Fat Transfer Surgery

This is a procedure which involves using fat that has either been specifically removed for the operation or as a separate procedure involving liposuction, from another area of the body.

Fat Transfer Surgery

Used for: If you have very deep smile lines, sunken cheeks or very deep acne scars your best, and really only, option is to have these areas filled with your own body fat. There are both advantages and disadvantages to using your own tissue. The advantage, obviously, is that there is no chance of any allergic reaction or rejection. The disadvantage is that you first have to have the fat extracted from elsewhere.

The procedure: Before you can have the fat injected, it must first be ‘harvested’. This is done by mini-tumescent liposuction. Under local anaesthetic, a tiny, fine needle is inserted, usually into the abdomen or flanks (‘love handles’) of men and thighs of women (only one of my patients has had to go home to put on weight before the procedure). A solution of local anaesthetic, epinephrine (a vaso constrictor) and bicarbonate of soda is included in the needle to inhibit stinging. The fat is then withdrawn through the same needle. Sometimes a single suture (stitch) is required which will stay in for about a week.

What fat isn’t needed immediately is carefully labelled, stored in sealed bags and frozen for future use (for up to one year later). What is to be used is loaded into a fine canula — a sort of blunt-ended tube. It scores tunnels in the lower dermis or in the subcutaneous fatty layer beneath and as it is withdrawn tubular grafts of fat are left behind.

After: You might have some swelling and/or bruising and some local discomfort which will last a few hours.

Possible risks: If the procedure is done properly there shouldn’t be a noticeable depression where the fat was taken but there may be some swelling and perhaps even a little temporary discoloration. If injected into parts of the face where there is very little subcutaneous fat — such as lips or around the eyes — there is a risk that you will get lumps and bumps — which is why it is not recommended that the procedure should be performed there.

Duration: Fat transfers lasts longer than the fillers, largely because it is usually used in areas such as cheeks or scars which aren’t subject to much movement. Most patients achieve about a 40-60 per cent persistence over two to three years. In scars it can last longer.


Isolagen

If you don’t like the idea of having bovine collagen injected there is another option — your own. Just approved, Isolagen is the trade name of a new service in which 3 mm biopsies of your own skin are taken — usually from an inconspicuous area — and sent to the company’s US laboratory. There, scientists culture your own collagen and the fibroblasts which produce it. Several weeks later the results of your donation and their labours are sent back to your physician.

Used for: Isolagen can be used to correct fine smile, frown and lip lines, augment the lips and also fill out concave scars.

The procedure: This is similar to that for collagen.

Afterwards: The bruising reactions are exactly the same as for bovine collagen.

Possible risks: These are the same as for bovine collagen but without the risk of allergy.

Duration: According to the company’s own literature, Isolagen is longer lasting than bovine collagen but it’s a relatively new service and time will tell.


Botox

As its name suggests, Botox is indeed derived from botulinum toxin. A fantastically dilute and highly purified version of the very same bug that causes life-threatening gastric upsets, it is injected into the muscles which cause crow’s feet, the folds of a frown or those that cause excessive lip pursing. There is no effect on the central nervous system because the toxin remains locked in the muscle into which it is injected. Gradually, over eight to ten days after your procedure the flow of nerve signals to the muscle is staunched. No longer able to pull on the skin in the way that caused the dermal trench to form, the line is either softened or completely eradicated. The effect is temporary, however, and after three to eight months, the nerves eventually regain their ability to receive and transmit signals. Botox has really revolutionized the treatment and prevention of line formation and is fast becoming the most popular procedure performed.

Used for: Botox is currently being used to paralyse the muscles that cause creases in our forehead — both frown and horizontal lines, eye, upper lip, marionette areas and sometimes the neck. Botox is also being increasingly used by doctors to help alleviate the muscular spasm often associated with Bell’s and cerebral palsy and is now being investigated for the relief of tension headaches and migraine.

The procedure: For at least the first time you have Botox your physician will probably attach an EMG (electromyogram) to the area to ensure the precise placement of the needle into the muscle. Then the solution is injected into the muscle, probably in several places to ensure that all areas of the muscles are hit. There is no anaesthetic in the solution but apart from some stinging as the solution goes in, the sensation is quite bearable.

It takes up to ten days for the nerves to be completely incapacitated, during which time you may feel nothing at all or perhaps a little light flickering or twitching of the muscle. Many patients are worried that they will look expressionless, but it is our experience that because the face has such an enormously wide range of movements freezing one from your repertoire goes unnoticed. If total lack of movement is still a concern, the dosage and depth of the injection can be adjusted simply to weaken the muscle rather than paralyze it completely.

Afterwards: If you bruise easily you may have some light marks which will take two or three days to fade. Equally there may be some slight swelling at the injections sites. Occasionally patients complain of a headache.

Possible risks: There is as yet no evidence of allergy. The only complication can be a slight droop of one eyelid, but in my experience a less than 0.5 per cent risk. It resolves itself within two weeks. There is, however, the reverse risk that you may be resistant to the toxin. Some people may have unknowingly had a sub-clinical bout of botulism which has left them with antibodies to it.

Duration: In the first instance, the paralysis lasts only about three to four months, slightly longer with horizontal forehead lines. We are now finding, however, that with each subsequent dose the time lengthens.


Spot check

An efficient way of prolonging the life of your temporary filler is to have the muscles that caused it in the first place paralysed. An injection of Botox at least two weeks before that of your chosen filler will relax the muscles around the line for several months and can double or even treble the life of your filler.