Have Researchers Found the Best Method of Harvesting Autologous Fat?

A study published in the Journal of the American Society of Plastic Surgeons sought to examine the method that will optimize the process of harvesting lipoaspirate before grafting.

Dr. Emily Cleveland, together with her colleagues from the New York University Institute of Reconstructive Plastic Surgery, examined various articles on the methods of processing human fat for autologous grafting in an evidence-based review.

They found that there was no single viable method that may be advocated as the best technique for lipoaspirate process.

Autologous fat harvested through liposuction techniques is used by both cosmetic and reconstructive surgeons. As a filler, it has several advantages including availability, biocompatibilty, ease of harvest without risk of allergic reaction or rejection, and it's inexpensive.

This technique has been used in several procedures including, but not limited to, facial rejuvenation, breast augmentation and reconstruction, treatment of congenital anomalies, and improvement of soft-tissue damage due to radiation therapy.

Despite its advantages, the autologous fat transfer technique is also wrought with setbacks. Viability and the retention of fat graft cannot be predicted with certainty because of lack of clear data pinpointing factors which may be responsible for the variability in results.

However, there is a wide belief among practitioners that the lack of standardized procedure, especially with that of postharvest fat processing, significantly contributes to the variability. Currently, several techniques of fat harvest before transplantation are used.

Among them are the use of simple decantation, cotton gauze rolling, centrifugation, and washing in physiologic solutions.

In the study, randomized controlled trials, clinical trials, and comparative studies comparing at least two of the following techniques were included: decanting, cotton gauze (Telfa) rolling, centrifugation, washing, filtration, and stromal vascular fraction isolation.

Results of the study were as follows:

  • There is a lack of superior method for processing harvested lipoaspirate.
  • Simple decantation has previously been demonstrated to preserve a large number of intact and nucleated adipocytes. However, it allows a significantly greater amount of aqueous and lipid contaminants to remain in the specimen, particularly hematogenous cells and other materials that are believed to be proinflammatory and thus harmful to graft survival. Recent publications further confirm this, demonstrating lower rates of decanted graft viability relative to centrifuged and washed specimens.
  • There are limited data to suggest that cotton gauze rolling of the lipoaspirate produces a graft largely free of contaminants, with superior in vitro adipose-derived mesenchymal stem cell content and high rates of in vivo retention but the technique is quite labor intensive.
  • Centrifugation is perhaps the most widely used technique for postharvest fat processing, and has previously been considered the criterion standard. The most commonly used settings are those described by Coleman, in which lipoaspirate is spun at 1200 g (3000 rpm) for 3 minutes, followed by discarding the aqueous inferior layer and wicking off the free oil top layer. The middle adipose layer is then grafted. Some have suggested this may not be the most viable technique, in that it fails to incorporate the “pellet,” which contains the highest number of adipose-derived mesenchymal stem cells in the harvested specimen. Recent literature has demonstrated lower rates of graft viability after centrifugation relative to washing,although equivalent or superior results have been shown by some after “soft” centrifugation (400 g for 1 minute). Nevertheless, other research continues to support the equal effectiveness of standard centrifugation in preserving adipose-derived mesenchymal stem cells and producing viable in vivo grafts.
  • Washing the lipoaspirate has previously been demonstrated to preserve both a large number of mesenchymal stem cells and a large number of adipocytes, thus satisfying both theories for graft survival. Several commercially available technologies that use washing techniques also appear promising for efficient, effective processing of lipoaspirate. This finding is somewhat confounded, however, by the use of multimodality technologies such as those used by Salinas et al. (washing then Telfa rolling or centrifugation), and processing with the Puregraft and Revolve systems, which first filter the lipoaspirate before washing. In addition, limited or no data are available to demonstrate in vivo superiority of these techniques.
  •  Filtration methods appear to eliminate contaminants, and maintain viable adipocytes and a large portion of adipose-derived mesenchymal stem cells. This processing technique may be more efficient in producing viable graft material for large-volume fat transfers, which are becoming increasingly popular among both cosmetic and reconstructive surgeons. The Tissu-Trans Filtron inline filtration system holds promise, but there are to date only extremely limited data available to support its use.
  • Similarly, there is only limited evidence to date to support the supplementation of processed lipoaspirate with additional stromal vascular fraction. Although viable isolation methods have been developed, a great deal of further research is required to determine whether this additional cost and effort is justified by superior clinical outcomes. The Celution 800/CRS System may be a viable method for isolating stromal vascular fraction in clinical settings for augmentation of autologous fat used for grafting; however, no subsequent in vivo study was performed to demonstrate its superiority relative to the other proprietary systems examined in this study. 

In conclusion, the authors said that they 

 did not find compelling evidence to advocate a single technique as the superior method for processing lipoaspirate in preparation for autologous fat grafting. A paucity of high-quality data continues to limit the clinician’s ability to determine the optimal method for purifying harvested adipose tissue. Novel automated technologies hold promise, particularly for large-volume fat grafting; however, extensive additional research is required to understand their true utility and efficiency in clinical settings.

More information about the study can be found at: http://journals.lww.com/plasreconsurg/Fulltext/2015/10000/Roll,_Spin,_Wash,_or_Filter__Processing_of.16.aspx?WT.mc_id=HPxADx20100319xMP

Dr. Michael C. Edwards: Board Certified Plastic Surgeon In Las Vegas, Nevada

Dr. Edwards thinks he's found numerous advantages over the current system. Let's find out why.
Las Vegas Board Certified Plastic and Reconstructive Surgeon Dr. Michael C. Edwards

Name: Michael C. Edwards, MD, FACS
Clinic: Edwards Plastic Surgery
Location: Las Vegas, NV
Website: MEdwardsMD.com

Many doctors have been taking advantage of social media and SEO in marketing their practices. Has it been helpful to you as well?

