Fat injections into the face have come a long way since the pioneering work of Dr Sydney Coleman of New York in the early 1990’s. At that time it was not certain that a permanent result could be obtained. In fact, many people thought the result was due to prolonged swelling! But this is not the case and it is now proven that it is possible to successfully transfer fat, which then permanently survives and is maintained its new location without moving. In fact, the transferred fat continues to behave like the fat at the original site of origin. For example, hip and lower abdominal fat on the face continues to behave like hip and abdominal fat: so that if a person gains weight the fat cells increase in volume. Conversely if a person loses weight the transferred fat on the face shrinks just the same as it would were it still on the hip or abdomen.
In recent years it has become apparent there is more to fat injections than first thought. It was noted that the appearance of the tissues over the injected fat improved in quality in many people. Now, it has been found that the ‘body fat, is actually the largest source of stem-cells in the body. The LIPOGEMS system is designed to maximise the amount of stem-cells as it purifies the fat.
The greatest concern about injecting fat on the face, other than obtaining a sufficient result is that the fat may be invisible lumps are seen mostly in areas with thin tissue, the areas that most need fat, particularly around the eyes. This problem of lumps is frustrating and difficult to treat. But now, lumps can be completely avoided when using LIPOGEMS, because of the purification process.
After being prepared the fat is passed through a 1mm. filter. Interestingly, fat which had previously been considered to be fine, is seen in the LIPOGEMS chamber to not be as pure as was thought which may explain unexpected lumps.
This is a liberating breakthrough, but the stem-cells being more benefits. Patients who previously had regular fat injections and now have LIPOGEMS, report other differences.
As a result of these advances, new horizons have opened up in facial rejuvenation. We are now becoming proactive in recommending LIPOGEMS around the eyes. Not only does this improve the look of liveliness of the upper lids, the tissue tone and shape of the brow is also improved, so that it provides a subtle temporal lift effect by slightly raising the outer brow. The small amount of hollowing that develops across the lower lid at the top of the cheek is quite aging and can now be safely improved with LIPOGEMS alone. Correction of advanced hollowing here still requires surgery: but LIPOGEMS are added for fine tuning.
The other advance is in the infiltration cannula. These are the very fine blunt ended tubes which are passed through the skin to place the LIPOGEMS particles. These are now even finer and more slippery as the fat particles are finer, so there is less tissue trauma as the finer particles are injected, with less swelling and a quicker recovery.
The LIPOGEMS system maximises a remarkable finding that was not known in the early years of fat injections (lipofilling). LIPOGEMS, a patented closed microfat system that maximises stem cells has been available in Australia only from the beginning of 2015. LIPOGEMS are used either to enhance a natural feature e.g. enlarging the lips, the lids or the jawline, or to correct volume loss caused by ageing. As the volume of the tissues become plumped up there is also a beneficial degree of tightening and lifting of slightly sagged areas to further improve appearance.
SNIFS is a new variation of fat injections in which the fat is reduced to even finer particles. This allows the fat to be injected using a fine hypodermic needle directly into the wrinkles, something not done before. A traditional weakness of lipoinfiltration and fillers is that they are placed beneath the skin and don’t work directly on wrinkles. Now, with microfat injected through a fine needle, individual deep wrinkles can be reduced. The improvement may be of the order of 30% to 50%. Accordingly, a second, and possibly a third, treatment can later be undertaken to further treat, what was previously untreatable. Performed alone this is a relatively minor procedure. Inevitably there will be improvements with this new technique to obtain more predictable results more easily. But so far there is no good alternative. Other treatments using lasers, peels or dermabrasions always lead to permanent lightening.
This is a completely new variation of ‘fat injections’ in which the preparation process is taken to the next level. Now what is being injected is nearly all stem cells. Stem cells are tiny in size compared to fat cells, which are almost 100 times larger! Nanogems use a tiny needle to place a film of stem cells into the skin to rejuvenate and strengthen areas of weakened skin quality.
The only risk with this is of the result being less than desired. But it is the beginning of a new era. The trade-off is the possible need for a second treatment at some time to achieve a sufficient degree of correction required.
Many people are not sure what a facelift actually achieves, which is understandable when this word is trivialised by alternatives such as non-surgical lifts. In reality, when required there is no substitute for a proper, internal support type of facelift, which corrects laxity and sagging of the cheeks, jawline and neck to obtain a natural looking result that is also long lasting.
Some years of ageing changes are usually evident before a facelift is required. While injecting fat is not an alternative to this type of facelift, having lipogems performed at the right time may defer the need for a facelift as LIPOGEMS can very effectively camouflage early ageing changes. Soft tissue fillers are also used for this purpose but they do not have the stem cell qualities and are not permanent. Lipogems are then used to complement a facelift.
For people who have previously had the benefit of a good facelift, as the ageing changes slowly reappear, LIPOGEMS are used to regain the fuller youthful
appearance, deferring the requirement for a second facelift. This is provided of course, the original facelift was a quality one that obtained a proper correction. Even then, the secondary facelift is often a partial, lower face only while the upper face obtained using LIPOGEMS only.
During the first few days, when swollen, some people may be understandably concerned that the fat injections have been overdone, but this concern settles as the swelling subsides rather quickly. With the controlled way the procedure is performed it is not possible to place too much fat and have too much of that fat survive in a first treatment.
