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TriBeCa Plastic Surgery

Sydney R. Coleman, MD  |  Mary Lombardi, PA-C

As we age, fat tends to accumulate in places hard to reach with diet and exercise alone.

Stubborn fat can appear on parts of the body such as the abdomen, hips, back, and thighs. Fortunately, with fat grafting we can now remove this obstinate fat and use it to enhance other areas of the body.

What is Fat Grafting?

The fat grafting procedure, also known as fat “transfer” or “LipoStructure®,” naturally enhances the face and body by providing volume using your own fat cells. During the procedure, unwanted fat is removed from one part of the body via mini-liposuction. The fat is purified using a centrifuge and then carefully injected with specialized blunt needles (cannulas) into the areas needing improvement.

Fat grafting can improve the following conditions:

  • Skin laxity in the eyebrow and upper eyelid regions
  • Hollows in the temples, below the eyes, and in the cheeks
  • Deep nasolabial folds
  • Thin lips
  • Drooping skin on the chin and jawline
  • Thin, bony, or aged hands
  • Irregularities in the skin resulting from liposuction
  • Depressed scars
  • Breasts that are small or misshapen secondary to nature or previous surgery (including implants)
  • Flat buttocks
  • Undefined calf muscles, sometimes resulting from nerve injury or trauma

Who is a Good Candidate for Fat Grafting?

Ideal candidates for fat grafting have:

  • Good physical health
  • Good mental health
  • Enough excess fat to be removed from certain areas to be used for augmentation of the volume-deficient area
  • Realistic expectations

Facial Rejuvenation

When we are young, our facial skin is nicely padded with a natural layer of fat around the eyes, cheekbones, temples, chin, and jawline. However, factors such as sun exposure, stress, and natural aging can cause that layer of fat to disappear, allowing wrinkles and hollows to form. In the upper face, the shape of the skull and rims around the eyes may become more visible. The eyebrows can also lose some of their volume and drop toward the eyes, which can make the eyes look more sunken in and project an angry expression.

Fat grafting can correct these problems and provide a plumper and more youthful face that looks healthier. Patients who desire lip augmentation can also benefit from fat grafting to achieve their desired results.

Hand Rejuvenation

As we get older, even if our face has a rejuvenated appearance, our hands tend to give away our age. Over time, we lose volume in our hands, and the smooth, youthful surface becomes replaced by visible veins and tendons. The skin becomes thin and wrinkled, allowing the bones and underlying structures to become more prominent.

Fortunately, with the fat transfer procedure, a thin layer of fat can be placed in the back of the hands to restore volume and smooth out the skin. The fat is injected through small incisions between the fingers and in the creases of the wrist with minimal pain and a rapid recovery, resulting in youthful-looking hands.

Correction of Liposuction Deformities

Any patient who undergoes liposuction can be faced with its most common complication: superficial surface irregularities. Some of these irregularities are exaggerations of preexisting problems, some are caused by cellulite, and some are newly created. The thigh and abdomen are particularly prone to irregularities, and physicians have come to accept such indentations as an acceptable outcome of liposuction. Structural fat grafting can be used to smooth many of these surface irregularities.

In addition to the issue of surface irregularities, changes in body proportion can sometimes occur after liposuction, resulting in an unnatural or bizarre shape. For instance, a dramatic decrease in the size of a woman’s lateral thighs without an appropriate decrease in the size of the waist can result in a “boxy” and even masculine appearance. Flattening the lower abdomen without addressing the upper abdomen can add to this “boxy” appearance. Minor reductions in the volume of the buttock or lengthening and deepening of the buttock crease can make the buttock appear droopy. Structural fat grafting is an essential tool, and often the only tool available, to address deformities created by the removal of too much fat in certain areas.

Scar Correction

Fat transfer can correct depressions in the skin resulting from scarring. As the harvested fat is injected and fills in the indented scar, the depression becomes plump and rises to the level of the rest of the skin, resulting in a smooth surface.

