Autologous fat transfer (AFT)

Question 1

Autologous fat transfer can be used to correct soft tissue defects and rhytides, in addition to skin atrophy associated with ageing.

Answer 1

T

Question 2

It is essential to overcorrect when performed autologous fat transfer.

Answer 2

F

Small volumes preferred.

Question 3

Autologous fat transfer has no potential for infectious disease transmission

Answer 3

T

Question 4

Autologous fat transfer follows the patient’s anatomical landmarks by placing fat within or adjacent to facial muscles.

Answer 4

T

this is Fat autograft muscle injection (FAMI)

Question 5

Rejuvenation of the dorsum of the hands is an indication for Autologous fat transfer (AFT)

Answer 5

T
usually 10mls per hand injected
although Coleman recommends 20–30 mL per hand

Question 6

Potential complications of fat transfer are generally unavoidable.

Answer 6

F

Avoid by careful, sterile technique.

Question 7

Autologous fat is harvested by gentle syringe aspiration then is universally directly injected into subcutaneous fat or muscle.

Answer 7

F

Often rinse or centrifuge prior to reinjection.

Question 8

The transplanted fat becomes ischaemic following transfer to the recipient site.

Answer 8

T

Question 9

Volumes of autologous fat up to 5mm diameter have optimal viability.

Answer 9

F

3mm

Question 10

A volume of 20-100mL is needed to restore full facial volume.

Answer 10

T

this vol is not feasible with synthetic fillers

Question 11

The outer thigh is often used for fat harvesting due to its non-fibrous nature and relative avascularity.

Answer 11

T

avascular fat may survive the transfer process better

Question 12

Lignocaine has been reported to have negative effect on fat cell viability

Answer 12

T

But recent studies suggest it is better than other local anaesthetics and it is widely used

Question 13

Normal saline, Klein’s solution or Ringer’s lactate can be used in fat harvesting.

Answer 13

T

Used to minimise contact with lignocaine and enhance fat cell viability.

Question 14

Fat cells can be harvested by syringe, machine aspiration, or direct excision.

Answer 14

T

All techniques have similar fat cell viability.

Question 15

Syringe aspiration with high negative pressures is the harvest technique most often recommended.

Answer 15

F
Low negative pressures.
pressure of 700mmHg or higher can cause partial rupture of fat cells

Question 16

Gentlest harvesting is reported using 10mL syringes to minimise vacuum pressures with the plunger held back no more than 2-3mL.

Answer 16

T
some use larger syringes.
dont use needles less than 18 gauge as may disrup the adipocyte

Question 17

The first step after fat harvesting is to stand syringes upright for 15-60 minutes to allow separation into supra- and infra-natant fractions.

Answer 17

T

Question 18

After fat harvesting, the supranatant fraction is decanted off and discarded.

Answer 18

F
This is the fat to be transplanted.
infranatant is discarded and often the oil fraction on top is too

Question 19

After separating the harvested fat, it can be washed with saline or Ringer’s lactate to remove lignocaine and blood.

Answer 19

T

Question 20

Blood has no effect on phagocytosis of fat cells.

Answer 20

F

Stimulates phagocytosis so should avoid injecting blood with the fat

Question 21

Centrifugation can be done as an alternative to rinsing harvested fat.

Answer 21

T

Question 22

Centrifugation concentrates fat cells, resulting in a larger number of cells per mL of volume transferred.

Answer 22

T

removes blood products, proteases, free lipids, and lipases which may degrade freshly grafted adipocytes

Question 23

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

Answer 23

F

30-40%.

Question 24

Centrifuged fat may result in improved longevity and aesthetic results compared to non-centrifuged fat.

Answer 24

T

Question 25

The most common placement for transplanted fat is within the subcutaneous fat.

Answer 25

T

Question 26

When injecting harvested fat, overcorrection of 30-50% should be made to allow for fat degradation.

Answer 26

F | Minimal or no overcorrection.

Question 27

Postoperative oedema is not directly related to the amount of fat transferred.

Answer 27

F | Directly proportional.

Question 28

Anterograde injection with gentle pressure should be performed for fat transfers.

Answer 28

F | Retrograde – reduces risk of intravascular injection and injection of large fat bolus.

Question 29

1 to 10 mL syringes can be used for fat injections.

Answer 29

T | smaller fat particles are dispensed if a smaller syringe is used and the pressure required is less with small syringes

Question 30

Prolonged air exposure negatively impacts fat cell viability.

Answer 30

T | use female to female adaptor to transfer to syringes of different sizes without exposure to air

Question 31

Blunt-tipped cannulae should not be used for fat transfer.

