What is lipofilling?

Lipofilling (or structural fat grafting) is now an established technique. It uses patients’ own fat as a permanent filler to add volume to soft tissues. The fat is harvested with thin cannulas, through small incisions, using the conventional liposuction technique. After washing and filtering, the isolated fat cells are injected into the deficient area(s). In addition to adding volume, micro fat transfer reduces scarring, improving the quality and elasticity of the overlying skin. Its mechanism of action is not yet fully understood but by repeated clinical application, this technique has demonstrated its safety and efficacy.

Lipofilling is used in soft tissue augmentation, body contouring, facial rejuvenation, facial reconstruction (e.g. Romberg’s disease) and breast surgery (both reconstructive and aesthetic). Another term for this procedure is autologous fat grafting.

Advantages

• Improvement at both the recipient site and the site from where the fat is harvested.
• The fat surviving the transplant is permanent.
• A completely natural material.
• Day surgery, minimal discomfort and a short recovery.
• Minimally invasive, with a low risk of complications.
• Small scars at the donor site and no additional scars at the recipient site.
• Improves the quality of the overlying skin. This can be particularly important in facial rejuvenation procedures.

Disadvantages

• Repeated procedures may be necessary.
• Lipofilling is not possible if you are very thin.
• Hormonal or weight changes may be responsible for future gains or losses in the volume of the transplanted fat.

How does lipofilling work?

First a fat graft has to be taken from anywhere on your body, mostly the stomach or the inside of your upper legs. Then, this fat will be washed with saline and injected into the recipient area with very fine cannulas or needles specifically designed for this purpose.

What can lipofilling do for you?

Lipofilling can help to augment and restore volume. Fat fades away progressively as we age. Fat grafting can restore the volume that was lost or even create contours that have never existed before.

It has also been shown that fat grafts have a beneficial, rejuvenating effect on ageing or damaged skin. Cells within the fat grafts are capable of “repairing” damaged tissue and they are presumed to stimulate the skin cells to produce substances that improve skin elasticity and deposition of essential structural proteins.

Who is a good candidate for lipofilling?

• Any person that has a volume deficit in any part of the body. The person should have enough fat available to fill up the deficit.

The areas where lipofilling is used most:

• Lips
• Cheeks
• Around the eyes
• Nasolabial folds (folds running from the wings of the nose to the corners of the mouth)
• Breasts

Who is not a good candidate for lipofilling?

• People suffering of anorexia or athletes in whom no fat at all can be found for grafting.
• People with a very unstable weight. When they significantly gain weight, the transplanted fat can become larger and vice versa.

How to prepare for lipofilling?

There is no specific preparation for this procedure.

There is no use in trying to gain weight preoperatively by eating more than usual. This does not increase the number of fat cells, it just adds to the volume of the existing fat cells. This extra volume will get lost as soon as the uptake of calories is normalized.

How is lipofilling performed?

• Lipofilling can be performed under either local or general anaesthesia. Local anaesthesia is only used when small volumes of fat are required. If this procedure is combined with other procedures, it will mostly be done under general anaesthesia.
• The donor site is always infiltrated with a mixture of local anaesthesia and adrenaline to reduce postoperative discomfort and bruising.
• Liposuction—The fat can be taken by means of a liposuction from any part of the body that has a sufficient amount of fat, in most cases this will be the stomach or the upper legs, but it can also be taken from the inner knees, the thighs, the buttocks or love handles.
• After injecting local anaesthesia, which minimizes bleeding in this particular area, a very small incision is made and fat is aspirated using a blunt needle with multiple perforations and a special aspirator. The small incision is closed with one dissolvable stitch.
• Filtration—The fat is washed and filtered to separate blood, oil and local anaesthetic from the fat cells.
• Injection of the fat— If the procedure is performed under local anaesthesia, the recipient site is injected with a minimal amount of local anaesthesia after which the fat cells are injected with very fine cannulas. If the procedure is performed under general anaesthesia, no local anaesthetics will be injected as it has been observed that the local anaesthetics have a negative effect on the survival rate of the injected fat. The trick of the fat transfer is to inject only a very small amount of fat with each pass of the cannula. This way, the grafted fat will be in direct contact with the surrounding tissues which allows the fat to grow in the vessels really fast. As a result, the fat can survive.
• MAFT-gun— For the injection of the fat, we use a MAFT-gun. This is an innovative instrument developed in Taiwan by Dr Lin. It allows the steady, accurate and precise injection of the fat in drops with a diameter of only one mm, which has been proven to be the optimal diameter of the transferred fat. With this instrument, not only the survival rate of the fat is higher, the degree of bruising and swelling is far lower as well.
• The amount of fat that survives depends on the part of the body where it is injected and differs from person to person. It is our impression that on average 50% of the fat that has been injected is still there after six months. Therefore, we may do some overcorrection during the operation.
• After six months we can speak of a final result because after that we do not see much change anymore. How the transplanted fat will behave over the following years/ decades is still unknown. However, it is likely that the normal aging process will continue and that the fat slowly goes away. On the other hand, we also expect that the difference made by the transplantation will last very long.

• After six months, if necessary, another fat graft may be performed until the desired effect has been obtained. Repetition is needed for about 20% of our patients.

What is the average treatment plan of lipofilling?

As a stand-alone treatment, lipofilling can be performed as an outpatient procedure.

What to expect and do during the recovery period after lipofilling?

• Swelling—Immediately after the surgery, the injected area can be swollen and bruised. In the beginning the correction may look rather exaggerated. We usually over-correct, which means that we inject more fat than is actually needed. We do that because about 50% of the transplanted fat cells do not survive.
• About seven to ten days after the surgery you will feel confident about going out and taking up your normal social life again. If any bruises have developed, these might remain visible for a little longer but you can hide them quite well with a good concealer.
• In about three weeks’ time approximately 80% of the bruising and swelling will have disappeared.
• After four months you get a good impression of what the final result after six months will be.

Other common aftereffects

• Discomfort
• Transient numbness (takes a few days – weeks)
• Bruising

Correction

A second session may be scheduled to top up any shortfall in volume. There are many factors that determine how long fat grafting lasts. Your body naturally absorbs fat, so the surgeon must over-inject initially, and success rates can vary considerably. However, some fat is reabsorbed by the body and sometimes only a certain percentage is permanent although newer techniques are showing an increased longevity.

If you gain weight in the future

If you gain a considerable amount of weight after fat grafting, it may show up in the area that was treated.

What are the risks of lipofilling?

General complications

• Haematoma (< 1%) which may require another surgical intervention
• Wound infection (< 1%)
• Seroma (< 5%)

Complications specific to this procedure:

• Fat reabsorption requiring additional surgery

How long can I expect the results of lipofilling to last?

How the transplanted fat will behave over the following years/ decades is still unknown. However, it is likely that the normal aging process will continue and that the fat slowly goes away. On the other hand, we also expect that the difference made by the transplantation will last very long, if not forever.