Moving fat from an area where you do not need it to some place where it might be an advantage is an old concept in the history of medicine. Techniques have evolved making this more possible today than when it was first tried. Fat transfer to the face and to liposuction defects have been used with success for the last decade. Fat transfer to the breast has proceeded cautiously because of two concerns. The first is the fear that the transplanted fat could interfere with the interpretation of mammograms. The second was that the fat tissue might contain stem cells that could stimulate growth of breast cancer cells. Recent investigations have shown these concerns to be unwarranted. Mammograms taken after fat transfer to the breast have been shown to be no more difficult to read than those taken after other types of breast surgery, such as reductions. Fears of tumor stimulation by fat transfer have also been debunked, as fat in a mastectomy site or partial mastectomy has not been shown to increase local or distant recurrance of breast cancer.  

These findings raise hopefulness for lipo transfer (fat grafting) to the breast. Fat grafting has provided good results when used to give more tissue cover over an implant in breast reconstruction. Fat transfer can bring the same advantages in breast augmentation for cosmetic purposes. Using fat without an implant usually requires several transfer procedures to get enough volume. It works best when there is excess loose skin,particularly with a sagging post partum breast. For the woman with a tight skin envelope, a device (called a Brava) is used several weeks ahead of time to stretch the skin. It takes perserverance and motivation on the part of both patient and surgeon to accomplish an enlargement without an implant. The increase in size is less than can be achieved with an implant, but use of a foreign body is avoided. Stay tuned, as it may be the way of the future.

The term cellulite means different things to different people. Cellulite refers to an uneven texture of the skin that varies from skin dimpling to lumps and bumps. Eighty-five per cent of adult women have cellulite so it is an entirely normal finding, and probably under the influence of hormones. In some women the irregular contour is barely noticeable and in others quite extreme. It is most commonly located on the legs, abdomen and buttocks. The contour irregularity worsens with aging. Cellulite can be a source of significant body dissatisfaction.

Because the degree of cellulite changes can vary so much, a classification system was proposed by Curri in 1991. There are four grades in this classification system. Grade I has no noticeable changes to the observer, but under the microscope the tissues show typical signs. Grades II-IV show progressive loss of elasticity, dimpling, waviness and bumps of the surface.

The cause of cellulite has not been clearly shown but the interaction of genetics, hormones, inflammation and weight changes are all being investigated. Connective tissue that crisscrosses through fat is largely responsible. The fat cells bulge over these restraining bands into the deep dermal layer of the skin creating nodularity.

Many therapies have been proposed for cellulite. It has shown itself to be resistant to most. The ineffective treatment modalities include lasers, massage, contact cooling, radio frequency energy, ultrasound, infra red light, suction, topical creams, oral medications and iontophoresis. The long list of unrelated therapies speaks both to the appeal to find a treatment and to the lack of understating of its cause.

Mild cases of cellulite are not worth undertaking frustrating treatment attempts. More severe cellulite may respond to skin tightening surgical procedures, such as a body lift or thigh lift. Fat transfer can help to camouflage surface irregularities. The surface therapeutic tools such as lasers and light based therapies are likely to disappoint. Additional scientific studies are necessary to draw final conclusions.

Stem cells are multi potential cells that have the capacity to develop into a variety of fully differentiated tissues and can enhance regeneration and repair. There is much excitement in the world of medical research about their therapeutic possibilities, all in experimental stages to date. In the laboratory, stem cells have been able to evolve into heart cells, neurons, skeletal muscle, pancreatic cells, bone, cartilage, and blood cells. Stem cells are present in embryos but have also been identified in bone marrow, umbilical cord blood and in fat. Stem cells from embryos have been highly controversial, but those derived from adult tissues are being explored as more acceptable. Fat tissue is an ideal source as it is plentiful and easy to harvest by liposuction, the most commonly performed procedure by plastic surgeons.

Fat grafting is now used by plastic surgeons for both cosmetic and reconstructive purposes. Harvested adipose tissue is treated and then reinjected for facial rejuvenation, lip enhancement, for contouring bodies and for restoring post traumatic defects. In the future it maybe possible to enhance the restorative properties of the transplanted fat by supplementing it with stem cells derived from the fat. These adipose derived stem cells (ADSC) have properties that include attracting new blood vessels into the area, referred to as angiogenesis. ADSC also are able to reproduce themselves, so it is hoped that they will make fat transfers more likely to thrive in their new area of transfer and more likely to last a long time.

Research is being conducted in hopes of using stem cells to regenerate whole organs. If a person’s own stem cells can be harvested and directed to grow into what is needed (say a kidney or a liver) it may be possible to get around rejection of transplanted tissues from other people. ADSC provided as a byproduct of liposuction procedures could prove to be a valuable resource rather than medical waste.

It is unknown how long it will take to advance to making new differentiated tissues, but their use in plastic surgery for enhancing the take of transplanted fat may be a new and exciting development. Plastic surgeons are watching closely to see how this medical research evolves.

America’s body conscious culture sees fat as the enemy. Our weight loss industry has grown around a never ending battle of the bulge. Fat may have been an energy depot for the cave man when hunting was unsuccessful, but most of us never face food shortage. Modern man is learning that fat is a metabolically active tissue that may have a variety of uses and may even hold the key to treating some diseases. Plastic surgeons are repurposing fat for its value in contouring and are continuing to evolve new uses.

Whenever a plastic surgeon undertakes to change or improve some aspect of the body he or she will run through a mental list of options before arriving at the best choice in the particular setting. Often there is more than one way to approach any problem. Guiding principles may include “first do no harm,” “substitute like for like whenever possible,” and “the simple solution is not always the best.” Fat grafting requires careful assessment using plastic surgical principles of how to get fat’s contouring usefulness with a minimum of disadvantages. There are pluses and minuses to every choice. 

In recent years fat grafting to the face is used more and more. The transfer is often made from the abdomen because that is where excess fat is readily available in most people. The fat is processed in a manner that separates the fat cells gently so to keep them viable. The treated fat is loaded into syringes and injected in a series of small droplets.