Best filler: autologous fat
Although transplanted fat was already used over 100 years ago, fat transfer gained worldwide significance only in the 1990’s via the American Sidney Coleman. He corrected facial wrinkles, dark eye circles and enlarged lips using improved techniques. Over the years, the techniques have dramatically improved for fat removal and fat transfers.
Meanwhile the autologous fat transfer knows virtually no bounds. Autologous fat can in principle be incorporated in all areas of the body to achieve an aesthetic correction. Apart from the face, autologous fat is transferred mainly in the following areas of the body: chest, hands, buttocks, outer labia and penis.
In addition to breast augmentation, the autologous fat transfer is particularly well suited to balance different sized breasts, a very commonly desired correction. Currently a breast augmentation using autologous fat transfer, a volume increase of about 150-250 ml / breast is possible in the course of a session.
2001 was the presence of stem cells in fat tissue, so-called ADSC ( adipose derived stem cells ) first described. ADSC have unusual biological properties: they send signals to the environment, thereby increasing healing rates of the transplanted fat. In addition, they also have the ability to transform into other cell types, thus their use was not only excellent for aesthetic but also for the reconstructive surgery:
- Improvement of skin quality in general
- Improving the appearance of scars
- Improving the skin after irradiation
- Improving the skin after burns
- Correction of tissue defects
- Form of improvement in reconstructive breast correction
Autologous fat transfer with stem cell enrichment
Immediately after the discovery of its valuable properties, “stem cell enrichment” began to be applied in the context of autologous fat transfer. The double amount of fat is removed, with half prepared for the transfer and the other used for stem cell enrichment. The stem cells of the second half are isolated and added to the first half – achieving an increase of healing rates of 10-30 %. Clearly stem cell enrichment is only useful if fat is present in excess, and it is much better with slim people to transplant twice without stem cell enrichment than once with enriched. More details about stem cell enrichment.
Autologous fat grafting with PRP
The most recent development in the field of autologous fat transfer is the use of ‘platelet-rich plasma – PRP‘. It was discovered that the healing rates of transplanted fat can be increased by the addition of platelets ( these are the blood cells that are responsible for blood clotting) to a similar extent as via “stem cell enrichment”. The necessary volume of PRP to achieve the required optimisation is approximately 20% by volume, therefore one needs a relatively large amount of blood sufficient to achieve the ideal enrichment of the fat. For minor procedures such as eyes, lips and nasolabial folds this is not a problem, but for breast augmentation this was. Through the use of a new technique almost any amount PRP can now be obtained without losing a drop of blood. Read more about PRP
1. What is an autologous fat graft?
In contrast to organ transplantation, in autologous fat grafting fat is removed from a body site (e.g. stomach, thighs, etc.) and introduced in a different body site (e.g. lips, eye rings, etc.). It is therefore the transplantation of one’s own body tissue, whereas organ transplantation is the introduction of foreign tissue into the body.
2. For what can one’s own fat be used?
The autologous fat transplantation is used primarily for cosmetic corrections in the face. These include lip augmentation, elimination of the nasolabial folds, filling of dark circles or general rejuvenation of the face. Fat transplantation has been used for several years, but since the discovery of stem cells in fat tissues (ADSC), it is also used to improve damaged skin, correction of larger tissue defects and for beautifying scars.
3. What are the properties of the stem cells of the adipose tissue?
Stem cells in the fat tissue (ADSC) have the useful property of being able to evolve as a function of their environment in different cell types (niche theory). These include inter alia skin tissue, connective tissue, blood cells, blood vessels and fat cells. Just this property allows significant improvement in the appearance of irradiated skin, burn scars and scars in general.
4. How is the transplanted fat biodegraded by the body?
The purpose of autologous fat transplantation is to achieve noticeable fat healing in the recipient site. The fat cells will be re-vascularized and survive in the new region. The amount of take varies between 30-80%, so several sessions may be necessary to achieve the desired effect. Healed fat will not disintegrate, and the result is permanent.
5. If more procedures are planned, how much time should elapse between the surgery?
There should be at least two months between procedures.
6. Can fat grafting be used to replace implants in a breast augmentation?
Breast augmentation with autologous fat transplantation is in its early stage and still limited, however; technically the road has been paved. Amazing results can already be achieved with the enrichment of the fat tissue with ADSC (stem cells of adipose tissue), the expansion of the breast with a suction cup (BRAVA method) and multi-layer placement of the fat. However, breast augmentation with autologous fat transfer still has its limits.The current ceiling is approximately 150 – 250 ml/chest. This also implies that between 500 – 1000 ml of pure fat has to be taken, a lot of which is not available in every woman.
7. Can fat grafting be used to replace a facelift?
No. Characteristic of the aging process is a loss of subcutaneous fat and the associated volume loss in the face. Fat grafting re-introduces volume in the face. A facelift corrects excess skin and lifts the sunken structures. Therefore, autologous fat transplant is regarded as an ideal complement to a facelift and the two procedures are often performed together.
8. Which is better, body fat or artificial fillers?
In my view, one’s own body fat should be given preference. Initially operating efforts & costs are somewhat greater, however, in the long term fat grafting is more cost effective. Fillers such as Hyaluronic acid are metabolized by the body within 4 to 6 months; therefore it must be repeated regularly. In fat transplantation the volume gain achieved is permanent, the healing rate of transplanted fat however varies between 30-80%, and. In addition, there can be no allergic reactions and/or intolerances of any kind, because it is the body’s own tissues.
