Fat can also be transferred to the backs of the hands, and even the eye area, which requires an intimate understanding of the area’s structure, like the expertise of a plastic surgeon or oculoplastic surgeon such as Dr. Douglas. “Fat transfer in this area is usually a relatively small procedure with rapid recovery and results that are long-lasting with highly desirable improvement in appearance,” he explains. “I most often use micro lipoinjection or autologous fat transfer when I remove some excess fat from specific areas of unneeded or unwanted healthy adipose tissue and place it in and around the tear trough, by injection, to fill the hollows.
However, autologous treatments aren’t without their disadvantages, from stem cells’ lack of clinically proven effectiveness in aesthetic treatments to fat’s unpredictable longevity. “The volume you will get is less and may require repeat treatments,” according to Wayne, NJ facial plastic surgeon Jeffrey Wise, MD. “The take-rate is 25 to 50 percent, which makes it challenging to predict how much volume the patient will see. ” That retention, however, will last forever, and fat will also improve the quality of the overlying skin, which does not occur with synthetic fillers.
However, it’s worth noting that this procedure has one of the most difficult—and risky—recovery periods. “You can’t sit or lie down on your buttocks because putting pressure on them can kill the fat cells that were injected,” he explains. “Additionally, fat transfer to the buttocks carries the dubious distinction of having the highest mortality rate of all elective cosmetic surgery procedures. ” This is due to the risk of fat making its way into the large veins of the gluteal region, causing fat embolism to the lungs. “It is important that your surgeon follow the guideline for safe fat transfer set by the major cosmetic surgery societies in the world such as ASAPS and ISAPS.
There’s also a few days of downtime with fat transfer, whereas fillers have no downtime. “Patients who get fat transferred for facial contour often get it simultaneously with other procedures, such as a facelift,” says New York plastic surgeon Craig Baldenhofer, MD, who explains that, in these cases, it’s often under local IV sedation or general anesthesia. “Fat transfer for lip augmentation can work, but fat is happiest in areas that don’t move a lot,” Dr. Shah says. “Because we move our mouths with talking and chewing, the motion can cause more reabsorption of the fat.
The two most common versions are follicular unit strip surgery (FUSS) and follicular unit excision and extraction (FUE). “With FUSS, a thin strip of tissue is taken from the back of the head and then slivered and dissected into the individual naturally occurring follicular units,” explains Beverly Hills, CA hair restoration specialist Dr. Craig Ziering. “During an FUE procedure, the follicular units are harvested one graft at a time using either a handheld device or the hair surgery robot,” which will leave tiny individual scars, in contrast with FUSS’s thin, linear scar across the back of the head.
Shah echoes the enthusiasm. “I am very excited about the role nanofat injections will have in the future in terms of stem cell treatments on the skin and scars,” he adds. “Additionally, amniotic membrane-sourced growth factors for hair treatment and wound healing,” while not FDA-approved, “are showing some interesting results.
By definition, autologous describes any cells or tissues that are obtained from and then used on the same individual. “It means ‘from yourself’ or the same tissue composition, as opposed to an allogenic procedure, which would be using something foreign or from others," explains New York plastic surgeon David Rapaport, MD.
Fat alone isn’t the only option for transferring tissue in this area. “When doing a blepharoplasty, I often use a range of autologous procedures to lift and hold up the eyelids in the right place, borrowing tissue from the mouth, which shares many properties with the eyes inside the ocular region,” Dr. Douglas says. “It is moist, stable, soft and supple, and offers great benefits, including offering contour and holding its shape for many, many years when placed inside the eyelids to reconstruct them.
Aesthetic medicine has been equally ingenious in the category, finding ways to enhance one’s contours with fat harvested from an area of the body that can spare it, improve the results of treatments through the introduction of a patient’s own platelet-rich plasma (PRP), and add hair nearly anywhere it’s desired, from the top of the head to the eyebrows.