The entire process entails some steps. First, the doctor starts by harvesting fat by utilizing Nutational Infrasonic Liposculpture, “Tickle Liposuction” method which involves a gentle harvest of fat to preserve the delicate architecture of fat cells.
Next, your fat is then purified using the PureGraft method which entails removing nonviable components, cell-damaging free lipids, as well as contaminated white and red blood cells.
So then we are ready to inject the fat into the chosen areas into small aliquots to be sculpted and molded while finalizing the process with immediate PRP therapy, which serves as the elegant finish to the scaffolding formed by the fat injections; refining and locking in the optimal textures and ultimate shape. Scientific studies of this technique have shown that this method yields fat with high survival and normal cellular enzymatic profile.
DONOR SITE SELECTION AND PREPARATION
The ideal donor site is patient-dependent and based on patient preference and availability of fat at the donor site. The posterior hip, back, love handles, and lateral thighs do have the advantage of being more forgiving, whereas the abdomen and medial thighs are more prone to wrinkling and deformity. Small incisions are hidden in scars, stretch marks, creases, or hair-bearing areas whenever possible. Using these incisions, a blunt cannula is used to infiltrate tumescent fluid. For smaller cases, performed under local anesthesia only, this fluid consists of 1% lidocaine with 1:200,000 epinephrine. For larger cases using general anesthesia, 2% lidocaine with 1:400,000 epinephrine is used instead. Ideally, the volume infiltrated should equal the volume of fat the surgeon intends to remove.
Fat harvest is carried out using a specially designed harvesting cannula and are suctioned up slowly to avoid rupturing adipocytes with excess negative pressure. Harvesting cannula size is also optimized to allow collection of intact fat parcels while ensuring that fat is small enough to pass through the desired injection cannula.
After the amount of fat that has been aspirated into a sterile container, 10-mL syringes are then used to transfer fat into the PureGraft system to remove undesired components.
Fat grafting to the face or hands should be done using 1-mL syringes.
3-mL and 10-mL syringes can be utilized for convenience in larger volume sites, such as the breast, arms or buttock.
As with harvesting sites, the incision for placement should be hidden wherever possible. Planned sites are anesthetized using lidocaine with epinephrine, and a small incision is made just large enough to fit injection cannulas. In order to increase the blood supply in the recipient area, we conduct PRP treatment for this area 4 weeks before fat transfer to maximize retention rate of the grafted fat. Graft to recipient volume ratio is also an important consideration because grafts tend to coalesce at higher ratios despite best efforts at dispersion. Fat should be placed gently, in small parcels while withdrawing the blunt injection cannula because large globules of fat undergo central necrosis, volume loss, and may result in oil cysts.
Grafts are placed at a variety of depths to promote greater dispersion, and specific locations are targeted when certain outcomes are desired. For example, injecting fat just below the dermis is more likely to enhance skin quality, decrease pore size, reduce wrinkles, and improve scarring. However, care must be taken with these techniques because superficial injections are the most likely to cause visible contour irregularity, particularly in such areas as the eyelids where the skin is fragile. Alternatively, fat is targeted to just above the periosteum to simulate the appearance of the bony structure. Molding to displace previously injected fat should be avoided except in instances of noticeable irregularity after injection. If applied to larger aliquots or more densely placed fat, molding promotes fat pooling, resulting in necrosis and long-term contour irregularities. When grafting is complete, incisions are closed with single interrupted nylon sutures.
Postoperative care depends on the body regions involved. The core principle is to pad recipient sites and provide compression to donor sites. To accomplish that, we use a specially designed compression garment. Cool therapy also used for the first 72 hours to limit inflammation, but proper care should be taken to avoid direct icing or overcooling, as low temperatures may precipitate damage/apoptosis of the newly transplanted fat. The compression garment should be on 24 hours for 14 days, and only during daytime for next two weeks. Sutures on the recipient site are removed on postoperative day 2. Deep massage of recipient sites should be avoided during the first month, but a very light touch to promote lymphatic drainage is advantageous.
COMPLICATIONS AND FOLLOW-UP
Common complications are generally mild and self-resolving. Contour irregularity is the primary aesthetic concern, but this can usually be avoided by vigilance during harvest and placement with careful adherence to proper technique. Bruising, pigmentation and small bumps may be present in donor or recipient sites but typically resolve within 2 to 3 weeks. Rarely, pigmentation lasting for several months has occurred in thin-skinned areas, such as the eyelids. Infection is generally rare, but it can severely compromise volume retention and aesthetic outcome when it occurs.