Microfat grafting Orange County Microfat Grafting Fat Transfer to Face
MICRO FAT GRAFTING INTRODUCTION
Have you ever wondered if you could take a little excess fat from this part and put it somewhere else where you’d like an enhancement? Our skilled surgeons can now remove unwanted fat from one area and use it to enhance cheeks, nasolabial folds, Marionette lines, lips, chins, hands, skin depressions and scars and even the buttocks (Brazilian Buttocks Lift). Microfat grafting is a safe, natural, non-allergenic procedure to add fullness wherever it is desired. These fat grafts last longer in larger areas of non-movement like the cheeks than they do in dynamic areas like the lips. Microfat grafting is very effective in the cheek areas and can be used to correct the appearance of aging hands.
The following information has been prepared to familiarize you with facts about the surgical procedure known as microfat grafting also called fat transfer. You are requested to read this information thoroughly and to discuss any questions which might arise with your surgeon before you give your consent to have this procedure. You are also requested to keep this form as a reference in the postoperative period.
Microfat grafting is a time tested technique that uses your own fat cells to fill an area of deficiency.
It is most frequently used as an adjunct to facial surgery to help rejuvenate the cheeks, midface and areas around the eye. Strategically placing fat into the face often produces subtle rejuvenation. As we age our faceslose the fullness of youth and the ideal substance to restore our own fat. Lips thin with age and microfat grafts to the lips can make them look more youthful as well. Much has been written recently about stem cell facelifts and Vampire Facelifts ®. In these procedures, platelet rich plasma and fat are injected under the skin and the benefits are purported to be from the stem cells in the tissues. The stem cell facelift, a misnomer as nothing is lifted, entails taking liposuctioned fat and injecting it into the hollows of the cheeks or around the eyes. Injecting fat in such a manner will cause the face to look more youthful. There is little scientific research to support claims that the improvement is due to transferred stem cells and it is most likely that the benefits derive from the transfer of fat to an area of deficiency!
Microfat grafts have been very effective in rejuvenating hands as well, adding a little subcutaneous tissue in older hands in which the fatty layer has dissolved with time. Microfat grafts can be used to enlarge a buttocks, the so called Brazilian Butt Lift procedure, but in our experience, most women who are thin and would like their buttocks enlarged do not have sufficient fat donor sites to effect a significant buttocks enlargement, and may be better served with buttocks implants. Microfat grafts can also be utilized to fill deformities in extremities or the trunk caused by overaggressive liposuction, other injuries or ones with hereditary causes, but the procedure is less effective for these purposes. The problem with any microfat grafting procedure is the unpredictability of fat survival.
Harvesting of the fat is usually done from the abdomen or thighs using specially designed cannulas. Harvesting entails making an incision and aspirating fat from an area of excess – this is difficult to do in an office setting without saturating the donor area with local anesthesia, something preferably not done in order to enhance graft survival. The ideal technique uses a delicate harvesting and processing procedures with the patient sedated in an operating room, in order to enhance the viability of the transferred fat and long-term permanence. Fatty tissue is very fragile. Microfat harvesting usually allows a certain portion of the fat to survive the transplantation but a surgeon can NEVER predict in advance when the grafts will survive and when they will fail.
Once placed, the body may accept the transferred fat with ingrowth of blood supply to the transplanted fragments, leading to a permanent correction – or the blood supply many not develop and the fat will dissolve in a few months, similar to what happens after a Juvederm® or Restylane® injection.
A common question is, "How long will the results of this procedure last?" The traditional fat grafting techniques from the 1980’s had a very high, almost universal resorption rates, but the newer techniques employing tiny cannulas and transplanting microfat globules, increases the chance of success, with perhaps 50% or more of the fat lasting indefinitely (more likely to succeed in the face, less so in trunk and extremity deformities). Conversely, as one gains weight, the grafted areas could gain in volume!
MICRO FAT GRAFTING PREOPERATION PREPARATION
You may visit your surgeon as many times as you wish, to have all of your questions answered. At your final preoperative visit, your final questions will be answered and you will confirm that you understand the procedure to be performed, that this material has been explained to you, that you have read and understand these information sheets, and that you accept the risks by signing the informed consent forms. You will be given prescriptions for pain pills and antibiotics along with instructions for their use. Certain laboratory tests will also be required within two weeks of surgery. If you are over the age of 50 or if you have any history of cardiac problems, you will have to obtain a cardiogram at your doctor’s office and any certified laboratory. You may have blood drawn by our office nurse during your final preoperative
visit, or, if you prefer, at your family doctor's office or any laboratory (e.g. Kaiser Hospital, etc.). All patients will be asked to stop smoking at least a month prior to surgery in an effort to maximize your body's ability to heal the incisions following the operation.
