Fat Grafting: Techniques and Uses in Different Anatomic Areas

Abstract

Introduction: Fat grafting can be used to place fat in the face, hands, breasts, buttocks, calves, and genitals for cosmetic purposes. The procedure is also used to reconstruct some congenital abnormalities (such as hemifacial atrophy) or to correct selected traumatic facial defects; it may also be used in combination with other surgical procedures (facelifts) or as part of a facial rejuvenation program. We present a review of the steps for fat grafting performed at our center. We have experienced excellent cosmetic results using these techniques. Method and Materials: Of the 867 patients, 367 underwent facial fat transplant; 153 underwent bilateral augmentation mammaplasty by injection (BAMBI); 67 underwent fat injections to the buttock, calves, and other areas of the body; and 280 received fat grafts to the genitalia. Two hundred seventeen patients were men and 63 were women. The operations were performed as ambulatory procedures. Local anesthesia and intravenous (IV) sedation (midazolam plus fentanyl) were used. For all of our patients, we used a modification of the classic Klein formula. All of our patients were operated on under IV sedation. Results: Fat survival was approximately 70% at the end of 1 year. Of the 367 patients undergoing facial fat transplant, 65% were satisfied with the results, and 35% were not satisfied and required a touch-up procedure. Of the 153 undergoing BAMBI, 72% were satisfied with the results, and 28% were not satisfied and required touch-up procedures. Of the 67 patients undergoing fat transplant to the buttocks, calves, and other areas, 76% were satisfied, and 24% were not satisfied and required additional fat grafting. Of the 217 men undergoing genital fat transplant, 82% were satisfied with the results, and 18% were not satisfied. Of the 63 women undergoing genital fat transplant, 86% were satisfied with the results, and 14% were not satisfied. Absorption, infection, and embolism are the most common complications mentioned in the cases of fat injection. Out of 867 total fat transplant operations, absorption occurred after 1 procedure in an average of 30% of cases. In 5 cases, we saw some degree of infection, which was rapidly treated with antibiotics. We did not see any cases of fat embolism. We saw 2 cases of cysts in the dorsum of the hands and 2 in the breasts; these cysts were easily treated with triamcinolone injections. Discussion: When administered properly, autologous fat transplantation is an acceptable procedure resulting in highly satisfied patients. This satisfaction is mostly due to the fact that this process utilizes the patients' own tissue instead of a prosthetic or synthetic implant. Rejection or allergic reaction is not possible with autologous tissue.