We have maintained a good internet presence with a lot of educational information on our site(s). Like most would say print media does not help you. I would recommend on focusing on educating your patients and not a lot of flash animation. Many patients don’t have the patience for that and they will move on. I do use some social media but not to the degree that many other plastic surgeons use.

You're using IPL in your clinic. What affected your buying decision? Where do nonsurgical technologies fit in your practice?

I no longer use the IPL however I do perform a lot of non-surgical treatments with neuromodulators and fillers. I purchased an IPL when I opened my practice and it was used for skin treatment as well as hair removal. The proper maintenance did not make the potential profit worthwhile, especially as my practice transitioned away from facial surgery.

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German Plastic Surgeon, Dr. Simone Hellmann of the H-Practice

Surprisingly, plastic surgery in Germany is a taboo. Physicians strive to achieve a natural, un-operated look for their patients.Germany Board Certified Plastic Surgeon Dr. Simone Hellmann

Name: Dr. Simone Hellmann
Location: Cologne, Germany
Clinic: The H-Practice
Website: h-praxis.de

Can you tell us what is it like practicing cosmetic surgery in Germany?

In Germany, cosmetic surgery is not highly accepted – unlike in Brazil for example. Most patients –at least in my practice - are female and they are not very open to talk about that topic with their friends and family. They mainly gather their information on the internet and we are all aware that not every written word is true and that one should hardly trust all of those reports, forums or blogs. Therefore, you have to be very discreet as a doctor and you really have to thoroughly inform and educate your potential patients. Only if you are consistently showing excellent results and offer highly qualified services you are able to build up a pool of loyal patients who will refer you to their best friends. At this level you can create a solid patient base, but it will take you quite a while.

Cosmetic surgery patients in Germany are very much afraid of what they see in magazines and on tv – celebrities with unnatural looking faces or breasts. So it is my assignment to convince those patients that these looks are avoidable and once they will trust you and your skills, German people can be very decisive for ‘getting it all done’.

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Dr. Anna Rosinska Of Body Focus Laser & Longevity Center In Midland Texas

Dr. Anna Rosinska Board Certified Physician Midland, TexasOA dermatologist from Poland, Dr. Anna Rosinskas aesthetic practice also offers medical weight loss and wellness medicine in Texas.

Name: Anna Rosinska
Clinic: Body Focus Laser & Longevity Center
Location: Midland, TX

Personally, I’m most interested in integrative medicine, which is the combination of traditional medical therapy with complimentary natural components that address each patient in a holistic way.

That's interesting: Dr.Rosinska was voted a Silver Medalist in Midland’s Top 100 Businesses and Personalities in category for Midland’s Favorite Physician in Year 2008. Dr.Rosinska was also voted a Gold and Silver Medalist in Midland’s Top 100 for 2009 (Best Physician and Weight Loss Clinic) and Silver Medalist in Weight Loss Clinic category in 2010 .

Can you tell us a little bit about how your interest grew in cosmetic medicine?

I always had an interest in weight loss and as one of the very few female physicians at that time in our area I had huge female patient population. My ladies were frequently complaining about

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Thomas Lamperti, MD: Lamperti Facial Plastic Surgery In Seattle, Washington

Thomas Lamperti MD Plastic Surgeon

Dr. Thomas Lamperti specializes in facial plastic surgery with clinics in Seattle and Bothell Washington. 

Physician: Dr. Thomas Lamperti
Clinic: Lamperti Facial Plastic Surgery
Location: Seattle and Bothell, WA

That's interesting: Dr. Lamperti participates in "FACE TO FACE: The National Domestic Violence Project". Formed as a partnership between the American Academy of Facial Plastic and Reconstructive Surgery Foundation and the National Coalition Against Domestic Violence, FACE TO FACE surgeons offer consultation and surgery, pro-bono, to eligible victims of domestic violence.

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Myrtle Beach Cosmetic Surgeon, Dr. Jerry M. Guanciale

Dr. Jerry Guanciale Myrtle Beach Cosmetic SurgeonBoard certified in general and cosmetic surgery, Jerry M. Guanciale MD is operating in Myrtle Beach, South Carolina.

Name: Jerry M. Guanciale, DO, FACOS
Location: Myrtle Beach, SC
Website: yourjourneytobeauty.com

That's interesting: Dr. Guanciale was accepted to the American Academy of Cosmetic Surgery fellowship program with the Beverly Hills Cosmetic Surgical Group in Beverly Hills, California. He's been awarded medical licenses in Ohio, Kentucky, South Carolina, Arizona, and California with current active licenses in South Carolina, Arizona, and California.

What attracted you to cosmetic surgery and how did you get started?

While practicing in Myrtle Beach South Carolina, I had the good fortune to be asked by Dr. Steven K. White, a Board Certified Plastic and Reconstructive Surgeon to assist him in his larger plastic surgery procedures.  I had, over the years, become somewhat disenchanted with certain trends in General Surgery in which procedures were being introduced that were clearly not changing patient outcomes but were narrowing the scope of my practice by creating multiple subspecialties of General Surgery. I needed something to infuse some vitality into an aging practice and frankly, into the monotony of the diseases and patients I had been treating for nearly two decades. 

I applied for and was accepted into an approved AACS cosmetic surgery fellowship with the Beverly Hills Cosmetic Surgery Group in Beverly Hills, CA. The cool thing was, I had no

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