Not All Fat Processing Is Equal

This is part 2 of a 2 part series

Part 1: Fat Grafting: Problems & Opportunities

Over her decade of fat-grafting experience, Kamakshi Zeidler, M.D., has used every system available. However, she likes the Puregraft system (Puregraft LLC) for its effective filtration and ease of use.

“Not all fat processing is equal,” she emphasizes.

Removing blood and contaminants during processing removes a significant volume before arriving at pure fat, she says, but it's absolutely crucial for optimal results.

In one study, researchers found that processing fat with Puregraft produced significantly higher adipose tissue viability and significantly less red blood cell and free lipid content compared to gravity separation and Coleman centrifugation.⁴

Fat-grafting results have been studied most thoroughly in corrective breast procedures. In a 26-patient prospective study of the Puregraft procedure, Sforza et al. showed a resorption rate of 27.5 ± 0.8% (mean ± standard deviation) at one year.⁵

“We tell patients they can expect roughly a 75% take,” says Dr. Zeidler.

In the midface, one study showed an average retention rate of 41.2% at 17 months.²

When rejuvenating the midface, she says, some patients clearly require surgery. In other cases, she says, the need for surgery can be debatable. For example, a patient in her mid-40s who wants to look her best but feels she looks tired, Dr. Zeidler explains, either fat transfers or fillers may provide highly satisfactory results.

“Various products can be used in various areas to achieve very beautiful, natural results. My counterargument is that it’s sometimes hard to compare with the long-lasting results of a very mini facelift with fat transfer, particularly in the upper cheek region, to achieve a radiant, youthful glow.”

For the eyes, Dr. Zeidler frequently uses nanofat — essentially broken fat cells — in conjunction with upper and lower blepharoplasty. She says that although data are lacking in this area, she employs nanofat in much the same way that platelet-rich plasma is used.

In calculating fat volumes, Dr. Zeidler typically overcorrects by 25%. Three months post-procedure, she says, patients may have a minimal amount of residual swelling and a significant improvement in upper-face volume and skin tension.

"Younger patients are looking for this, particularly in the tear-trough region." Here, she says, many aesthetic fillers can provide durable results, but not the long-lasting corrections of fat transfer.

Often, adds Dr. Zeidler, younger patients seek augmentation of the lid-cheek junction, along with the lips, which are a very popular treatment target. Fat transfer can provide lasting results in these areas as well, including correction of lip asymmetries, she says.

“As a caution, filler is much more powerful in changing the shape of a lip. If patients really want to ‘poof’ their lips, fillers are going to be more successful.”

Overall, Dr. Zeidler says, fat grafting presents both problems and opportunities. Presently, she explains, the technique is rarely used for facial filling. “But could it be? It's perceived as invasive, surgical, messy, unsterile and time-consuming — an operating-room procedure.”

However, that may not always be the case. Dr. Zeidler says she's excited about new technologies under development, particularly the Dermapose Access and Dermapose Refresh devices (Puregraft), which are kits designed to allow office-based procedures. Using a small suction cup much like Cellfina (Merz) or CoolSculpting (Allergan), the new devices suck up a small bulge of fat and withdraw tumescent liposuction contents straight into a syringe.

“The syringe has a built-in filtration system. You can just push the fluid through,” says Dr. Zeidler “The system processes and cleans it with the same type of predictability and reduction of contaminants that we see in the operating-room system.” Within 20 minutes, the technology can provide a very fine filler for injection through a syringe.

“Think about fat as an option as new techniques and devices come out,” says Dr. Zeidler. “Consider joining the trend. These new technologies may make it a little bit easier to do office-based procedures.”

Article based on Dr.Zeidler presentation “Fat transfers versus fillers: a plastic surgeon's thought process on choices,” last year at The Cosmetic Bootcamp, Aspen, Colo. June 21, 2019.

REFERENCES:

1. Gerth DJ, King B, Rabach L, Glasgold RA, Glasgold MJ. Long-term volumetric retention of autologous fat grafting processed with closed-membrane filtration.Aesthet Surg J. 2014;34:985-994.

2. American Society for Aesthetic Plastic Surgery. Cosmetic (Aesthetic) Surgery National Data Bank Statistics, 2018. https://www.surgery.org/sites/default/files/ASAPS-Stats2018_0.pdf. Accessed October 4, 2019.

3. Zhu M, Cohen SR, Hicok KC, et al. Comparison of three different fat graft preparation methods: gravity separation, centrifugation, and simultaneous washing with filtration in a closed system. Plast Reconstr Surg. 2013;131:873-80.

4.Sforza M, Andjelkov K, Zaccheddu R, Husein R, Atkinson C. A preliminary assessment of the predictability of fat grafting to correct silicone breast implant related complications.Aesthet Surg J. 2016;36:886-94.

DISCLOSURES:

Dr. Zeidler reports no relevant financial interests.