Factors That Can Affect Fat Grafting Success in Brazilian Butt Lift

Fat grafting is the latest trend in body sculpting. A fat grafting procedure transfer autologous fat (from your own body) from areas in which patients have excess fat, such as arms, abs, flanks and back, and injects it into areas that may need volume-enhancement, such as face, hands, breasts or buttocks. In particular, many of my patients who desire a fuller, more curvaceous derriere opt for a buttocks augmentation with fat grafting (BBL). Since the fat grafted is not a foreign material such as an implant, there is no risk of rejection and very little risk of complications associated with implants such as often reported ruptures or leaks.

After the autologous fat is re-injected, 65% to 85% of the transferred fat will usually take and stay in the area for years to come, providing a permanent solution for the patient’s cosmetic needs. The rest of the transplanted fat will be harmlessly and naturally metabolized by the body.Due to this variable amount of fat graft take patients frequently require more than one session of grafting to attain their desired result. The percentage of the fat that survive will vary depending on many factors, some of which doctors can affect (the method of harvesting, processing and placement) and some others which are under patients’ control.

 The method of harvesting is among the factors that enhance survival of the transferred autologous fats, and surgeons can definitely influence it. Clinical studies have shown that fat transfer procedures success is dependent on factors during the removal of the fat, such as the aspiration pressure used, and the cannula’s size used. The area where the fat comes from per se is not a determinant factor in fat grafting attainment. In this respect, I favor VASER liposuction system for viable fat harvesting. Fat cells treated and removed during VASERlipo procedures are typically of high quality and are viable to re-introduce the body (1). The VASER lipo system was designed to maintain the integrity of fat cells, by using ultrasound energy to selectively target and dislodge fat cells from the fatty tissue matrix. Atraumatic VentX cannulas give you the ability to fine tune suction pressure to remove the treated fat. Typically, 2.9mm to 4.0mm precision cannulas are used, depending on the donor site, and the pressure utilized to extract the fat with VASERlipo system is minimal (around 15 inch Hg) as opposed to the standard 25 inch Hg, which can affect the viability of the fat cells harvested. Two recent, independents studies have confirmed the viability of fat removed with VASERlipo: Cytori Therapeutics conducted a multi-site study that confirmed the viability of VASER-treated fat at 85% and regenerative cells at 87%, and the University of Pittsburgh Medical Center found the viability of VASER-treated fat to be over 80%, six weeks post re-injection (2). Research concluded that breaking apart adipose tissue prior to aspiration allows the use of atraumatic cannula and lower vacuum levels, which prevent the fat from tearing or shearing during aspiration.  

Moreover, the method of processing is the second key factor that surgeons can use to maximize fat survival. The preparation process clears the donor fat of blood, pain killers and other unwanted elements that could cause infections or other undesirable complications. Separation from excess fluid (purification of the fat) ensures that the surgeon is injecting a higher proportion of fat. After the fat selection process is completed, only 500cc to 1500cc of the fat will be injected into each butt cheek. Three primary methods (sedimentation by gravity, filtering technique, and centrifugation) have been used clinically to process fat grafts. In this respect, centrifugation is the more effective method of choice for processing facts, based on numerous clinical studies that concluded: “although may be more aggressive on adipocytes, centrifugation clears the fat from most blood remnants and is able to possibly maintain the highest concentration of stem cells within the processed lipoaspirates” (3). For fat processing, centrifugation at a low speed is preferable to high-speed centrifugation, sedimentation by gravity or filtering technique. Research determined that fat grafts processed with centrifugation at 1200 g for 3 minutes have better viability and should be recommend for processing fat grafts.

Third, high success rates of fat survival can be achieved by choosing a proper method of placement. After the harvested fat is purified, the surgeon carefully transfers fat cells into each buttock. To do so successfully, he or she will make small incisions (less than 1cm in diameter) in the butt cheeks and use a hollow tube to insert small quantities of fat cells into each side of the buttocks (micro-fat injections). This process is repeated until the desired correction has been achieved, creating a grid of grafted fat. At the end, the surgeon proceeds to massage the grafted areas to create a satisfactory contour. By all means, fat placement requires slow injection techniques and is time consuming. Clinical studies in patients found that “a slow injection speed of 0.5 to 1.0ml/second resulted in larger fat grafts compared with a fast injection speed of 3.0 to 5.0 ml/second” (4). Increasing injection speeds can result in cellular damage. The studies also reinforce the principle that fat grafts, once placed, should have a maximal amount of contact with the vascularized tissue in the recipient site for better survival.

