FAT TRANSPLANTATION
(Microlipoinjection)
In the youthful face, one notes well-balanced and proportionate facial volumes, and smooth aesthetically
pleasing contour. The cheekbones are prominent, the lips are full and the skin is homogenous, lustrous and
unblemished. With the aging process, the facial soft tissue thins, involutes and descends, disrupting the
aesthetic harmony and balance. As these facial changes gradually occur, the pillars of youth and beauty are lost
and the overlying skin begins to drape, resulting in furrows, wrinkles and bags.
Due to the innovative work of Dr. Pierré Fournier from Paris, France, the technique of volume restoration by fat
transplantation was revolutionized. I had the privilege of working with Dr. Fournier in 1991, who is considered
to be the pioneer of this cosmetic technique. This procedure is a “natural” remedy to restore volume and
balance back to the aging face using the patient’s donated tissue. Many approaches have evolved from this
technique to include the Coleman and Fami procedures, however, the definitive goal remains the same:
Structural Fat Grafting for Facial and Bony Rejuvenation.
Presently, fat transplantation is a refined and safe technique indicated for many cosmetic applications. In the
aging face, it is utilized to reduce the deep facial furrows and creases, and to restore volume to the cheekbones,
orbital rims, lower eyelids and midfacial areas. In effect, it relifts and augments specific areas of the facial
contour by restoring the depleted underlying soft tissue volume. Further indications include facial and
congenital defects, traumatic and postsurgical defects, liposuction depressions and irregularities, and hand
restoration.
The advantages of fat transplantation are many, namely: It is the only “natural” method available for aesthetic
volume restoration. Since the patient’s own tissue is used, the technique avoids the risks of immediate and
delayed foreign body reaction, rejection and other adverse effects seen with synthetic material. Using one’s
own tissue prevents the risks of transmittable diseases and autoimmune reactions. This technique may be
performed repeatedly, and can be applied virtually to any area of the face or body. Dependent upon individual
response to the technique and in faces with severe soft tissue deficiency, staged procedures will be required to
build up soft tissue volume. There are numerous clinical studies which have documented the viability and
stability of adipose tissue as a fat graft when compared to temporary injectibles (i.e., collagen, restylane,
sculptra). Recent clinical observation has revealed that skin overlying the areas of transplantation long term,
often demonstrates a smoother, less wrinkled appearance.
Appropriate candidates for undertaking the fat transplantation technique will be evaluated and considered on an
individual basis. During your initial consultation, the skin and underlying supportive structures of the face will
be analyzed and the donor sites inspected for adequate adipose donation. Common adipose donor sites for
transplantation are the thighs, hips and abdomen. Preoperative photographs are taken on all patients for a
comparison and procedure planning purposes.
Fat Transplantation: The Procedure
Fat transplantation is routinely performed under local anesthesia in our office procedure suite. For patient
comfort, an oral sedative is available if requested (if a sedative is used, a responsible adult should be available
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to assist with driving after the procedure). Initially, ice packs are applied to the treatment areas. The donor site
(from which the fat will be removed), and the facial areas to be transplanted are then anesthetized with an
injectable local anesthetic. The fat is extracted with a syringe and microcannulae. Once the appropriate volume
of fat has been removed, the small fat graft slivers are then washed prior to injection. The prepared tissue grafts
are then injected with a small cannulae through small incisions into the desired areas. The fat is molded and
sculpted into the appropriate aesthetic contour. The incisions are closed with fine sutures. Topical facial
dressing may be applied, which is site specific. After the procedure, a moderate amount of facial swelling can
be expected (most pronounced with lip augmentation). Please understand that there is a recovery period for
several days at the donor and recipient sites to include swelling, bruising and mild tenderness. All areas
injected are “over-corrected” to account for anticipated fat resorption which occurs over several weeks to
months. You must understand that there are no guarantees as to the volume of fat that will remain stable as a
graft at the injected areas, as fat transplantation stability and “take” is variable. In my experience, the resorption
is site specific and varies among individual patients. I have found the fat stability to be most consistent at the
cheek and midfacial areas, with highest resorption in the lips.
It is common practice to require repetitive serial injections of fat for corrective augmentation. During your
initial session, additional fat may be removed and frozen (cryopreservation), available for injection at future
visits. There remains controversy however as to the viability of frozen fat, with freshly extracted fat having the
best potential for long term survival. Recommendations for additional “touchup” procedures will be made
during your follow-up visits. Patients should anticipate swelling, bruising and nodularity at the injection and
donor sites, which is often remedied with massage and time.
I have found with this procedure that patient satisfaction is very high. It is a minimally invasive technique that
relocates your own natural tissue to specific areas for aesthetic improvement by an injectable process. Very few
complications with this technique have been reported in literature and in my practice. Variable resorption
occurs with all patients, thus no guarantees can be acknowledged as to your final result. Risks such as bleeding,
infection, cysts, small scars, persistent swelling, visibility of the grafts, irregularities/unevenness and
asymmetrical or total resorption are possible. There have been rare and infrequent documented cases in
literature which resulted in visual loss from an embolic-type occurrence. It is now speculated that this risk is
rare with the smooth cannulae injection technique. At the donor site, tingling, numbness, bruising, and surface
irregularities (rare) may occur, and are usually temporary, only to resolve with recovery time. Aging, weight
fluctuations, excessive exercise with low BMI (body fat index), and smoking can affect fat graft survivability.
It is postulated that hormones (perimenopause), caffeine and chemotherapy may adversely affect graft yield.
Please acknowledge that you have read and understand this information by signing your name below.
___________________________________
Patient Signature
_____________________
Date
___________________________________
Peter M. Schmid, D.O.
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Date
PMS/rdc-7/1/05
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