Dr. Kristina Tansavadti / May 10, 2018
A Natural Youthful Look Using Your Own Fat
Happy holidays. Let’s start off with that we all have to be very thankful for our lives, for our homes, for those who are protecting us, our fire fighters and policemen who are protecting our homes and us. There was a huge RSVP list and some people weren’t able to make it because of the fires So if you know any friends who wanted to come and they weren’t able to make it just let them know that what specials we have tonight we’re going to extend to next week until next Thursday so that people didn’t miss out.
So without further ado I am going to go over the main talk tonight and that is about fat transfer. This is a procedure I’ve been doing for a while now. Actually this has been done for a long time but it’s actually been changing and the evolution of fat grafting has gotten better and better with time and that’s why I want to present it because it really truly is the best natural filler you can use.
This is not to kind of point a thorn to some of our reps who are supporting us tonight on facial fillers because they are like well then that’s going to take business away. Yes and no, because the right candidate for fat grafting procedure is going to be somebody who is able to take some down time and is okay with a result that’s gonna last a few years versus somebody who’s okay with coming in once a year with the yearly maintenance and that office visit.
There is a difference between the two procedures. I’m going to talk about fat grafting and that is the grand prize tonight. I don’t know if everybody got to hear about that that’s the grand prize; we have some fabulous prizes tonight, and that one is worth $6000 and I only saw 6 raffle tickets in there. I was like, whoever wins has great odds. If you have any raffle tickets left right now you may want to put it in that one.
And the other prizes that we have tonight Botox, Dysport, Restylane which is a hyaluronic acid filler, Juvederm or any one in that family we are going to decide based on if you win that i’m going to decide which filler is best in the family for you.
And then we have Hydrafacial — there’s 3 winners in that, so if you put it in that bowl we are actually going to draw 3 winners out of that bowl for the Hydrofacial and then an IPL treatment there is going to be two winners from that bowl so there are more odds for those two prizes and then the last one is a skin care package from my line, which is worth $500.
I saw only a couple raffle tickets in there too, so that one is probably one you should put in as well because you could probably win that. Alright, without further ado I am going to talk to you about “A Natural Youthful Look Using Your Own Fat”.
First thing I think I want to talk to you about is what the natural aging process looks like. We all know as we get older we see fine lines and wrinkles on the outside, we see the outside but we don’t know what’s going on in the inside and on the inside what’s going on is that we’re losing fat and we’re losing volume.
I didn’t know if anyone could hear me because this is a big space and my voice can’t carry because it’s very weak anyways, so about aging we do lose volume in our face and one of the things that we lose is fat. If you can see this picture what happens is as we get older the volume of fat decreases and then it descends in the face. So if you start seeing those jowls that’s what’s happening that fat is not only less but it is descending in our face.
The other thing that happens is that we lose bone structure. The thickness of our bone decreases and then the muscles in our face weakens and they thin out as well. So all the volume loss results in the wrinkles. And the hollowing that we see in our face, what can we do about it? Well, that is why fat grafting is the ideal filler because we are losing fat already, so why not take fat from another area of our body and fill it with our own, natural fat.
You don’t get an allergic reaction to your own fat, to your own material. You have plenty of fat. We lose fat in our face, but we don’t seem to lose it in our body so that’s a great source for it. When you’re taking like with like, you’re refilling what was already lost now with fat that you’re getting from somewhere else in your body.
When we take fat from another area of our body we are obtaining Stromal fat cells, which are stem cell progenitors and they stimulate the production of new tissue in the area. So when I take fat from your belly this fat lives in your face but there are also some stem cell fat cells that stimulate growth of not only the fat cells there, but also your skin cells and other cells in the area so your skin looks even slightly smoother and rejuvenated. I will go over that with the post surgery pictures.
Next, what I want to talk to you about is traditional fat grafting. This is a technique that was developed about 25-30 years ago by a plastic surgeon by the name of Dr. Coleman.
This is what everyone has been doing for the past 25 years. It fell out of favor then it regained in favor and the old technique was you would take Tumescent saline anesthesia and inject wherever we were harvesting to numb the area first.
Then we would suction the fat. We would use large cannulas. Meaning the holes were very large. So you would get lobules of fat instead of really tiny fat cells. Then we would centrifuge that, spin it down, take out the blood on the bottom and the serum and oils on the top. We would just harvest the fat. Then we would re-inject the fat. We wouldn’t do anything else with the fat. We would just re-inject it and it would be large chunks of fat.
That’s why you can hear people say that was because it was done using this old technique that you could get bumpiness. That’s what people didn’t like. The free large fat lobule grafts are then transplanted. So it’s a transplant; it’s a graft. But, it doesn’t have its own blood supply. Because of that, you don’t know what’s going to take. Something that has a blood supply and you transfer it to the area, 100% will take.
If it doesn’t have its own blood supply it is a new tissue and it has to find a blood supply from its host site. Because of that, you won’t get a 100% of it to take. The unpredictable nature of this old technique made it hard for people to judge. They would have to go back in and add more fat or take out fat because there was too much that took. This is a fat section of if we harvested the fat.
You have all of these little fat lobules and in the fat lobule itself you have tiny fat cells. The problem with the old technique is you would have to take this huge fat lobule and re-inject it instead of taking the finest cells. What happened was you couldn’t get blood supply to the center.
The center would die, so all the fat cells in the center would die but the sides ones would live a little bit. It caused the dying of the fat cells so not all of it would take. This is just a depiction of what a big fat lobule would look like. It has all these little cells in one big group.
That was the problem with the Coleman Technique is the survival of free grafts is about 30% in reports if you look at the literature. Some reports show as much as 30% and some as much as 80%. There were discrepancies. We might get more because of one technique, but it couldn’t be repeated.
It was inconsistent and unpredictable. Fat could not be injected too close to the skin because there were fat lobules. They were bumpy. If it got too close to the skin, you would see it. Large injection volumes in the face would result in bumps. This is why we changed our technique with time.
This new technique we do is micro fat grafting. It has only been over the last 2-3 years that this has come out. It came about in Europe and then we started learning the technique. What it means is we use smaller cannulas when we harvest the fat. So, the wholes are very small, 1mm small.
Once the fat is harvested we process it through smaller holes through a mesh and that is why it’s called micronized fat because the mesh size is in microns. So not a millimeter, but less than a millimeter. In terms of size. We are harvesting the fat cells down to the very smallest cells.
We don’t want large fat lobules. Then, when we re-inject it, it is easier for that fat cell to survive. Now you can get blood supply to all the little fat cells. Those fat cells that we are trying to harvest, we re-inject. Then the other addition that has made an improvement in our technique is platelet-rich plasma.
What is platelet-rich plasma? It is actually from our own blood. In our blood, we have a high concentration of growth factors that mingle with the platelets. The platelets carry those growth factors, so when we try to spin the blood we are harvesting just the platelet-rich plasma in order to obtain those growth factors which contain important stimulants to help collagen be produced in our skin, to really stimulate new skin cells, and to increase vessels to nourish the fat.
That’s what we want. This is a natural product for speeding up healing, wound healing for scars, for burns and especially that’s where we took it from. We took it from the burn literature. From burn literature and wound healing as well as orthopedic surgery. Orthopedic surgeons were using it in the knees to promote healing instead of doing surgery. They would stimulate the healing process in the knees.
That is where we got the literature to now combine this with our micro fat grafting, combining it together. This is what a PRP looks like. We take out the blood, we just harvest the platelet-rich plasma, which is at the top. That’s what it looks like. That yellow serum. The most concentrated form is at the bottom.
That is what we want to re-inject. We combine two techniques really. We combine micro fat grafting with PRP. Some of our aestheticians, I know I have some aestheticians here, Some aestheticians know what the beauty of PRP is and why it is helpful. Combining those two together has really increased survival of the fat grafts. That is what I’m doing now. It is a smooth, natural filler.
It can be injected close to the skin. Now you’re not creating bumps and I can inject into wrinkles. I’ll show you some pictures later so you can see that and some more predictable grafting. I am going to show you a video of me doing this. This is actually my first case doing this. About a year and a half ago. You’re just going to see me doing what I’m doing. That is the PRP in one tube and that is the fat in the other. Then I’m mixing it now.
I’ve already processed the fat and put it through the mesh. Well not through the mesh yet. Just adding PRP first. Then I’m going to put it through the mesh. You’ll see what I’m doing. That yellow serum is the PRP. Going to mix that a little bit. I’m struggling there. So the fat is very small and we are pushing it through smaller, we want to harvest smaller particles. That’s what I’m doing there. So now I’m mixing the two and it turned a milky white.
I don’t know if you guys can see that. Turning the fat to white. It’s now engulfing the fat with this PRP. It’s actually very nice when it comes out. Very smooth, it’s smoother than some of the fillers I use. This is where now I’m putting it through the mesh. The mesh is in here.
I am pulling out the fat. I am going to start re-injecting it. It’s very nice and white. It’s purified fat. This is the injection that I am doing. Now if anyone is grossed out, please look away. She is awake. This is something I do in the office. I don’t do it this way anymore.
The technique is a little bit different. I actually do it like a filler, so I use a micro cannula. That’s what I do for fillers. This is the older technique. I want to show you my before and after photos. You are like “Well, does this work? What does it look like?” I want you to see around the eyes. Underneath the eyes. The problem I have with fillers under the eyes is it’s not so smooth. It can look like there’s a ridge if you over do it.
Restylane is our gold standard. It’s still a little bit ridged. If you could see under her eyes even her fine lines and wrinkles got better. That’s where we did it. We also did it here and in the chin. You will see in the next few pictures. That was her chin, so we also gave her instead of doing a chin implant we just put fat there.
This is another patient of mine. We did, if you could see the texture and tone of the skin. As well as volume in the cheeks. It pulled the cheeks forward a little bit. I’ll show you another picture where we show you just the eyes. This is just the eye area. She had hollowing under the eyes.
You can see a little bit of discoloration there too. Now that is filled up and smoothed out. We also do the cheeks. You can see that as well. These are subtle. These are sort of the results you would get with the filler. With the filler around the eyes, I get problems because it could get too ridged and look obvious. With fat, it’s natural. It is what is in your face. It should be in your face.
That’s why I look so smooth. This, I did it for the wrinkles. You can see these deeper lines got smoother. That is why I could use fat there. Now I’m harvesting in such a small size that I can inject it within the wrinkles whereas we couldn’t do that before with fat grafting. Another one, this is what I love to use around the eyes. Fat grafting is perfect for around the eyes. It is a very natural filler. There you have it.
This is my conclusion; that I just want to let you know this is a more predictable graft take. It can be injected in thin skin areas around the eyes with faster healing times. I would do this on a Friday and you would be back to work on Wednesday. Some people might take a little bit longer.
Just depends on how you heal. If you do get bruising it would be longer. It requires less volume. I usually use a cannula. I use a 25 gauge microcannula.
That’s the same thing I use for fillers. It’s blunt tipped. It’s not going to be sharp. It’s a plastic cannula. It’s not going to jab you like you were seeing there earlier. That was like the steel cannula. It can be done under sedation in the office.
Patients are comfortable with this. The downtime can be 7-10 days or it can be less than that even. The results last 5 years. If you haven’t put it in that prize yet I recommend all of you do it now. Any questions? We can take the fat from anywhere. Ideally, the belly because then I don’t have to move you around to get it.
You’re lying on your back and I get it from your belly. Your inner thighs and outer thighs and some other areas are other areas we obtain fat from. This is the same graft material that is used for orthopedic cases that they’re using for knees. We’re using the Stromal fat cells that have stem cell potential. Yes, that’s what we’re doing.
We’re doing the same sort of technique, but we’re doing it for the face. Any other questions? We’ll be doing some demos. We’ll be doing a Botox demo and we’re going to be doing some filler demos. If you want to be watching, I’ll be doing an injection in the cheeks.