For many patients, the idea of using their own biological materials to rejuvenate their skin and bodies is enticing. These procedures present a more natural alternative to dermal fillers and implants while promising longer-lasting results. But are patients really buying? And do these procedures truly offer comparable results to existing modalities? We spoke with plastic surgeons and dermatologists about some of the most highly publicized biological products and procedures to determine where—and if—they are finding a lasting place in medical aesthetics practices.
Autologous Fat Transfer
For years plastic surgeons have used fat transfer to replace lost volume and fine-tune liposuction outcomes, but only in the last decade has it become part of the public’s lexicon. In medical aesthetics practices, fat is being used in place of injectables to replace lost volume and smooth wrinkles.
There has been significant debate about optimal harvesting techniques. Some doctors advocate centrifuge, others prefer gravity separation or rolling the fat on cotton gauze to separate out oils and blood cells. Today, physicians are finding that harvesting technique takes a back seat to proper injection in achieving lasting results.
“All of these harvesting methods have been studied, and there hasn’t been anything consistent showing that one method is better than the other, which leads one to think that how you separate the fat isn’t an essential matter of importance,” says cosmetic and reconstructive surgeon Val Lambros, MD, FACS, who has been performing fat transfer for more than 20 years.
The challenge with facial fat injection is that the patients who benefit the most tend to be the patients who need volume least. “Fat is a great tool when used appropriately, but you have to have a high tolerance for ambiguity,” says Dr. Lambros. “If you’ve got a chubby young face and you’re putting fat in, it works great. If you’ve got an older, fat-depleted face, it’s not as reliable and that’s a major issue: the age of the patient.”
Some areas of the face that can benefit from fat transfer include the brows, temples, cheeks and jaw line. “These are the prime targets for fat in my practice,” says Dr. Lambros.
One area he cautions against the use of fat is in the lower eyelid. “You have to be extraordinarily careful there,” he says. “Even people who have lots of experience with fat transfer see problems with lumps and bumps in the lower eyelid, and it’s hard to get rid of. You can make it better, but you can’t go back to where you were—at least not with current technologies.”
The best solutions for poor fat grafting outcomes include liposuction or surgery—neither of which is ideal for the undereye area, particularly because the fat is typically grafted into all the tissue planes. “A heat-based or ultrasound-based device might come along to help these patients,” says Dr. Lambros. “But it is an issue—there are thousands of patients out there who’ve had fat grafting to the lower eyelid, and it’s really hard to do much for them.”
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