Fat transfer has seen a revival in recent years. Although the first reported cases of transplanting a patient’s own fat to other areas date back to the late 19th century, it has not held much promise until the last few decades. The main reason why fat transfer was slow in becoming was due its poor tenacity. Fat has a very limited blood supply; and needs to be handled very carefully. The original fat harvesting technique involved anesthetizing the donor area with a lidocaine solution; and aspirating the fat into a large barrel syringe. The collected fat then needed to be separated by centrifuge. Both of these steps are highly operator dependent; and even in the best of hands, the fat is only partially viable with this method. There is a certain amount of trauma to the fat cells, during the harvesting and separating technique, that can injure the cell membrane of fat cells – making them useless for grafting.
The next step needs close attention to detail as well; and that involves injecting the fat into the recipient area. We already know that the fat is very sensitive to any trauma. It cannot be injected through very small needles or cannulas; since that can be harmful to the fat. It’s also very important to make sure that the fat is injected evenly, and to areas where blood supply is not questionable. Once the fat is placed into the recipient area, the goal is to have the fat cells develop connections to a nearby blood supply by a process called angiogenesis, or neovascularization. It stands to reason that the best chance of survival is at the interface (of fat and blood supply). Fat surrounded only by other fat does not do well; and undergoes what’s termed central necrosis. This means that unless the transplanted fat is “touching” other tissue with good blood supply, it will not survive.
Recently there has been a great interest in adding PRP to the transplanted fat. The goal is to improve the fat retention, or survival, rate. Several well conducted studies have shown exciting and very promising results. Recently at the annual cosmetic conference sponsored by the National Society of Cosmetic Physicians (NSCOP) in Tucson Arizona, the subject of PRP in fat transfers was a hot topic. The results showed increased retention, and overall enhanced wound healing. No doubt we are witnessing a very promising role of PRP in fat transplantation.
This information was written by our specialty expert, Dr. Paul Fondacaro. You can find more information about Dr. Park Ave on his website at: http://www.drparkave.com