Patients should shampoo they hair the morning of or the night prior to surgery. Absolutely nothing may be taken by mouth after midnight prior to the day of surgery (except medications prescribed by your family doctor, but please mention these to the anesthesiologist in advance.)
Sometimes, your anesthesiologist will call you the night before surgery to discuss the anesthetic care plan with you. But if you miss the call or your anesthesiologist does not call you, do not worry as you will be able to discuss your anesthesia and have all your questions answered in the morning, at the Surgery Center prior to your procedure (Orange County Surgery Center in Newport Beach, Southern California or Tracy Surgery Center in Tracy, Northern California). It is absolutely imperative that you make arrangements in advance to have someone drive you to and from the surgery center on the day of your operation. Most patients who choose to have a fat grafting procedure by itself can go home with any responsible adult who can spend the next 24 hours with you at home – if you choose to have a traditional facelift in addition to the midface procedure, care by a trained nurse for the first night will be imperative.
Please wear loose fitting clothing, which will be easy to get off and on after the operation. When you arrive for your operation, please give the receptionist the name and phone number of the person who will take you home and spend the first night with you. Wear no makeup to the surgical facility on the day of surgery, and do not apply facial moisturizers.
All patients anticipating an elective surgical procedure are to stop taking any medication containing anti-inflammatory agents (Aspirin®, Advil®, Motrin®, etc.) as these interfere with the body’s clotting mechanism and can result in dangerous blood loss and excessive bruising.
MICRO FAT GRAFTING OPERATION
The operation will be performed at an outpatient facility under a very light general anesthetic or a deep sedative, supplemented by local anesthesia, to insure your comfort. A very short stab wound, typically within the navel, is used for harvesting the fat. Tiny stab wounds are also made where the fat is to be injected, usually not much bigger than needle pricks that heal without visible scarring.
MICRO FAT GRAFTING POST-OPERATIVE CARE
Adequate pain medication will also be prescribed. Discourage massage and excessive facial animation immediately following facial fat grafting. These restrictions are to prevent migration of fat away from the desired areas of treatment. Compression dressings to prevent migration have been described; however, they are often difficult to maintain and probably add little to the final result. Ice compresses may be applied for 24 hours to minimize swelling and bruising.
FOLLOW-UP CARE AND SOCIAL ACTIVITY
Patients should be seen in the first week postoperatively to check the donor and recipient sites. Some edema and a minimal amount of bruising may be apparent. An additional follow-up appointment should be made for approximately 6-8 weeks. At this point, most of the edema has subsided, and early results can be assessed. Whatever fat persists at the 6 month follow-up visit will likely be a permanent success! Social activity should be limited while the patient is uncomfortable. Basically, most patients find that they can return to normal activity as the discomfort of the operation fades away.
MICRO FAT GRAFTING POSSIBLE COMPLICATIONS
The major concerns following fat grafting are related to under correction and over correction. Under correction can be the result of the placement of less than the required amount of fat or from the resorption of some of the graft. Under correction is easier to treat than over correction. Additional fat may be grafted at a separate sitting to complete the correction. An overcorrection or the development of a firm scar layer around the transplanted fat can lead to a visible and palpable mass – the only way to effectively remove this is through an open surgical procedure. It is important that you understand that the patient is responsible for all costs associated with all secondary surgical procedures or for the treatment of any complications that may arise as a result of this elective surgery.
Damage to underlying structures, particularly around the eye, is possible but exceedingly rare, reported in the literature but never seen at our office.
Swelling is usually evident for 2 weeks after the procedure; however, as with any procedure, prolonged swelling is possible. Bleeding complications usually are limited to transient mild bruising. Additionally, donor site scarring is a potential concern. Contour irregularities can result from overly aggressive harvesting in a small area.
This procedure is not covered by insurance. The office staff can assist you to obtain financing if desired. In compliance with suggestions adopted by the American Society of Plastic Surgeons®, it is customary for the patient to pay all fees for cosmetic surgery prior to the desired operation. This insures that the patient is sincere in her motivation and can afford the surgery, thus creating a better patient/ physician relationship. A non-refundable deposit will be required to secure your desired surgery date. The remainder of the fees must be paid prior to the surgery, usually at the time of the preoperative visit, but no later than two weeks before surgery. Additional fees are also required for laboratory tests, surgical facility fees, the anesthesiologist, and if necessary, mammography.
If additional surgical procedures become necessary, additional facility, laboratory, anesthesia, implant costs and professional fees will be incurred. The surgical facility and anesthesiologist fees quoted will be based on our best faith estimate; the final fee may vary as these fees are based on surgical time, and it is not always possible to predict exactly how long a procedure will take to complete.