We ask plastic surgeon Dr. Bryce Cowan about the history of fat grafting, and the procedure’s safety profile. The last 2 to 3 decades have seen impressive improvements in the success rate of fat grafting, changing the landscape of the procedure.
In terms of history, fat grafting has been used in medical circles for almost a century. In recent decades, however, new research and innovations in technique have improved the success rate of fat grafting significantly. Harvesting, processing, application, and introduction of the harvested fat cells have all seen dramatic improvements, reducing errors and making for an optimized outcome.
In the past, many of the grafted fat cells were expected to die at the new site, meaning that more fat needs to be grafted than necessary to account for this. With new improvements, fat cells survive at a much higher rate, and now a surgeon uses near a 1 to 1 ratio, making the procedure more predictable and safe. These advances have allowed the procedure to be much more reliable cosmetically than in the past. Again, a major advantage of fat grafting is that the fat cells at the new site last for a very long time.
Fat grafting can be done under local anesthetic, or if it’s a larger procedure combined with other surgical treatments, general anesthetic (the kind that puts you to sleep) is used. Volume deficiency is first identified and marked, and harvest site is chosen, usually the abdomen or the flank. That area is then anesthetized or a tumescent solution is used if larger volumes of fat are required.
The surgeon makes a 3mm incision in the harvest site and using a suction based cannula system, harvest whole fat cells. These specialized cannulas avoid unnecessary damage to the fat cells. Once extracted, the fat cells are washed, processed, and then transferred to larger syringes. Then they are transferred to finer 1cc syringes for introduction.
At this stage, the surgeon uses a blunt tip cannula of appropriate shapes and sizes to reintroduce the fat cells to the new site. A 3mm incision is used, and multiple passes are made in different planes to add volume in a layered fashion. The blunt tipped cannulas minimize the risk of trauma to surrounding blood vessels and minimizes the chance of introducing fat into the vessels that can potentially cause fat emboli, a possible risk of the procedure. Once the fat is successfully introduced, a small suture is used to close the site and the area is allowed to heal with just a fine dressing.
