being used extensively for a variety of therapeutic and reconstructive purposes. Dr R Sadove has been performing fat grafting since the 1990’s.
Who performs Fat/Stem Cell Grafting and where?
Fat/Stem Cell grafting procedure involves a small amount of liposuction as a preliminary step, and therefore the procedure is generally performed by trained Plastic Surgeons. The amount of fat removed is small and not evident afterwards. Dr Sadove is trained to maintain the standards of care during this small liposuction procedure as well to manage the procedure-related adverse events/complications.
Fat/Stem Cell Grafting process
Fat/Stem Cell transfer involves three main steps:
• Liposuction – extraction of a small amount of adipose fat from the donor area- usually the side of the lower abdomen
• Processing or purification – decanting and processing of the extracted fat/Stem Cells. Often a blood sample is removed at the same time, processed, and the PRP or platelet rich plasma mixed with the cells prior to re injection.
• Fat/Stem Cell Grafting – Grafting or re-injection of the purified/processed fat/Stem Cells into the recipient area that needs to be improved or treated.
The first step of grafting involves extraction of fat cells (lipocytes) and stem cells from the donor area by employing standardized liposuction methods. Manual techniques are the preferred choice of method, in which, thin liposuction cannulas are inserted through the small holes to extract fat from the donor site. Ultrasonic or laser liposuction should be avoided as it can potentially destroy the lipocytes.
After extraction, the fat is often processed by carefully spinning the fat/stem cells in a special centrifuge, or mesh, followed by washing to isolate the viable fat/stem cells from debris, dead cells and excess fluid. The discarded fat cells are usually dead cells that are unlikely to survive if transplanted. In certain cases, these cells can harm the good cells and hence it should be discarded.
Finally, the purified fat/stem cells are re-injected in small droplets into the subcutaneous tissues of recipient areas that need reconstruction/treatment. In this way, adequate blood supply to the transplanted cells and their survival (post-procedural) can be ensured.
The amount of injectable fat/stem cells is generally measured in cc’s which varies from one patient to another, depending on patient’s requirement and the recipient site.
Types of Anesthesia Used
Fat/Stem Cell grafting procedure is performed by employing a variety of local anesthetic drugs and the choice of anesthetic drug depends on the volume of fat that needs to be extracted by liposuction technique. Small volumes of fat can be conveniently harvested under the influence of local anesthesia.
As local anesthesia administration does not change your level on consciousness it can be performed by Dr Sadove in the office. You are comfortable but awake. However, General anesthesia or IV anesthesia should be administered by a Board Certified Anesthesiologist at the Surgical Pavilion of NFRMC.
Auto fat is not for Ice Pick or Box Scars. It can be very helpful in Rolling Atrophic Scars either with or without subcision.
Face Acne Scar
• Requires 10cc –20cc of injectable purified fat/stem cells in total.
• Efficiently repairs scar tissues including traumatic scars
• Restores youthful appearance by filling-in the hollow cheeks, temples and orbital area
• Corrects wrinkled areas including nasolabial folds and area below the eye(s).
• Enhances the appearance and texture of the skin.
There are soft rolling scars that can be improved with “off the shelf” filler injectable products. If injection is not successful in raising the scar subcision shold be performed. Rolling scars have smooth, sloping borders, and there are scar injection techniques capable of producing positive results.
Only injection treatments which deal with the fundamental loss of thickness of the dermis and underlying fat will raise the skin to the level of the surrounding skin.
While injectable fillers may be used successfully, they are best reserved for smaller areas of acne scar. Often the large size of the affected area makes fillers an unappealing financial option. If several syringes of a filler are required, it make more financial sense to use the patients own fat. In softer scars, they are able to push the depressed skin up to the level of surrounding skin. In such cases, fillers become a desirable option.
–Juvederm Treatment for Acne Scar– Juvederm is a large sugar molecule commonly used for cosmetic injection in the face. It is an extremely safe material, but not permanent.
–Sculptra Treatment for Acne Scar– Dr Sadove has used Sculptra successfully in soft rolling scar acne scar treatment cases where subcision was not necessary.
There is no place for injection of ice pick or box scars with fillers.