9. How complex is an autologous fat transplant?
The transfer of small amounts of fat (up to 100ml) can almost always be performed on an outpatient basis and under local anesthesia. For larger quantities or if fat is to be transplanted into many regions, a light sedation is recommended. An average autologous fat transplantation (dark circles, nasolabial folds or lips) lasts 20-25minutes and needs about 10ml of patients’ own fat.
10. What complications can occur?
Complications associated with autologous fat transplantation at the recipient site are extremely rare. Medical complications such as local infections are easily manageable. Improper handling may result in oil cysts and calcifications. Other complications can be asymmetry, lumps, bulges, bumps and displacements. Cosmetic complications can almost always be completely corrected. Complications with fat removal are negligible at low suction.
11. Is there any permanent scarring after autologous fat transplantation?
An incision of 1-2mm in length is necessary for the transfer of fat and generally heals without a trace, suturing is not necessary. The scars in the donor region are roughly the same size and therefore also difficult to see.
12. As of when are you “socially acceptable” after autologous fat transplantation?
Depending on the recipient region, varying degrees of swelling can occur for several days but will usually subside after a week at the latest. For minor corrections no abnormalities should be visible within 1-2 days.
13. What are the long-term results after autologous fat transplantation?
In general, long-term results are excellent. Additional procedures may be performed at any time and as often as necessary.
The first consultation takes up to 30 minutes and costs EUR 180. For consultations lasting longer than 30 minutes EUR 250 will be charged. All other consultations are free of charge.
If you purchase the Enzyklopaedia Aesthetica book “Eigenfett, Botox & Filler” (Autologous Fat Transfer, Botox & Filler) ( EUR 29.90 ) the first consultation is free of charge! You can purchase the book during your first visit in the ordination or order it online.
Surgical preparation for performing the procedure under local anesthesia
For public health reasons, a blood test (so-called “blood count”) is necessary, including tests for HIV and Hepatitis A, B, C. If you are insured in Austria there is no additional cost.
Surgical preparation for performing the procedure under sedation
The surgical preparation includes a blood test (so-called “complete blood count “), a chest X-ray, and a surgical release by a general practitioner or internist. If you are insured in Austria and the procedure is medically indicated, there are no additional costs. The same applies to the OP-release by an internist or general practitioner, who is contracted with the usual social security institutions in Austria. In our medical center, there is an internist that the insurance considers a physician of choice. In this case, the insurance will cover about 50% of the cost.
Hospital, out-patient or day clinic (no overnight)
EUR 500 – 1.500, – depending on the duration of the surgery and hospital
To carry out the surgery in the treatment room of my private clinic
In general, the operation takes place under local anesthesia, therefore there are no additional costs. For surgery under general anesthesia instead, an anesthesiologist is needed for surgery. The cost of the anesthesiologist varies depending on the duration of the operation between EUR 250 – 600. On average EUR 400 can be expected.
Depending on how much fat is removed and in how many regions of the body fat is to be grafted, the surgical fee is between EUR 500-10000, – An average autologous fat transfer (lips, nasolabial folds, or dark circles) comes to EUR 900-1.200
Visits and Check-ups
Visits and check-ups are included in the surgical fee.
For surgery under local anesthesia, the following tests should be conducted:
- Preoperative complete blood count including blood type, HIV and hepatitis A, B, C
For surgery under sedation, the following additional tests are necessary:
- Lung X-ray
- Operation approval by a general practitioner or internist.
Please note that the test results may not be older than 10 days at the time of surgery. Please bring all the results for the procedure to the hospital.
Aspirin, Thromboass and similar anticoagulants should not be taken 14 days before the procedure. If necessary, a switch to heparin can be arranged.
Please come 2.5 hours before the procedure on the day of surgery to the hospital and sign in at the porter. After completing the admission formalities you will be placed in your room. On request, you will receive an infusion, which reduces your thirst.
Should the surgery take place in the treatment room of my private clinic, please arrive about 30 minutes ahead of schedule.
- OP-date plan
- OP-date set (take a vacation, compensatory time or sick leave, arrange for child care if necessary, etc.)
- 2 weeks before the surgery, complete the necessary preoperative exams (blood lab, X-ray, ECG, surgical release)
- A preoperative interview will take place the day before the surgery. It will assess the findings, discuss final details and sign the consent form. An instruction sheet will be given to you by the assistant to complete and bring to the hospital. Planing of the 1st Follow -up Visit.
- Arrive at the hospital 2.5 hours before surgery to complete admission formalities. If requested, an assistant can accompany you to help shorten the time before the surgery.
- Discharge from the hospital is same day. Please do not drive yourself. Take a taxi or let yourself be picked up.
- At home, relaxation and recovery should be in order. Avoid strenuous activities.
- 1st Follow-up Visit (about 5-7 days after surgery) Change of band-aids
- 2nd Follow-up Visit (approximately 10 days after surgery): Removing the stitches of the donor site
- 3rd Follow-up Visit (approximately 30 days after surgery)
- Further follow-up visits will take place after two months
- Final follow-up control after one year