Dermal & Soft-Tissue Filler: Autologous fat

Generic name: Autologous fat

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Cost: $1,500 - $7,500, varies widely depending on the area and scope of treatment

Allergy test required: No

Durability: A certain percentage of injected fat dissipates within 6 month, and the remainder is durable and may persist for years.

Function / Purpose:
Restore the facial volume lost due to aging, disease or other factors. In particular, far grafting is often used to restore lost facial volume in the eye area, cheeks, lips, under deep smile lines and so forth.

Summary:
Autologous fat transfer (a.k.a. structural fat grafting, fat injections, etc.) is a procedure whereby a patient's own fat is harvested (e.g. from the abdomen), processed and injected into the subcutaneous tissue to add extra volume to depressed areas. Since the procedure involves autologous (patient's own) fat, there is no risk of rejection or disease transmission. Generally, some of the injected fat integrates in the treated area and stays permanently (for at least a year and often much longer) while the rest dissipates over a few months.

Contraindications:
Contraindications to fat grafting include the presence of any disease processes that adversely affect wound healing and poor overall health status of the individual. The use of free fat grafting for the treatment of contour abnormalities resulting from breast biopsy or for breast augmentation is generally contraindicated. The grafted fat can cause both palpable nodules and calicifications, situations that may hinder a diagnosis of certain conditions or cause unnecessary intervention.

Details:
The idea of autologous fat grafting is clear and simple: take some fat from the area of the body where it is plentiful and put it where it is missing. The procedure itself, which is usually done on an outpatient basis within one day, is also relatively straightforward: the fat is harvested under local anesthesia using suction and a special aspiration needle; then the fat is purified, homogenized and treated to prepare for injection; finally, the fat is injected under local anesthesia in the subcutaneous tissue in the desired area. However, due to many subtleties of the technique, the surgeon's skill and experience are important.

There are some obvious benefits to autologous fat injections: no risk of rejection and disease transmission, quick recovery after the procedure, and potentially better durability than for some biodegradable alternatives, such as Restylane SubQ.

However, there are caveats and uncertainties too. The biggest issue is that only a percentage of the injected fat takes hold in the treated area. Furthermore, this percentage may vary widely: from about 10% to 50% depending on a variety of factors. Many surgeons have their favorite harvesting and injection techniques and claim higher than average clinical longevity of the grafts. However, the factors specific to the individual patient and area treated play at least as big a role. In fact, Drs Sommer and Sattler (from Cosmetic Dermatologic Surgery, Darmstadt, Germany) reviewed the effectiveness of fat injections in an article published in Dermatologic Surgery journal. They concluded that:

Clinical longevity of correction after autologous fat transfer is determined by the degree of augmentation resulting from the amount of fibrosis induced and the number of viable fat cells. Survival of aspirated fat cell grafts depends mainly on the anatomic site, the mobility and vascularity of the recipient tissue, or underlying causes and diseases, and less on harvesting and re-injection methods.