Fat Grafting

Although the popularity of fat transplantation is a relatively recent development in plastic surgery, the concept of fat transfer is not new. As early as 1893, free fat autografts were used to fill a soft tissue defect. The use of autogenous abdominal fat to correct deficits in the malar area and chin was reported in 1909. Throughout the early part of the 20th century, attempts were made to correct other conditions, including hemifacial atrophy and breast defects, but modern fat grafting did not develop until the early 1980s with the popularity of liposuction.

With refinements in technique, fat grafting has become the procedure of choice for an array of problems, including facial scarring, lip augmentation, and facial rhytides (such as several otherwise difficult-to-address areas such as the nasolabial fold and glabellar furrows).

Aging and scarring result in loss of subcutaneous tissue, which is amenable to replacement by fat grafting. Indications for fat grafting include correction of atrophy due to aging or scarring and enhancement of facial elements (eg, to provide a fuller, more voluptuous lip; to correct glabellar frown lines). Areas of the face not well treated by procedures such as rhytidectomy include nasolabial folds, glabellar creases, and tear troughs. Lip augmentation may improve the appearance of fine perioral lines and increase the amount of vermilion show.

Older patients may present for correction of specific areas or for overall facial rejuvenation. The anatomic areas not addressed by traditional rhytidectomy, auxiliary lifting procedures, or facial resurfacing often are ideal for fat grafting. Patients of all ages may present for facial enhancement; lip augmentation is the most common request.

Fat Grafting can be performed on an outpatient basis with local anesthesia. The preoperative consultation is crucial. By far, the most important part of the preoperative workup is an extensive discussion identifying areas to be treated. In addition, details of the procedure, postoperative care, expectations, and possible adverse outcomes should be discussed.

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