Lastly, proper BBL post-operative care and healthy lifestyle habits are factors that significantly affect fat survival. Patients can actively contribute a great deal on the success of the procedure and longevity of the results by following their surgeon’s recovery recommendations. In my experience, patients who successfully avoid sitting or putting pressure on their buttocks or stretching for the first eight weeks after their surgery are much more likely to have long-lasting results than patients who fail to follow this advice. The longevity of transplanted fat cells can also be affected by lifestyle factors. In particular, smoking can lead to the degradation of new cells because reduces circulation throughout the body. By eating right and avoiding cigarettes, patients can considerably increase the longevity of their Brazilian Butt Lift.

References:

(1) Schafer, M.E., et al. “Acute Adipocyte Viability After Third-Generation Ultrasound-Assisted Liposuction”. Aesthetic Surgery Journal. 2013 Jul; 33(5):698-704.

(2) Fisher, C., et al. Comparison of Harvest and Processing Techniques for Fat Grafting and Adipose Stem Cell Isolation. Plastic Reconstructive Surgery. 2013 Aug; 132(2):351-61

(3) Lee L.Q. Pu. “Towards more rationalized approach to autologous fat grafting”. Journal of Plastic, Reconstructive & Aesthetic Surgery.pdfs.semanticscholar.org

(4) Strong, Amy L. “The Current State of Fat Grafting: A Review of Harvesting, Processing, and Injection Techniques”. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov

Potential Complications of a Tummy Tuck Procedure (Abdominoplasty)

One of the most common cosmetic surgeries patients are interested in when they come to my office is the abdominoplasty. This procedure, generally known as tummy tuck, can flatten your abdomen by removing loose, excess fat and skin and tightening muscles in the abdominal wall. One benefit that patients appreciate the most is that it can also remove the stretch marks in your lower abdomen. It is popular following pregnancy, massive weight loss or whenever a saggy abdomen with weak muscles impairs body contour.

            When performed by an experienced board certified plastic surgeon, the abdominoplasty will result in flatter, firmer abdominal contour with narrower waistline that wouldn’t be achieved by liposuction procedures only. All in all, abdominoplasty is a very safe operation. Unfortunately, as with any other cosmetic surgeries, there are post-operative complications that should be addressed by a specialist in a time manner. The most likely possible complications after abdominoplasty are: swelling, infection, wound separation and fluid collections (seromas and hematomas). 

The swelling is manifested in the upper thighs and in some cases in the lower legs. The abdominal skin flap can stay swollen due to lymphatic blockage weeks after surgery. This type of swelling requires compression, because swollen tissues themselves can cause more scarring. To prevent the swelling that can occur following a tummy tuck procedure, I prefer the Lockwood technique because separates less tissues than the standard technique. Moreover, one significant thing you can do to control the swelling after the surgery is to wear the post-op compression garment 24/7 for at least eight weeks. Have in mind that tissues heal better and faster when there is minimal swelling.               

Infection is another possible complication that can occur after abdominoplasty. Usually, I prescribe patients antibiotics during their final pre-operative visit to prevent wound infection. It is important that patients make sure they are not allergic to the antibiotics prescribed by their surgeons. Oral temperature over 100.4 degrees, yellowish or greenish drainage from the incisions and/or foul odor are among the indicators of a possible infection. A suture abscess is typically not dangerous and it’s easily taken care of by lancing the area under a local anesthetic, and packing the small puncture with a medicated gauze. However, infections can also be life threatening, like those of MRSA (Methicillin Resistant Staph Aureus). It’s always best for patients to contact their doctor promptly if they have any sign of infection. Therefore, I facilitate my cell phone number to all of my post-op patients so they can communicate immediately if any problems or concerns arise.  

Wound separation can also be a possible complication after an abdominoplasty. Excess skin tension if too much skin was taking out during the procedure can cause the wound to separate. Small wound separations are easily taken care of by packing the wound with medicated gauze. Slightly larger wound separations can be taken care of by a suction device called a “Vac Dressing”. Large wound separations caused by poor blood supply may need revision and re-approximation of the wound edges in a procedure room.

In any case, I highly recommend patients to schedule an in-person visit to get the wound treated promptly and prevent further complications such as getting the wound infected or extending the recovery period.

Lastly, fluid collections (namely seromas and hematomas) are among the possible complications after a tummy tuck procedure. A seroma is a collection of wound fluid. Sometimes it occurs when patients do not wear the compression garment adequately or he/she has a lot of activity in the post-operative period. For its part, a hematoma is a collection of blood in the dead space. It usually needs to be evacuated because it can be painful, can lead to infection or cause excessive scarring. Although seromas and hematomas can be easily treated with a needle aspiration, the best remedy against fluid collections is prevention. The proper use of compression garments and foam pads (Topifoam pads) over areas of potential fluid accumulation are significantly beneficial to prevent these post-operative complications.   

