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Question: What is the purpose of the centrifuge in the fat transfer procedure? And how long after fat transfer can I expect to see results?

Answer: Fat transfer to the face has become a frequently requested procedure. The results of well performed autologous fat transfer are very satisfying for the patient and the surgeon. The major issue with fat transfer is being able to predict the exact amount of transferred fatwhich will survive in the transferred site. Most surgeons expect about a 20 percent reduction in the volume of transferred fat from the time it is injected to a few weeks following the procedure. Experienced surgeons are careful not to over inject the recipient site with fat as this transferred fat is very difficult to get rid of. What we have learned over years of studies in fat transfer is that the higher the concentration of pure fat, and the less trauma to the individual fat cells, the better the survival of individual fat cells. When fat is harvested from places like the abdomen, hips, or thighs, the fat is in a solution of blood and damaged fat cells. Centrifugation allows us to get rid of the impurities of the aspirate and harvest a highly concentrated mixture of pure fat cells which is the best substance to inject. The results of the fat transfer procedure can be realized immediately, however, because well performed fat transfer requires numerous injections of fat into the face, swelling and bruising will be present and last for a few weeks.

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Question :
I’ve read a lot of different review about fat transfer, from amazing reviews to horrible ones. What are the best uses for fat transfer?

Answer :
The reviews that you have read with regards to fat transfer are probably all correct. There are many success stories with fat transfer, but, in inexperienced hands, especially around the eyes, the results of fat transfer can be horrendous. I try to limit the use of fat transfer in my practice to augmentation of the mid-face and cheeks, filling of the nasolabial folds, and correction of deflation of the brow and temple hollowing. I have been performing fat injections for many years and have gotten to the point where my results are generally consistent. There is not only discussion and controversy in the lay literature regarding fat grafting, but, there is a tremendous amount of controversy regarding fat grafting in the scientific literature as well. I am still a big proponent of conservative fat transfer and have used the technique successfully in my practice for many years.

Posted by Dr. Philip Schoenfeld

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Question :
How exactly is fat removed from the donor site for fat transfer and is this a painful process?

Answer :
Harvesting of fat for fat transfer is actually a fairly non painful procedure.  I prefer to harvest fat from the lower abdominal area.  Not only is there usually a decent amount of fat available for harvest and fat transfer, but, the fat of the lower abdomen has recently been shown to contain more stem cells which may lead to increased survival of the transplanted fat and the production of fibroblasts which would lead to skin tightening.  Fat harvesting from the abdomen takes about 30 minutes and is performed under local anesthesia.  I use tumescent liposuction solution to anesthetize the area and provide hemostasis for reduced blood loss during fat harvest.  I use extremely small liposuction cannulas placed through small incisions around the belly button in order to harvest the fat but large enough to prevent damage to the fat cells.  Recovery from fat harvesting is quite rapid.

Posted by Dr. Philip Schoenfeld

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Question:

In terms of recovery, how is the donor area affected with fat transfer?

Answer:

The area that will heal the quickest in fat transfer procedures is the donor site. The incision used to harvest fat for fat transfer is very small and the amount of fat needed for fat transfer is also very small compared to the amount of fat that I would remove from any donor site if I was performing liposuction for body contouring. The donor site will heal within days although you still may have some mild soreness for a few weeks.

Posted by Dr. Philip Schoenfeld

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Question:

What are common areas of the face where fat transfer is used?

Answer:

There are many areas of the face that benefit from autologous fat transfer. The most common area of the face and the area that I feel benefits the most from autologous fat transfer is the cheeks and midface. Restoring fullness to the cheeks of an individual really makes a person look refreshed. I also use a great deal of fat transfer to the nasolabial folds. The fat will last a great deal of time there. One of the most fastidious areas but popular, none the less, is fat transfer to the lower eyelids. Unfortunately, when performed properly and flawlessly, the lower lids can benefit nicely from autologous fat transfer, however, the area with the most frequent and highest complication rate is the lower lids. I feel that dermal fillers such as Restylane and Juvederm are just as effective as fat transfer to the lower lids if blepharoplasty surgery is not planned without the risk of long term asymmetry and irregularity of the lower eyelid.

Posted by Dr. Philip Schoenfeld

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Question:

For fat grafting, do you retain the stem cells when removing fat from the donor area? I’ve heard that this can produce amazing results.

Answer:

When autologous fat grafting is performed fat cells are harvested from various areas of the body such as the abdomen, hips, and thighs. The fat which is harvested is cleaned so that pure fat can then be injected into other areas of the face and body which may need fat augmentation for cosmetic purposes. The fat which is harvested has stem cells within the fat and one cannot really select for stem cells, but, rather they are already present in the harvested fat. The area of the body which seems to contain the highest concentration of stem cells is the lower abdomen. The lower abdomen is my preference for fat harvesting for autologous fat transplantation to the face.

Posted by Dr. Philip Schoenfeld

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Question:

I have some problem areas on my body: Hips, thighs, belly pooch, love handles, the usual. I’m thinking about getting a facial fat transfer, but I’d also like to see significant results from the fat removal used to provide cells for the face. When fat is being taken from the donor site to be injected into the face, is as much removed as for liposuction, or is just enough removed to use for the grafting procedure?

Answer:

Many of my patients who are having facial fat injections are also interested in having enough fat removed from the harvest sites such as the abdomen, thighs, and hips to make a difference in the appearance in these areas. The amount of fat which is used to inject the face is usually around 30 cc maximum. In order to get 30 cc of usable fat it is necessary to remove about 50 cc of fat and fluid from the fat donor site. 50 cc of fat from any site is not a great deal of fat. If I was to perform liposuction on a normal individual interested in improvement in their abdomen and love handles I would need to remove over 1,000 cc of fat to really make a difference. Clearly, this is a much greater amount than is necessary in facial fat transplantation. I frequently harvest the fat that I will need for facial augmentation from the donor site and then proceed with full laser liposuction of the areas where the patient is interested in improvement. After the liposuction has been completed I will then inject the fat I harvested earlier into the face.

Posted by Dr. Philip Schoenfeld

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Question:

I keep hearing great things about the stem cell facelift, but I’m dubious. Isn’t this really just fat grafting?

Answer:

If you are reading and hearing about the “stem cell facelift” you should be wary. The stem cell facelift is precisely autologous fat grafting to the face. The claim is that if fat cells are harvested from the lower abdomen there are a greater percentage of stem cells in these fat cells. The ultimate claim of the stem cell facelift is that the results are longer lasting and can even induce your body to produce more fat cells in the area where the autologous fat from your abdomen has been injected. Fat grafting to the face is an excellent procedure to enhance the appearance of many individuals who not only have sagging of the skin from sun or age, but, also in those individuals who have lost volume to their face. I have not seen a single study that demonstrates any difference in the results of a well performed facial fat injection procedure to that of a stem cell facelift.

Posted by Dr. Philip Schoenfeld

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