Sydney plastic surgeon, Dr John Flood, explains that liposuction and fat transfer are two separate procedures and should be treated as such. Lauren Alexander reports.
As we age, the face loses volume, often resulting in skin laxity (sagging skin). To determine the approach that may be suitable for the patient – a fat transfer or a facelift – their expectations must first be determined.
Sydney plastic surgeon Dr John Flood explained: “When someone comes in requesting a facelift, I do a thorough analysis of their face and find out what they want to look like.” He then explains that, sometimes, an alternative option (such as a fat transfer) may be suitable.
Using a technique of liposuction, fat can be removed from other areas of the body and re-injected into the face where it’s needed. However, the process is slightly different than liposuction for fat removal alone, and these differences are vital.
“Fat injection isn’t a matter of just performing liposuction,” said Dr Flood. “It is important to look after the fat cells. It’s just like doing a graft – the fat cells must be treated carefully to survive.”
The percentage of fat cells that survive the transfer ranges between 50 to 75%. If the fat cells do resorb, the patient may require a further injection after six to nine months.
To do this, the fat is aspirated under very low pressure. Dr Flood prefers to take the fat from the abdomen or the inner knees. Liposuction for fat removal uses a tool called a cannula, which is between three and five millimetres in diameter. However, for removing fat that will be transferred into the face, a special one-millimetre cannula is required. “Those fat cells you aspirate with liposuction can’t be used”, explained Dr. Flood. “They are unsuitable since they are damaged cells, and they will die.”
The fat cells must be living to survive in the face. To do this, they need a supply of blood, which brings them oxygen and glucose. The key to a fat transfer is ensuring healthy fat cells are being injected and that blood vessels will be able to grow around them.
Dr Flood explained: “Once the fat is removed, it is centrifuged to separate the fatty oils from the true fat cells. Of 10mls that I aspirate, there will be 4mls of pure fat cells and 6mls of fatty oils and blood.” Once the pure fat cells are separated, they are placed into glass injection syringes with a blunt tip needle.
“The fat is injected in 0.1 millimetre tunnels. These tiny tunnels allow blood vessels to grow into them”, said Dr Flood. “Where it is injected depends on the area. If it is put into the lips, it must be put into the muscle layer for better blood supply.”
Under the cheekbones, for instance, in the sub-malar hollow, the fat can be injected both deeply and superficially. “To address structure, the fat must be injected deeply. When you want to address skin concerns, such as fine lines and wrinkles, it can be injected more superficially”, said Dr Flood, stressing the need to always use tiny amounts.
Some of the fat will die regardless, and when it does, it is typically absorbed by the body. However, if large amounts are injected, sometimes it can cause scarring that feels hard underneath the skin and tethering can appear. If it is injected in tiny amounts, the likelihood of this occurring can be reduced. “It is important to take your time and do it gently. Injecting large amounts will result in less fat surviving,” explained Dr Flood.
The procedure can be performed under local anaesthetic with intravenous sedation or under general anaesthesia as a day surgery procedure. Afterwards, a pressure dressing is applied and remains for 24 hours to minimise any bruising and swelling. After 48 hours, the patient can gently massage the area to help prevent lumps or bumps.
Bruising or swelling may take about five days to subside, but most patients can go back to work within a couple of days. “Most patients can see a result straight away, but to see the final result, it can take between two to four weeks.”
If the patient will undergo a fat transfer to the face, only a relatively small amount of fat needs to be extracted. If the patient undergoes a liposuction procedure for fat removal as well, the first thing to establish is what the patient wants to achieve. “It’s very important to determine what the patient wants from liposuction”, said Dr Flood. “What are their goals, and what are their expectations?”
Visual communication helps the surgeon and patient understand each other. Dr Flood explained: “I can have different terminology than the patient. When someone says I want to focus on my thighs – what does “thigh” mean? The whole thigh, the front, the sides? When they show me a picture, I can see exactly what they mean.”
Once the patient's expectations and preferences are established, the process is explained in detail. When the liposuction surgery is actually taking place, fat that is removed for the purpose of removal and not to re-inject is treated differently than when fat is used for a fat transfer.
While the two procedures go hand in hand, the approaches are different. Establishing this at the beginning of the consultation is important to manage expectations for the patient.