Breast Augmentation and Contouring

Breast augmentation by fat transfer involves suctioning fat from problem areas of the body and injecting it into the breasts. Dr. Coleman innovated the LipoStructure® technique used for this procedure, which we also use for augmentation. The LipoStructure® technique is used not only for breast augmentation but also to “fine tune” breast reconstruction after lumpectomy or mastectomy and to disguise the edges or rippling of existing silicone gel and saline implants. The cannula is slid in and out of the treatment area to essentially “weave” layers of fat to achieve the desired contours.

Buttock Augmentation (“Brazilian Butt Lift”)

The addition of fat to the buttocks for augmentation purposes has become increasingly popular. Fat placed in the buttocks for enlargement can balance out a larger upper body, making it more proportional. It can also be used to round out buttocks that are flat without making them significantly larger. Depending on the degree of augmentation desired, a considerable amount of fat might need to be suctioned from another part of the body. This can be an added benefit for someone who has excess fat elsewhere that they are unhappy with. Small incisions are used for the removal and placement of the fat, and the results look and feel entirely natural.

Calf Augmentation

Fat grafting to the calves may be performed for several reasons. Individuals born with small or thin calves may desire an augmentation to make their calves more proportionate with the rest of their body. Fat may also be injected into the calf or calves of patients who have had atrophy, or shrinking, of the calf muscles caused by nerve injury or trauma. Small incisions behind the knee or near the ankle are used for fat placement to provide natural results.

Before Undergoing a Fat Grafting Procedure

During your initial consultation, we will evaluate whether you are a good candidate for the procedure. We will then explain the procedure and answer any questions you may have to ensure that you fully understand the risks and benefits of fat grafting.

Before surgery, all patients must undergo a pre-procedure evaluation. Your full medical history will be evaluated, and a physical examination will be performed. You should inform the doctor if you have a family history of abnormal swelling or bleeding after a procedure.Your smoking history should also be disclosed during this preoperative visit. Photographs will be taken to be compared to the final results of the fat grafting procedure.

How Invasive is Fat Grafting?

Fat grafting is a minimally invasive procedure. Either local (‘twilight’) anesthesia or general anesthesia will be used for the procedure. Using sterile techniques, a special suction cannula (thin, hollow tube) is used to harvest the fat through small incisions in the skin. After it is purified, the harvested fat is injected through tiny, inconspicuous incisions with a small cannula into the specific area requiring augmentation.

Fat Grafting vs. Fillers

While fat grafting uses the patient’s own fat to provide volume to certain areas, fillers use natural or synthetic materials harvested from other sources to provide enhancement. The only filler that requires skin testing before use is collagen, which is rarely used anymore. With fat grafting, you are using your own fat tissue for enhancement, which means that there is no chance that your body will reject the injected fat cells, and there is no risk of an allergic reaction.

Fillers, like fat grafts, are used to provide volume and reduce wrinkles in the face and hands. They can occasionally be used in the body to fill small defects, but they do not provide enough volume to be used for a significant augmentation of the body. Fat grafting provides natural-appearing results that will be long lasting.

What to Expect after the Graft

After the procedure, dressings will be placed on the donor as well as recipient areas. Compression garments should be worn on the liposuctioned area(s), and patients should avoid putting pressure on the fat grafted sites to allow the fat cells to settle in without disturbance. Temporary bruising and swelling may be apparent in the treated areas, but these conditions usually resolve within two or three weeks. The augmented area is often slightly overfilled due to the natural reabsorption of some of the fat, and the contours will improve as swelling decreases. As the fat adapts to your body, the new contours will become apparent.

Our skill and expertise with this procedure allow us to know how much fat to harvest and how much fat to inject to achieve enduring results. However, occasionally a touch-up procedure may be needed to improve the outcome of the original surgery.

If you are interested in fat grafting to eliminate stubborn fat and provide volume to almost any area of the body, please feel free to contact TriBeCa Plastic Surgery by calling (212) 571-5200 or filling out our online consultation form. We look forward to hearing from you!

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