The results are a definite but subtle enhancement. They are not dramatic or artificial as is seen with an ‘overdone traditional face-lifts’ and increasingly seen with people who have overdone fillers or overdone fat injections. Disappointment sometimes occurs when people become accustomed to, and came to like their appearance while some swelling remained! In this situation, a degree of disappointment is understandable as the last of the swelling resolves taking the fullness with it.
Examination of the pre-operative photographs can be helpful at this time. By comparing the final result to the `before’ appearance and not the `swollen’ appearance, the degree of improvement can be realistically appreciated.
About a third of patients subsequently have more fat placed. As with fat injection in general, lipogems can be done incrementally and can be performed as early as three months after the original procedure or any time after that. The need to have more fat placed is a reflection of the biologic limit of what can be achieved at any one procedure when LIPOGEMS is performed. It does not mean that the original LIPOGEMS was not well done.
In most situations it can be predicted ahead of time whether a second and occasionally a third LIPOGEMS will be required to achieve the desired correction. This will be discussed with you before you make up your mind to proceed with the first LIPOGEMS procedure. Obviously, if a further meticulous LIPOGEMS procedure is required, a further professional fee will be involved but with a courtesy fee reduction for encouragement.
The less mobile areas of the face, such as over the brow or jaw line tend to have more predictable results from fat injections. Whereas, highly mobile areas, especially the lips inherently have a greater need for secondary procedures.
Although the result cannot be guaranteed, most people find that their original objectives have been met, which becomes more apparent when comparing their post-operative face to their ‘before’ photographs. As with all surgery, there is no magic wand, so it is important to have realistic but high expectations of the outcome and to discuss your objectives fully in your pre-operative consultation.
LIPOGEMS is a minimal risk procedure; in fact, it would be considered the safest technique in facial rejuvenation. Infection, while possible after LIPOGEMS, is extraordinarily rare as the stem cells secrete a natural antibiotic. Another risk you may read about, was rarely seen with traditional fat injections, before the modern technique was established. A few cases have been reported where the injected fat got into the circulation of the eye, as occasionally still occurs with filler injections. With the easier injection of lipogems this is even more unlikely.
Visible irregularities (lumps) tend to be more apparent in broad flat areas, such as the forehead, or where the skin is extremely thin such as the eyelid. However, this does not seem to be a risk with LIPOGEMS, and is important advance! Irregularities are less likely to occur on thicker areas, as on the lips and cheeks. At worst, a `touch up’ procedure may be required to add small volumes of fat should that be insufficient originally.
If LIPOGEMS is being performed alone it is usually performed as a day patient in the Centre for Facial Plastic Surgery. Otherwise when included with other surgery, it is this which determines where the surgery will be performed.
This varies on the extent of the procedure. If only localised areas are being corrected, such as the lip, which is completed within an hour, local anaesthetic is usually sufficient. With a more extensive LIPOGEMS procedure which may take up to two hours most people are more comfortable having the benefit of a light general anaesthetic, but still performed in day surgery.
The fat used for the transfer can be taken from any area of the body, although the abdomen and hips are preferred. The highest quality fat is from the inner knees. Dilute local anaesthetic is injected into the donor area, then the fat is obtained using a special needle. There is no incision or scar, although bruising usually results and it may be considerable.
The aspirated fat is then meticulously prepared for the transfer. This process involves a process of washing, filtering and then transferring the treated fat to small syringes. Particular care is required to avoid trauma to the delicate fat tissue. Recent science has shown there are large numbers of stem which must be preserved with the fat to obtain the best result.
The technique of placing the fat to augment the tissue is a crucial aspect of the technique. Specially designed fine needles are used to ‘weave’ droplets of the purified fat through the tissue where the augmentation is to be performed. The needle is inserted through tiny, scarless incisions on selected areas of the face and the fat droplets are meticulously placed at all levels and from different directions. The incorporated fat tends to take on the characteristic texture of the tissue being augmented. The multiple passes of the fine infiltration needle account for most of the swelling and possibly a degree of bruising of the treated areas.
The only aftercare required, are measures to reduce swelling and to relieve discomfort, if present. Iced compresses applied to the treated areas for the remainder of the day minimise swelling and discomfort. As with any bruising, there may be minor discomfort, which is relieved by everyday analgesics, such as Panadol or Panadeine for the first few days. Most discomfort is experienced from bruising of the donor area! The level of discomfort varies according to the extent of bruising. For lip augmentation there is minimal to modest discomfort only, whereas even a full face treatment has only modest discomfort with LIPOGEMS.
The major disadvantage of LIPOGEMS is the inconvenience of having to put up with some swelling and bruising. Swelling always increases for the first 48 hours after the procedure before it starts to settle on the fourth day. While the face should not be scrubbed, getting it wet in the shower is not a concern.
Swelling during the first week may be such that it may be embarrassing to be seen socially. It is acceptable to wear makeup after 3 days, but be gentle when removing it.
During the second and third weeks the swelling has usually settled so much to be, at worst, a nuisance. For a full face treatment, it may take three weeks for the face to no longer look swollen. Even though it is no longer apparent, some residual swelling remains in the treated area for up to eight weeks.
Some people who are concerned that the duration of swelling could be inconvenient, elect to compromise the initial result (to reduce the duration of swelling) by having less fat injected, knowing this can be repeated in the future
With the major advances in the facelifts I now perform, swelling and bruising from the lift is often minimal and most of it comes from the fat injections! When LIPOGEMS are used, the facelift swelling is reduced, due to the action of the stem cells.
“Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.”