Answer 31

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

Question 32

The most common indications for fat augmentation of the face include the nasolabial fold and the marionette fold.

Answer 32

T

Question 33

Other areas of the face that can be treated with fat transfer include the cheeks, malar area and chin.

Answer 33

T

Question 34

Body areas which can be augmented with fat include the dorsal hands, buttocks, biceps, calf and breast.

Answer 34

T

Question 35

There are no additional risk factors associated with fat augmentation of the breast.

Answer 35

F Calcifications may develop post operatively which can mimic breast ca.

Question 36

Defects for disease or trauma can be treated with fat injection.

Answer 36

T Eg. acne scars, LE scars, cellulite.

Question 37

Lipostructure ™ refers to full-face three-dimensional enhancement of youthful contours.

Answer 37

T

Question 38

Using the Lipostructure ™ technique, minute quantities of fat are all placed within the subcutaneous tissue plane.

Answer 38

F | Placed in multiple planes eg adjacent to bone, fascia and muscle as well as subcut

Question 39

Using the Lipostructure ™ technique, each droplet of fat is placed 'Within 1.5mm of living vascularised tissue'

Answer 39

T | 30-40 injections (passes) per ml injected and over 100mls injected in a whole face

Question 40

Using the Lipostructure ™ technique, there is often marked oedema for weeks or months post-operatively.

Answer 40

T

Question 41

The method of ‘fat rebalancing’ involves the use of smaller procedures over a 1-2 year period.

Answer 41

T uses similar laborious layering as lipostructure also microliposuction of jowls or other areas

Question 42

Fresh fat must be harvested at each visit for the method of ‘fat balancing’.

Answer 42

F | Can use frozen fat for subsequent visits.

Question 43

Using the ‘fat rebalancing’ method, the entire face is treated with smaller total quantities (20-30mL).

Answer 43

T | Lipostructure ™ often exceeds 100mL in one procedure

Question 44

The downtime after ‘fat rebalancing’ is 1-10 weeks.

Answer 44

F 1-10 days.

Question 45

With the ‘fat rebalancing’ method, fat is placed exclusively in the subcutaneous space.

Answer 45

T

Question 46

Microliposuction of hypertrophied fat areas can be performing during ‘fat rebalancing’.

Answer 46

T

Question 47

An abundantly vascularised recipient site for transplanted fat will result in optimal survival of the fat.

Answer 47

T

Question 48

FAMI refers to the technique of injecting fat into or immediately adjacent to the muscles of mastication

Answer 48

F | muscles of facial expression.

Question 49

Volumes used for FAMI are similar to those of the Lipostructure ™ technique.

Answer 49

F | FAMI uses 70ml for full face and 20-30ml for partial face corrections

Question 50

FAMI utilises a set of blunt-tipped cannulae which are curved and angle to conform to the skeletal contours of the face.

Answer 50

T

Question 51

The FAMI technique has more apparent trauma that the Lipostructure ™ and ‘fat rebalancing’ techniques.

Answer 51

F Less trauma as fewer passes with syringe With FAMI a 1mL syringe is emptied in 1-3 passes (cf 30-40 with other techniques).

Question 52

With FAMI, the fat is placed along vectors which parallel blood supply, minimising trauma to the vessels.

Answer 52

T

Question 53

Patients have a downtime of 2-3 weeks after FAMI.

Answer 53

F | 3-7 days.

Question 54

The FAMI method of fat transfer can have a longevity of 3-5 years.

Answer 54

T

Question 55

FAMI is the preferred technique for treating localised volume loss on the lips.

Answer 55

F | Filler preferred.

Question 56

FAMI should not be used after rhytidectomy.

Answer 56

F | Ideal for pts after rhytodectomy who have thin taut skin.

Question 57

With the FAMI technique, the cannula is directed to the origin or insertion of the muscle, and fat is injected in a retrograde fashion with low injection pressure.

Answer 57

T

Question 58

There is a second step in the FAMI technique which consists of supraperiosteal injections of highly centrifuged fat.

Answer 58

T

Question 59

The postoperative course of FAMI typically consists of significant pain, bruising and oedema.

Answer 59

F Usually unremarkable post-operatively. downtime 7-10 days for full face and 3-5 days for partial face

Question 60

Re fat transfer longevity, poor results are often seen in the lip.

Answer 60

T | most mobile region of face

Question 61

Ongoing ageing and/or weight loss of patients generally does not require touch-up fat transfer procedures.

Answer 61

F

Question 62

The use of frozen fat in transfer procedures results in an inferior outcome.

Answer 62

F | Results can be equal or better.

Question 63

The complication rate is low with all fat augmentation techniques.

Answer 63

T

Question 64

Fat augmentation of the face does not require nerve blocks.

