Fat Grafting

Fat grafting is a wonderful new procedure that has become a standard addition to plastic surgeon’s armamentarium in recent years. Every month we are discovering new uses for it and new understanding into how it works. Full potentials of fat grafting will no doubt be realized more in future as research improves our understanding of several aspects of this new graft. Fat tissue can harvested easily and grafted to areas where there is a need. Fat tissue seems to be rich in stem cells and other cells which, when taken together have a lot of restorative, augmentative and regenerative properties.

Dr. Mohan Rangaswamy inducted fat grafting into his practice in 2002. His first case was a man who had very atrophic and skeletonized hand following a nerve problem. His hand was so bony that he used to hide it and was averse to shaking hands with others. Dr. Mohan performed multi-planar micro-fat grafting on this gentleman with spectacular results. The results are still stable 7 years later. Encouraged by this success and with the unfolding of new knowledge, fat grafting became an increasingly important part of our practice.

Benefits of Fat grafts:

• Brings fresh new tissue to the area both for volume improvement and rejuvenation
• Simple method
• Natural and permanent filler with no adverse side effects
• Applicable to most parts of the body
• Can be repeated
• Can be used in creative and imaginative ways to solve several problems

How is it done? Fat Transfer involves giving local anaesthesia to both the donor site (area from which fat is taken) and the recipient site (area to be treated). A blunt needle (cannula) attached to a syringe is inserted onto the donor site in a location which has a thick layer of fat such as the lower stomach, thigh or buttocks. Fat cells are drawn into the syringe and then purified. These fat cells are living cells. They are then carefully re-injected into the receiving area to build up a 3 D arrangement of fat cells. The process is repeated till the defect has been corrected. Since some amount of fat is always resorbed a repeat session or two may be needed to achieve stable correction.

Why do some doctors say fat does not stay? This often heard statement is born out of ignorance or out of seeing results of bad technique. Fat must be harvested, handled and transplanted very gently and using precise technique and precautions. It must be grafted as micro grafts or droplets such that each droplet is surrounded by living vascular tissue to nourish the fat. Done properly, fat stays well and lasts long.

Which areas can be improved by fat grafting?
Following are only some of the indications. This list is not exhaustive:

• Face: for filling out sunken cheeks, highlighting cheek bones, to get well defined chin, jaw-lines, correct minor issues with the nose, plump up and define lips, create chiselled lip contours, improve frown lines between brows and deep furrows beside the nose etc.
• Neck: to improve deep creases in the neck
• Breasts: To add volume to normal breasts [no implant], to give more natural look to breasts with implants and for breast reconstruction following mastectomy
• Buttocks: To enhance volume and give lift effect – the so called “Brazilian Butt”
• Calf: Enhance volume and contour
• Genitals: Enhance female genitalia and as part of male genital enhancement in selected cases
• Hands: To improve ‘bony’ hands, to give the appearance of youth to aged hands.
• Reconstructive: Depressed scars, burnt areas, non-healing ulcers and more

What’s New: Fat with PRP?
PRP is Platelet Rich Plasma. This is an extract of blood that can be prepared from the patient’s own blood. This is rich in platelets which in turn contain growth factors. We mix PRP with fat grafts to enhance their survival and to encourage greater rejuvenations. PRP can also be injected without the fat and has also been used to heal difficult wounds.

Breast Enlargement by Fat grafting: This is a new concept in Breast enlargement and shaping. Fat grafts are taken from buttocks or any other fat-rich areas and are transplanted to breast by injection. There are no cuts except tiny punctures for the needles. Fat cells are grafted to two areas: under the skin of the breast region and behind the true gland of the breast (same area where breasts implant is placed). Fat can also be placed inside the chest muscle. In this way one does not enter the breast gland itself. Women choosing this method of breast enlargement must remember that the gain in size can only be modest and not as dramatic as in breast implant. More enhancements can be produced in a second session 6 months later. Research by Dr. Roger Khoury has validated this method especially if combined with external Vacuum preparation of the breast by BRAVA method. The technique of fat grafting after preparation by BRAVA is currently under investigation in the USA.

Special concerns: Physicians have been somewhat hesitant to use fat grafts to augment the breasts. There was doubt whether it will work and also concerns if it will interfere with future mammographic evaluations for breast cancer. However, there is no concern that fat grafts will induce cancer. Now there is increasing consensus that it works and that it is safe. By taking a mammogram before the procedure and a year later, any calcification produced by fat grafting will become obvious and thus confusion can be avoided.

Fat grafting of breast is available with Dr. Mohan. The method is used only if patients fulfil certain criteria.

Buttock Augmentation by fat graft: Rounded and firm buttocks are a sign of feminine beauty in most cultures. A full butt is once again becoming popular and is recognized as desirable. The butt – waist ratio of 1.5 to 1.6 also fulfils the golden proportion of beauty (Leonardo da Vinci). Some may have an ample bottom, but it may not be shapely enough. By using a combination of liposulpturing and fat grafting, the curves in this area can be improved vastly. For women with deficiency in this area and ample fat elsewhere, fat grafting is an ideal method and is preferred over silicone implants. While both methods are available in my department, I prefer fat grafting wherever possible.

150-300 ml of fat can be grafted to each butt cheek in one session, some women need two sessions. Fat is harvested from hips, upper and mid-back, abdomen or inner/outer thighs usually. These areas are also benefitted by the reduction – this is a free bonus.

Before & After Images

Before and After photographs of plastic surgery are an important aspect of patient education and communication. For your interest, this gallery represents a variety of procedures that I perform and contains only photographs of my own patients. Depending on your area of concern, you will be invited to view other representative photos during your consultation.

Note: Appropriate Before and After pictures can be viewed during consultation.