Fat transfer techniques: the effect of harvest and transfer methods on adipocyte viability and review of the literature

BACKGROUND

Autologous fat transplantation is an excellent tool for filling defects and augmenting tissue. The literature provides a variety of reports with varying degrees of success or failure. The procedure is operator dependent and relies on the techniques of harvesting, cleansing, and reinjection.

OBJECTIVE

To evaluate various retrieval and reinjection techniques to see their effect on the viability of the fat cells.

METHODS

Fat was removed from five patients utilizing various cannulas, needles, suction pressures, and centrifugation for collection and reinjection. Preoperative external ultrasound and massage were evaluated as well as the use of the ratchet gun for injection. The fat was routinely cleansed of blood and tumescent solution products by means of washing with normal saline and then decanting repeatedly until the infranatant solution was clear.

RESULTS

Histologic examination of the fat cells showed the central core of fat and edges of the core had 98-100% intact cells (presumably viable) in every specimen except when -700 mmHg vacuum was used for fat collection where cell damage was greater than 10% and when preoperative massage was performed where cell damage was 30%. Preoperative external ultrasound did not appear to damage the fat cell but did disrupt some of the fibrous tissue holding the fat cells in large bundles.

CONCLUSION

The variety of techniques used to collect, clean, and reinject fat do not damage the fat cells except for the collection of fat at -700 mmHg vacuum. External ultrasound, preoperatively, does not destroy fat cells but produces smaller bundles of fat. The ratchet gun does not result in increased fat cell loss. Preoperative massage causes 30% cell loss and deformation of 80% of the remaining cells.

Medications Potentially Causing Lidocaine Toxicity

This article presents a first warning to surgeons using tumescent solutions for liposuction that inhibitors of cytochrome P450 3A4 (CYP34A) compete with lidocaine as substrates for this enzyme and, therefore, may diminish lidocaine metabolism, leading to a rise in lidocaine blood levels following tumescent infiltration. A table of medications that may cause adverse drug interactions is presented.

Effect of Various Methods of Fat Harvesting and Reinjection

Introduction:

Autologous fat transplantation is an excellent tool for filling defects and augmenting tissue. The literature has provided a variety of reports with different degrees of success or failure. The procedure is operator dependent and relies on the techniques of harvesting, cleansing, and reinjection. The author evaluates the various techniques to see their effect on the viability of the fat cells.

Materials and Methods:

Fat was removed from 4 patients for collection and reinjection by use of various cannulas, needles, suction pressures, and centrifugation. External ultrasound was evaluated before the operation, as was the use of the ratchet gun for injection. The fat was routinely cleansed of blood and tumescent solution products by means of washing with normal saline and then decanting repeatedly until the infranatant solution was clear.

Results:

Histologic examination of the fat cells showed that the central core of fat and edges of the core had 95–100% intact cells (presumably viable) in every specimen except when a −700 mm Hg vacuum was used for fat collection and cell damage was >10%. Preoperative external ultrasound did not appear to damage the fat cells but did disrupt some of the fibrous tissue holding the fat cells in large bundles.

Discussion:

The variety of techniques used to collect, clean, and reinject fat do not damage the fat cells except for the collection of fat in a −700 mm Hg vacuum. External ultrasound before the operation does not destroy fat cells but produces smaller bundles of fat. The ratchet gun does not result in increased fat cell loss.

Autologous Fat Transplantation

A preliminary analysis of the methods that have been used and the results achieved since fat grafts were first used in 1889 is presented. Descriptions of the techniques used by several practicing physicians were collected by personal communication and a review of the literature and are recorded in this paper. Although the process of fat transplantation has not been standardized, it can no longer be considered an experimental procedure as enough surgeons have shown that there can be consistently good results. Failures and complications are not the result of the theory that fat cannot be transplanted, but the result of errors in technique and not adequate attention to detail.

Estrogen and thromboembolic disorders: should patients stop hormones prior to cosmetic surgery?

Oral contraceptives and replacement estrogenic hormones have been associated with a significant risk of thromboembolism. Cosmetic surgery consists of elective procedures in otherwise healthy individuals. The prospect of thromboembolism should be diminished in these patients by avoiding those factors that may give rise to the problem. Stopping oral contraceptives and replacement estrogens three weeks before surgery to two weeks after surgery is not difficult for most patients and should be part of the custom and practice of all cosmetic surgeons.

Fat Tissue Embolism following Fat Transfer

Complications of autologous fat transfer (injection) include fat tissue embolization from injection in the glabellar and nasal regions. A rare complication is fat tissue e mbolization to the lung. The author reviews the literature of fat tissue embolization and reports a new case of embolization to the lung from fat transfer to the buttocks. The arterial and venous anatomy is discussed and the mechanisms of embolization are described.

Fat Tissue Embolism Caused by Autologous Fat Transfer

Complications of autologous fat transfer (injection) include fat tissue embolization from injection in the glabellar and nasal regions, with blindness and central nervous system damage. A rare complication is fat tissue embolization to the lung that, so far, has always been fatal. The author reviews the literature on fat tissue embolization. The arterial and venous anatomy is discussed and the mechanisms of embolization are described. Also presented are measures to use to prevent embolizing of fat tissue while injecting.