What is Micro Fat Grafting?
Microfat grafting is a time tested technique that uses your own fat cells to fill an area of deficiency. It is most frequently used as an adjunct to facial surgery to help rejuvenate the cheeks, midface and areas around the eye. Strategically placing fat into the face often produces subtle rejuvenation. As we age our faces lose the fullness of youth and the ideal substance to restore our own fat. Lips thin with age and microfat grafts to the lips can make them look more youthful as well. Microfat grafts have been very effective in rejuvenating hands as well, adding a little subcutaneous tissue in older hands in which the fatty layer has dissolved with time. Microfat grafts can also be utilized to fill deformities in extremities or the trunk caused by overaggressive liposuction, other injuries or ones with hereditary causes, but the procedure is less effective for these purposes. The problem with any microfat grafting procedure is the unpredictability of fat survival.
Harvesting of the fat is usually done from the abdomen or thighs using specially designed cannulas. Harvesting entails making an incision and aspirating fat from an area of excess – this is difficult to do in an office setting without saturating the donor area with local anesthesia, something preferably not done in order to enhance graft survival. The ideal technique uses a delicate harvesting and processing procedures with the patient sedated in an operating room, in order to enhance the viability of the transferred fat and long-term permanence. Fatty tissue is very fragile. Microfat harvesting, if done properly, allows a significant portion of the fat to survive the transplantation but a surgeon can NEVER predict in advance when the grafts will survive and when they will fail.
Once placed, the body may accept the transferred fat with ingrowth of blood supply to the transplanted fragments, leading to a permanent correction – or the blood supply many not develop and the fat will dissolve in a few months, similar to what happens after a Restylane® or Juvederm® injection.
A common question is, “How long will the results of this procedure last?” The traditional fat grafting techniques had a very high, almost universal resorption rates, but this newer technique employing tiny cannulas and transplanting micrfat globules, increases the chance of success, with perhaps 50% or more of the fat lasting indefinitely (more likely to succeed in the face, less so in trunk and extremity deformities).
Micro Fat Grafting Overview Video
The following information has been prepared to familiarize you with facts about the surgical procedure known as microfat grafting. You are requested to read this information thoroughly and to discuss any questions which might arise with your surgeon before you give your consent to have this procedure. You are also requested to keep this form as a reference in the postoperative period.
Preoperative instructions
You may visit your surgeon as many times as you wish, to have all of your questions answered. At your final preoperative visit, your final questions will be answered and you will confirm that you understood the procedure to be performed, that this material has been explained to you, that you have read and understood these information sheets, and that you accept the risks by signing the informed consent forms.
The operation will be performed at an outpatient facility under a very light general anesthetic or a deep sedative to insure your comfort.
A very short stab wound, typically within the navel, is used for harvesting the fat. Tiny stab wounds are also made where the fat is to be injected, usually not much bigger than needle pricks that heal without visible scarring.
Post-operative care
- Adequate pain medication will also be prescribed.
- Discourage massage and excessive facial animation immediately following facial fat grafting. These restrictions are to prevent migration of fat away from the desired areas of treatment.
- Compression dressings to prevent migration have been described; however, they are often difficult to maintain and probably add little to the final result.
- Ice compresses may be applied for 24 hours to minimize swelling and bruising.
What complications may occur?
The major concerns following fat grafting are related to under correction and over correction. Under correction can be the result of the placement of less than the required amount of fat or from the resorption of some of the graft. Under correction is generally easier to treat than over correction. Additional fat may be grafted at a separate sitting to complete the correction. An overcorrection or the development of a firm scar layer around the transplanted fat can lead to a visible and palpable mass – the only way to effectively remove this is through an open surgical procedure. It is important that you understand that the patient is responsible for all costs associated with all secondary surgical procedures or for the treatment of any complications that may arise as a result of this elective surgery.
- Damage to underlying structures, particularly around the eye, is possible but exceedingly rare, reported in the literature but never seen at our office.
- Swelling is usually evident for 2 weeks after the procedure; however, as with any procedure, prolonged swelling is possible.
- Bleeding complications usually are limited to transient mild bruising.
- Additionally, donor site scarring is a potential concern. Contour irregularities can result from overly aggressive harvesting in a small area.
Follow-up care
- Patients should be seen in the first week postoperatively to check the donor and recipient sites. Some edema and a minimal amount of bruising may be apparent.
- An additional follow-up appointment should be made for approximately 6-8 weeks. At this point, most of the edema has subsided, and early results can be assessed.
- Whatever fat persists at the 6-8 month follow-up visit will likely be a permanent success!
Fees and financing
This procedure is not covered by insurance. The office staff can assist you to obtain financing if desired.
In compliance with suggestions adopted by the American Society of Plastic Surgeons, it is customary for the patient to pay all fees for cosmetic surgery prior to the desired operation. This insures that the patient is sincere in her motivation and can afford the surgery, thus creating a better patient/ physician relationship. A non-refundable deposit will be required to secure your desired surgery date. The remainder of the fees must be paid prior to the surgery, usually at the time of the preoperative visit, but no later than one week before surgery. Additional fees are also required for laboratory tests, surgical facility fees, the anesthesiologist, and if necessary, mammography. If additional surgical procedures become necessary, additional facility, laboratory, anesthesia, implant costs and professional fees will be incurred. The surgical facility and anesthesiologist fees quoted will be based on our best faith estimate; the final fee may vary as these fees are based on surgical time, and it is not always possible to predict exactly how long a procedure will take to complete. It is important that you understand that the patient is responsible for all costs associated with all secondary surgical procedures or for the treatment of any complications that may arise as a result of this elective surgery.
Pre and post-op photos will be taken of the treatment site for record purposes. I understand that these photos/videos will be the property of the attending physician. I do____, do not ___ agree to allow these pictures to be used for publication, teaching purposes or the practice web site. If I agree, I understand that my name will be kept confidential and protected.
IF YOU HAVE ANY QUESTIONS, DO NOT HESITATE TO CALL THE OFFICE DURING BUSINESS HOURS (949-888-9700) OR AFTER HOURS, CALL YOUR SURGEON – DR BUNKIS CELL PHONE NUMBER IS (949) 500-8856, OR REGISTERED NURSE, TRACEY PRESCOTT’S NUMBER IS (949) 338-6072.
WITH AN EMERGENCY THAT REQUIRES IMMEDIATE ATTENTION, CALL 911 BUT PLEASE HAVE YOUR FAMILY NOTIFY DR. BUNKIS OF ANY PROBLEMS YOU MAY HAVE!
I, ________________________________________________certify that I have read and understand the “Microfat Grafting” information sheets dated March 2008, that my surgeon has answered all of my questions to my satisfaction, and that I give my informed consent for this procedure.
Patient Signature_______________________ Date__________________
Witness_______________________________ Date__________________
I certify that I or a member of my staff has discussed all of the above with the patient and have offered to answer any questions regarding the procedure. We believe that the patient fully understands the explanation and answers.
Surgeon’s Signature_____________________ Date_________________
Initial if copy requested/given to patient____________________________
Copy placed in chart __________________________________________
Copyright, 11/87 Last revised 03/08
Juris Bunkis, M.D., F.A.C.S.
How long should I wait until I can go out socially?
Social activity should be limited while the patient is uncomfortable. Basically, most patients find that they can return to normal activity as the discomfort of the operation fades away.
