Facial fat transfer has become one the most versatile tools in the armamentarium of the facial plastic surgeon. It is not only a great means to restore facial volume in cosmetic surgery, but it can also play a substantial role in reconstructive procedures. Regardless of its purpose, facial fat grafting should always be performed in a sterile environment. This is key to prevent infections and avoid postoperative sequelae.
The 5 steps of facial fat transfer
Step 1: Infiltrating the harvest sites with anesthesia.
The first step consists of infiltrating the areas from which fat is to be harvested with a dilute anesthetic solution. It is important to use the right volume and concentration of the anesthetic to avoid overdiluting the fat.
Fat can be harvested after a few minutes of the infiltration with a special harvesting cannula. Gentle applied suction by means of a 10 ml syringe attached to the cannula allows efficient fat harvesting. Overharvest is important as the fat is mixed with blood products and anesthetic solution which must be extracted from the graft, and up to 50% of the injected fat will be absorbed.
Step 2: Processing the fat.
The harvested fat must be processed to separate the fat particles rich in stem cells from the blood, oil, and anesthetic solution. A centrifugation process is most efficient as it simultaneously concentrates the fat and separates it from the water and oil fractions of the harvest. The fat is spun for about 2 minutes at 1000 RPM. It is not necessary to centrifuge for long periods of time at high RPMs. On the contrary, this may damage the delicate fat particles and compromise their survival.
Step 3: Separating the fat.
The syringes containing the fat are carefully handled by the scrub nurse as she removes them from the centrifuge, making sure to maintain sterility throughout the whole process.
Each syringe will display three layers. A bright yellow layer made up of oil from ruptured cells can be seen at the top of the syringe. Underneath it is the layer that contains healthy fat particles for lipotransfer. At the bottom of the syringe is a dark red stratum of water containing blood and anesthetic solution. The oil is carefully poured off from the top of the syringe and the water component is discarded by allowing it to drain from the bottom.
Step 4: Preparing the fat for injection.
The middle layer containing stem cell- rich fat particles is transferred into 1-ml sterile syringes via a coupler device. Each syringe should hold a homogenous layer of fat without air bubbles or impurities. The best quality fat is set aside for infiltration around the eyes.
Step 5: Injecting the fat.
Finally, the fat is injected into the face through very small incisions in the skin using a meticulous technique in an artistic manner. Fat should be distributed throughout all the tissue layers, from skin to bone. Tulip infiltration cannulas specifically designed for this purpose are employed. The length and caliber of the cannula should be carefully selected according to the anatomical area.
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