Answer 64

F

Question 65

The infraorbital area is most prone to overcorrection with fat augmentation

Answer 65

T

Question 66

The infraorbital area should be treated using only minute quantities with low injection pressure

Answer 66

T

Question 67

Visible superficial nodules may develop if the infraorbital area is overcorrected, or if too much fat is injected superficially

Answer 67

T

Question 68

There is no way to treat overcorrection with fat augmentation.

Answer 68

F Low-dose steroid injection, massage, excision.

Question 69

Weight loss or gain does not affect the result of fat augmentation.

Answer 69

F | Fat hypertrophy can occur with weight gain.

Question 70

Patients undergoing fat transfer should be screened for concomitant, recurrent or chronic infections.

Answer 70

T Eg. sinus, dental or ocular regions.

Question 71

Prophylactic antibiotics are not routine for fat transfer procedures.

Answer 71

F Generally recommended in all patients to start day before for 7 days eg cephlex 500mg BD or mino if pen allergic

Question 72

Fat augmentation should be carried out as a sterile procedure

Answer 72

T

Question 73

The most serious potential complication of fat augmentation is vascular occlusion caused by inadvertent intravascular injection.

Answer 73

T

Question 74

Blindness has not been reported following fat injections.

Answer 74

F | has been reported after glabella and NLF injections

Question 75

Occlusion or emboli are rare complications of fat transfer.

Answer 75

T

Question 76

It is safe use sharp instrumentation and 10mL syringes with high injection pressures during fat transfer.

Answer 76

F | Should use blunt-tipped cannulae, low injection pressures, 1mL syringes to minimise the risk of intravascular injection

Question 77

Retrograde fill reduces the risk of intravascular injection.

Answer 77

T

Question 78

If there is evidence of vascular compromise during fat transfer, you should place the patient in Trendelenburg position, apply nitroglycerin paste and massage the area until the flush returns to the skin.

Answer 78

T

Question 79

There are no additional side effects reported with intramuscular fat injection, compared to subcutaneous injection.

Answer 79

F | Potential dysfunction of facial muscles reported

Question 80

The masseter muscle is injected in the FAMI procedure.

Answer 80

F

Question 81

Longest survival after AFT when the recipient site is relatively immobile

Answer 81

T | Sites including scars of linear morphea, the forehead, infraorbital area

Question 82

Future advances in fat transplantation lie in injection of preadiposites

Answer 82

T These are fibroblast-like fat cell precursors that are present in adipose tissue; survive ischemia better than mature adipocytes

Question 83

Adipocyte stem cells are known to release angiogenic growth factors

Answer 83

T Has been used in clinical studies in patients with Perry Romberg disease

Question 84

Potential complications of all fat transfer techniques include nodule formation due to overcorrection, fat necrosis, infection, and vascular occlusion

Answer 84

T

Question 85

grafts of diameter 3.5mm or more get central necrosis with only a rim of viable fat cells at the periphery

Answer 85

T

Question 86

AFT is only used on the face

Answer 86

F | other sites include buttocks, biceps, breast and calf and dorsal hands

Question 87

Fat transfer into the breast can cause calcifications radiographically resembling those in breast cancer

Answer 87

F Calcifications differ radiographically from those caused by breast cancer but may still need biopsy

Question 88

Centrifugation of the fat is a controversial factor in fat cell survival

Answer 88

T Other are; Choice of harvesting site Degree of negative pressure during harvesting Diameter and type of harvesting cannula Exposure of fat cells to air, blood, or lidocaine Rinsing the fat Vascularity and mobility of the recipient site Diameter and type of injecting cannula or needle Freezing fat for later use

Question 89

lumpiness has been noted with centrifuged fat injected in breast, thigh or buttocks

Answer 89

T | some use non-centrifuged fat at these sites to avoid this

Question 90

Pseudomonas has been cultured from centrifuges used for fat

Answer 90

T | must use sterilized canisters or sleeves within the centrifuge

Question 91

Mephyton or arnica may be prescribed to minimise post op bruising in fat transfer

Answer 91

T

Question 92

Transferred fat volumes tend to decrease with time

Answer 92

T | But increase has been shown in HIV pts between 2nd and 12th months

Question 93

Longterm fat survival of 50-60% is achievable

Answer 93

F | 30-40%

Question 94

Touch up procedures are common either due to need to split the initial treatmnet over multiple sessions or to replace volume loss with time or because pts want a fuller look

Answer 94

T

Question 95

Fat hypertrophy may develop if there is weight gain after AFT, and may require surgical revision

Answer 95

T | the symmetry with the FAMI technique appears to mitigate this problem