Keys to a Long-term Success in Liposuction

After liposuction, patient needs to have a realistic expectation to have a long-term succesful outcome.  There are 4 key elements to have a succesful outcome after liposuction:

1)Exercise - Exercising after liposuction is very important, especially after the initial surgery.  We encourage our patient to start exercising 2 to 4 weeks after their surgery.

2)Proper Diet - It is very important to eat a healthy diet consisting of fruits, vegetables and fish.  We recommend avoiding fatty food, drinking sodas, and eating excessively.  We recommend consulting with a nutritionist if one is having difficulty having a proper healthy diet.

3)Positive Lifestyle Changes

4)Succesful Body Contouring - It is important to choose the right surgeon who would perform your procedure.  Unfortunately, cosmetic surgery is unregulated here in the United States, and we recommend choosing a plastic surgeon who is trained in liposculpture surgery to perform your procedure.

Before & After Photos of VASER Liposuction (6 weeks after surgery) performed by Emmanuel De La Cruz MD, PLLC.

A clinical study conducted by Dr. Rohrich revealed that:

• "Among the 57 percent of patients who did not gain weight, 35 percent report exercising more postoperatively (compared with only 10 percent in the weight gain group, p = 0.002) and 50 percent report eating a healthier diet (22 percent in the weight gain group report eating a healthier diet, p = 0.002). "
• In the weight gain group, 67 percent report no change in their diet regimen and only 17 percent thought their productivity increased (compared with 25 percent among the no weight gain group, p = 0.002). Successful body contouring surgery requires a patient to embrace positive lifestyle habits. "

Thus, the long-term success of a liposuction procedure is dependent on having a healthy proper diet and exercise.  One can still gain weight after your liposuction procedure if one does not exercise and eat a healthy diet.

Reference: Rohrich, et al. The key to long-term success in liposuction: a guide for plastic surgeons and patients. Plast Reconstr Surg. 2004 Dec;114(7):1945-52; discussion 1953.

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon

Houston, Texas

Abdominal Exercises to Maintain your 6-Pack after 4D VASER Liposuction

After your surgery, it is critical to maintain your new body with exercise and diet. Your results are optimized if you live a healthy lifestyle which includes exercise at least 3 days a week, and a healthy diet with minimal caloric intake.

Here's a video I recommend to maintain your 6-pack after the 4 D VASER liposuction.  Your results will be optimized when you do this exercise.

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon

Fat Graft Harvested via VASER Liposuction is Viable and Suitable for Fat Transfer in Brazilian Butt Lift Patients

Although there's clinical evidence of successful autologous fat transfer (AFT), such as in Brazilian Butt Lift, using VASER liposuction is readily available, no study has quantified adipocyte viability using standardized methods until recently.

• The UAL system (VASER; Sound Surgical Technologies, Inc, Louisville, Colorado) was set at 60% amplitude in pulsed mode with vacuum aspiration of 15 in Hg or less.
• Laboratory analysis included free lipid volume, viability via lipolysis and propidium iodide staining, and cytological analysis, including cell surface protein examination and hematoxylin and eosin staining.
• The lipolysis assay revealed metabolically active adipocytes with a mean (SD) correlative viability of 85.1%
• Direct measures of acute viability via propidium iodide staining resulted in a mean (SD) viability measure of 88.7%
• Adipose tissue acquired via VASER liposuction is viable at harvest and isa suitable source for autologous fat grafts, especially for Brazilian Butt Lift.
• Adiposed-derived stem cells (fat for fat transfer) obtained via VASER liposuction were of equal quality when directly compared with the current gold standard harvest method according to a study conducted by Duscher.   "UAL- and SAL-derived samples demonstrated equivalent ASC yield and viability, and UAL ASCs were not impaired in their osteogenic, adipogenic, or chondrogenic differentiation capacity."

4D VASER Liposuction performed by Dr. Emmanuel De La Cruz of Houston, Texas

Reference:

Duscher, et al. Ultrasound-Assisted Liposuction Does Not Compromise the Regenerative Potential of Adipose-Derived Stem Cells.  Stem Cells Transl Med. 2016 Feb;5(2):248-57. doi: 10.5966/sctm.2015-0064. Epub 2015 Dec 23.

Schafer, et al.  Acute adipocyte viability after third-generation ultrasound-assisted liposuction. Aesthet Surg J. 2013 Jul;33(5):698-704. doi: 10.1177/1090820X13485239. Epub 2013 May 29.