Improvements to fat grafting techniques may give boost to aesthetic procedures

Miami Beach, Fla. - New and exciting advances in fat grafting techniques specifically focused around the way the fat is processed could result in a resurgence of the age-old cosmetic procedure, offering physicians a viable option to the popular synthetic fillers readily used.

Though fat grafting has always been considered to be an effective aesthetic tool used to replenish lost volume and correct contour deformities in cosmetic patients, the treatment modality has become somewhat eclipsed by the plethora of synthetic fillers often chosen by physicians in cosmetic procedures, such as hyaluronic acid fillers.

“Since the dawn of state-of-the-art synthetic fillers, fat grafting has often taken the backseat in corrective soft tissue filling procedures, in part due to the extra procedure required to harvest the fat,” says Naomi Lawrence, M.D., head of the division of dermatology section of procedural dermatology, Cooper University Hospital, Marlton, N.J. “However, recent advances in fat grafting techniques can make the procedure the treatment of choice, particularly in those areas where a greater amount of filler is required for voluminization.”

Using less to do more

New technological advances being researched in the processing of the harvested fat may allow physicians to more effectively and more efficiently use smaller amounts of fat because the harvested fat could survive longer than with older processing techniques, says Dr. Lawrence, who spoke at the annual meeting of the American Academy of Dermatology. Using innovative collagenase digestion techniques that disassociate the fat particles, smaller fat grafts could be transferred that revascularize better, increasing their potential for viability in the target area, she says.

The adipocyte stromal cells or stem cells can also be left in the mix, which could be partially differentiated and expanded once they are transferred to the target area. Moreover, the addition of factors that enhance the growth of both the fat and the stem cells could be added to the fat graft mix, Dr. Lawrence says, further increasing the potential viability of the fat grafts used.

“Fat grafting could be considered ideal for those areas where you really need a lot of filler, such as in those patients who have full-face lipoatrophy. Though numerous synthetic fillers can also be used for this cosmetic indication, eight to 10 syringes of product are often required to cosmetically correct the deformity, making fat grafting a much more desirable and economical treatment option,” she says.

The perception of facial youthfulness is synonymous with fuller facial features such as a healthy and youthful looking plump cheek and temple areas. Many older cosmetic patients today are fit and have low body fat, but nevertheless exhibit varying degrees of facial atrophy, resulting in a thin and drawn facial look. The volumizing required to correct the facial atrophy could ideally be done using fat grafting techniques, Dr. Lawrence says, as too much synthetic filler product would often be required to achieve this cosmetic goal.

Fat grafting indications

Much of the research in fat grafting is being performed outside of the United States, mostly because adipose stem cells isolated from mature fat are placed by the Food and Drug Administration in the drug category, Dr. Lawrence says, and most fat grafting research is focused around aesthetically filling the face.

Other areas where fat grafting techniques could be considered superior to synthetic fillers in terms of the sheer volume required to perform larger aesthetic corrections include the neck, breasts and the redundant skin around the knees. Another indication could be the atrophy typically seen in the aging dorsum of the hands, Dr. Lawrence says, offering a more lasting treatment solution for this cosmetic thorn.

“With the help of the new advances in fat processing, we hope that we will be able to fill these nonfacial areas, once we get grafts that can survive better in the target area,” she says.

Many physicians are already performing fat grafting techniques in off-face locations, Dr. Lawrence says; however, the refinement of fat graft processing techniques could lead to an improved product and to more consistent outcomes, particularly in areas that are less vascular such as the redundant skin around the knees or other areas of aging redundant skin.

“The hope is that as we learn to process the fat better into smaller packets, maybe leaving some of the stem cells in the mix, maybe adding growth factors in the mix, we will get a fat transfer that lasts indefinitely. Though fat grafting won’t necessarily surpass the popularity of synthetic fillers, the technique can be used in those patients that can benefit from it most, such as those with larger areas that need correction,” Dr. Lawrence says.

Disclosures: Dr. Lawrence reports no relevant financial interests.