Fat Grafting
Fat grafting, also known as Lipofilling, is a surgical procedure in which fat is extracted from one part of the body and injected into another. It’s a non-invasive cosmetic technique used by plastic surgeons worldwide for enhancing the appearance of the skin on the face, breasts, hands, feet, hips, and buttocks. Excess fat from any part of the body can be extracted and used in the procedure. Multiple sessions may be required until the patient has achieved desired results.
The Fat Grafting process
The fat grafting surgery involves the below steps:
The entire process is carried out under general anaesthesia and is completely safe, as we use your body fat instead of an implant.
Fat grafting using Adipose Stem Cells (ADSCs)
Fat grafting has taken the cosmetic industry by storm, not only because of its aesthetic capabilities but even because of its regenerative nature. The renewal properties are because of the high accumulation of mesenchymal stem cells (MSCs) inhabiting in the tissue of the fat. Human adipose/fat tissue which has always been considered as an unwanted part of the body is an ideal source of autologous cells, that is both easy and plentifully obtainable through the simple surgical procedure of liposuction.
By capacity, mesenchymal stem cells (MSCs) are three-hundred to five-hundred times more plentiful in adipose tissue as related to the tissue in the bone marrow. Hence, fat grafting using stem cells has emerged as a hopeful choice for the augmentation of soft tissue as no related incisional scarring or difficulties result from the implantation of foreign objects.
Common Areas of Fat Grafting
Some of the most common parts that undergo fat grafting are below:
Current Applications
Currently, our experts use Fat grafting using ADSCs for the below cosmetic and reconstructive procedures:
Donor Site Selection
Donor site selection is the first step in performing a fat grafting surgery, as the site needs to be completely healthy for providing donor stem cells. The donor sites are not only effortlessly reachable by the surgeons with a patient in the supine posture, but also systematically sound because they have an advanced concentration of stem cells than other donor sites as long as patients have a satisfactory amount of adipose tissue in those areas.
As soon as the donor site is thought of, the surgeon must estimate rough amounts to be transplanted into every area, to allow the collection of a suitable amount of fat. The area for liposuction is marked with a patient in the standing position after a sterile preparation. Often in a thinner patient, several areas have to be prepared and marked to accomplish the full harvest.
Harvest Method
Dr Satya Satya prepares almost all patients with short general anaesthesia as this helps to reduce anxiety and pain. Then area to be suctioned is infiltrated with 500 ml of ringer lactate mixed to 0.5cc of adrenaline. If minor infiltrate is needed, the process can be done under tumescent anaesthesia and in bigger areas, tumescent anaesthesia with sedation is advised.
As soon as the area is permeated, it is ideal to wait for fifteen minutes to permit the epinephrine to take complete effect and for the anaesthesia to evenly infuse the tissues. If one forces too quickly, the area inclines to give an excerpt that has a superior percentage of tumescent fluid and is blood-tinged. Most of the comprehensive studies consistently support that the atraumatic technique for the harvest of fat grafts is superior to conventional liposuction.
Isolating ADSCs from Lipoaspirate
Lipoaspirate, or the outcome of Liposuction, contains not only adipocytes, but also blood, collagen fibres, and debris. These rudiments could cause inflammation at the recipient site, unfavourable for the fat graft. Blood must be completely separated from the Lipoaspirate because blood increases the degradation of the transplanted fat.
Thus, the isolation of ASCs (Adipose-derived stem cells) from the Lipoaspirate becomes detrimental in the process of Fat grafting. The adipose tissue is first washed to eliminate blood cells (unavoidable pollutants of the liposuction procedure). Next, the washed tissue is treated with enzyme collagenase to take out the extracellular matrix cells. Adipocytes are then detached based on the therapy natural resistance, leaving behind an adipocyte exhausted population of vascular and stromal cells.
Regenerative capability of ASCs (Adipose-Derived Stem Cells)
ASCs are different from bone marrow mesenchymal stem cells as they can be obtained easily using a normal wet liposuction process. Performed under local anaesthesia, they do not need expansion in culture and they can disperse into multiple mesodermal tissue types. ASCs belong to the stromal vascular fraction (SVF) of adipose tissue and are a combination of a heterogeneous population of many other cell types.
Angiogenesis
SVF cells secrete vascular endothelial growth factor, hepatocyte growth factor, and transforming growth factor-β, in the presence of stimuli such as hypoxia which strongly influences the wound healing capacity of body cells and potentially aids new tissue growth and development. Angiogenesis is a crucial element for successful incorporation of an autologous fat graft into the recipient site and for long term retention and sustainability of the graft. The capability of SVF cells to encourage angiogenesis may clarify why supplementation of fat grafts with these cells leads to a substantial increase in graft protection.
Anti-apoptosis: Apoptosis is critical for cellular self-destruction for a variety of processes such as development or the prevention of oncogenic transformation. Apoptotic cell death allows the cell to commit suicide and it’s a genetically governed phenomenon. The SVF population has the potential to reduce cell apoptosis using growth factor secretion and direct cell-cell interaction. With the anti-apoptosis mechanism, SVF can pass through the graft tissue through hypoxic situations thereby further limiting the degree of graft tissue impairment and apoptosis.
Anti-Inflammation and Anti scar formation
Another potential therapeutic role of SVF is SVF mediated reduction in inflammation associated with a reduction in the size of the scar. If fat grafts are supplemented with SVF cells, it culminates into reduced tissue fibrosis at both six and nine months of follow-up time.
Fat Grafting Post care
Once the fat grafting procedure is successfully performed, patients might encounter mild swelling and discomfort in that area. Pain killers are suggestive, but not mandatory as the discomfort subsides in the next couple of days. Below mentioned is a few care tips that should be taken post the surgery:
