Autologous fat transfer (AFT) Flashcards
Autologous fat transfer can be used to correct soft tissue defects and rhytides, in addition to skin atrophy associated with ageing.
T
It is essential to overcorrect when performed autologous fat transfer.
F
Small volumes preferred.
Autologous fat transfer has no potential for infectious disease transmission
T
Autologous fat transfer follows the patient’s anatomical landmarks by placing fat within or adjacent to facial muscles.
T
this is Fat autograft muscle injection (FAMI)
Rejuvenation of the dorsum of the hands is an indication for Autologous fat transfer (AFT)
T
usually 10mls per hand injected
although Coleman recommends 20–30 mL per hand
Potential complications of fat transfer are generally unavoidable.
F
Avoid by careful, sterile technique.
Autologous fat is harvested by gentle syringe aspiration then is universally directly injected into subcutaneous fat or muscle.
F
Often rinse or centrifuge prior to reinjection.
The transplanted fat becomes ischaemic following transfer to the recipient site.
T
Volumes of autologous fat up to 5mm diameter have optimal viability.
F
3mm
A volume of 20-100mL is needed to restore full facial volume.
T
this vol is not feasible with synthetic fillers
The outer thigh is often used for fat harvesting due to its non-fibrous nature and relative avascularity.
T
avascular fat may survive the transfer process better
Lignocaine has been reported to have negative effect on fat cell viability
T
But recent studies suggest it is better than other local anaesthetics and it is widely used
Normal saline, Klein’s solution or Ringer’s lactate can be used in fat harvesting.
T
Used to minimise contact with lignocaine and enhance fat cell viability.
Fat cells can be harvested by syringe, machine aspiration, or direct excision.
T
All techniques have similar fat cell viability.
Syringe aspiration with high negative pressures is the harvest technique most often recommended.
F
Low negative pressures.
pressure of 700mmHg or higher can cause partial rupture of fat cells
Gentlest harvesting is reported using 10mL syringes to minimise vacuum pressures with the plunger held back no more than 2-3mL.
T
some use larger syringes.
dont use needles less than 18 gauge as may disrup the adipocyte
The first step after fat harvesting is to stand syringes upright for 15-60 minutes to allow separation into supra- and infra-natant fractions.
T
After fat harvesting, the supranatant fraction is decanted off and discarded.
F
This is the fat to be transplanted.
infranatant is discarded and often the oil fraction on top is too
After separating the harvested fat, it can be washed with saline or Ringer’s lactate to remove lignocaine and blood.
T
Blood has no effect on phagocytosis of fat cells.
F
Stimulates phagocytosis so should avoid injecting blood with the fat
Centrifugation can be done as an alternative to rinsing harvested fat.
T
Centrifugation concentrates fat cells, resulting in a larger number of cells per mL of volume transferred.
T
removes blood products, proteases, free lipids, and lipases which may degrade freshly grafted adipocytes
When 10mL of fat is centrifuged at 3600rpm for 1-3 minutes, there is approximately 5-10% of the volume separated at the bottom as infranatant
F
30-40%.
Centrifuged fat may result in improved longevity and aesthetic results compared to non-centrifuged fat.
T
The most common placement for transplanted fat is within the subcutaneous fat.
T
When injecting harvested fat, overcorrection of 30-50% should be made to allow for fat degradation.
F
Minimal or no overcorrection.
Postoperative oedema is not directly related to the amount of fat transferred.
F
Directly proportional.
Anterograde injection with gentle pressure should be performed for fat transfers.
F
Retrograde – reduces risk of intravascular injection and injection of large fat bolus.
1 to 10 mL syringes can be used for fat injections.
T
smaller fat particles are dispensed if a smaller syringe is used and the pressure required is less with small syringes
Prolonged air exposure negatively impacts fat cell viability.
T
use female to female adaptor to transfer to syringes of different sizes without exposure to air
Blunt-tipped cannulae should not be used for fat transfer.
F
Can be used.
Also can use 14-25G needles
(some suggest not using needles smaller than 18g same as the rule for fat extraction)
unclear if any difference in bleeding risk or tissue trauma whn needles or cannulae used
The most common indications for fat augmentation of the face include the nasolabial fold and the marionette fold.
T
Other areas of the face that can be treated with fat transfer include the cheeks, malar area and chin.
T
Body areas which can be augmented with fat include the dorsal hands, buttocks, biceps, calf and breast.
T
There are no additional risk factors associated with fat augmentation of the breast.
F Calcifications may develop post operatively which can mimic breast ca.
Defects for disease or trauma can be treated with fat injection.
T Eg. acne scars, LE scars, cellulite.
Lipostructure ™ refers to full-face three-dimensional enhancement of youthful contours.
T
Using the Lipostructure ™ technique, minute quantities of fat are all placed within the subcutaneous tissue plane.
F
Placed in multiple planes eg adjacent to bone, fascia and muscle as well as subcut
