Fat grafting is an old technique. In 1926, Charles Conrad Miller described the infiltration offat through a hollow metal cannula. This technique laid the foundation for what we do as surgeons today. Unfortunately, subsequent attempts at fat grafting were met with mixed success. In 1956, Lyndon Peer conducted formal experiments looking at fat graft survival. He concluded that only about 50% of the graft survived. This study injected pessimism into the surgical community and delayed the development of fat grafting. With the advent of liposuction, interest in fat grafting was renewed due to the readily available graft material. Beginning in the early 1980s, Dr. Sidney Coleman and others resurrected the art of fat grafting by careful study of the techniques and conditions necessary for graft survival. Based on his research, many practitioners now use fact grafting as part of their surgical armamentarium, particularly for facial rejuvenation.
With the passage of time, facial skin sags for two reasons. First, collagen and elastic fibers, which are part of the scaffolding of the skin, diminish in number. Second, there is fat atrophy which leads to facial wasting and hollowness which are indicative of facial aging. Restoring this lost fat volume thus restores a youthful appearance. Furthermore, and this is the exciting part, Dr. Coleman and others have astutely noted that placement of the fat often changed the condition of the overlying skin. The skin, for some unknown reason, looked more youthful. There appeared to be a resurrection factor hidden in fat.
In the last several years, the medical community has caught a glimpse of why skin rejuvenation with fat grafting is happening; the involvement of stem cells. Many basic science researchers have discovered the presence of stem cells in transplanted fat. As you probably know, stem cells are a very hot topic. Stem cells can be used to build new organs, skin, and other body parts for the sake of reconstruction. Now it appears that stem cells carry with them a potential ability to rejuvenate the skin. The specific pathways for this process have yet to be fully delineated. This is a very exciting finding and promises to take aesthetic medicine, particularly that involving the face, into the 21st century. In my vision, the 21st century will involve fewer scalpels. Rather, rejuvenation will involve manipulation at the cellular level to coax the body into a more youthful state and appearance. This is already being done to some degree with lasers and now fat grafting is following suit. This is where things are headed. Stay tuned.
- Dr. Andrew Gear