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Autologous Fat
Transfer (Fat Grafting):
Fat transfer, more commonly known as Fat Grafting,
is also referred to as free fat transfer, autologous fat grafting/transfer/transplantation,
liposculpture, lipostructure, volume restoration, micro-lipoinjection,
fat injections, f/g and even the "Space Lift(R)". For
Simplicity, Fat Grafting will be used from here on.
Fat Grafting or Fat Transfer
is the procedure to remove surplus fat cells with meticulous extraction methods and to re-implant where
needed - to the cheek
and other places such as the lips, nasolabials (mouth to nose folds),
undereyes,
cheeks, temples, etc. This is a very exciting procedure as
it is not incredibly invasive, produces natural results, but does create a moderate amount of
swelling. However, fat can be resorbed by the body and sometimes only a certain
percentage is permanent although newer techniques are resulting in
increased longevity. Although
it seems the longevity of fat in the cheeks is actually
pretty good if performed correctly.
If you would like to know more please
visit the Fat
Grafting page on www.FacialPlasticSurgery.net. Cadaveric
Tissue Grafts & Cultured Tissue: Cadaveric tissue
grafts are derived from deceased donors. Although most
of this tissue was "donated", some companies have
chosen to profit by their donations and sell the tissue at
exorbitant costs to patients
who desperately need it. In a 2 billion dollar a year market, many times
these tissue grafts are not available to or are too expensive for burn
patients -- yet find their way in plastic surgery operating
rooms. On the other hand, companies such as Advanced Tissue
Sciences, BioSurface Technology, Dermagraft-TC, Genzyme, and
Organogenesis (Graftskin(TM)) extract cells from purchased foreskins which
have been excised and sold by hospitals to culture skin in petri dishes and large trays.
These products were originally processed and approved for skin
replacement in patients with large burns or diabetic ulcers.
AlloDerm (Lifecell Corp.): (technically:
Acellular human cadaveric dermis) AlloDerm is made by
LifeCell Corporation in Palo Alto, California. The Tissue
Banks surgically remove a thin layer of skin tissue (an
allograft) from the 'donor' at the time of death, place it into
an antibiotic solution and transport it to LifeCell Corp.
There, the allograft is processed by removing the epidermis and
all of the cells in the dermis which may cause rejection.
The resulting AlloDerm graft is the protein framework without
any of the donor's DNA. This material is also used for
dermal augmentation, to cover implants on the cheek, chin and nose, as
well as augmentation of the lips (mobile soft tissue). It
reportedly lasts up to two years and in some instances,
indefinitely if proper collagenation of the scaffold occurs.
Website: LifeCell
Corp.
AlloGraft:
Also provided by both cadaveric and family donors. This product
is typically used for skin replacement and "slings"
for patients suffering from a "falling bladder" or
injectable form for urinary incontinence. Has been used for soft
tissue augmentation.
Apligraft:
This product is cultured from infant foreskin cells and
bovine (cow) collagen. The tissue is primarily used for
the replacement of skin in patients needing
reconstruction. Although, it has been used for soft tissue
augmentation.
Silicone Implants: Solid
silicone has been used as a material for facial implants since about
1956. The silicone facial implants are solid, yet flexible and
very durable. They are manufactured in different durometers
(degrees of hardness) to be soft or quite hard. These implants
are designed to enhance soft tissue areas and not the underlying
bone structure. They are usually easily removed as they
are quickly encapsulated by scar tissue. Some surgeons affix cheek
implants to the bone by way of one or several titanium screws per
implant. When used for cosmetic
purposes this implant rarely exhibits a biochemical reaction.
However, when used in functional surgeries such as TMJ disorder or
hip replacement, fragments can rub off of the implant and cause
inflammation within the joints.
Expanded
Polytetrafluoroethylene (ePTFE): These
implants are porous and utilize the benefits of tissue integration
as well to keep it in place. Not as firm as the more harder
silicone implants. There is less bone resorption underneath (ePTFE)
implants as opposed to silicone implants. When used for cosmetic
purposes this implant rarely exhibits a biochemical reaction.
However, when used in functional surgeries such as TMJ disorder or
hip replacement, fragments can rub off of the implant and cause
inflammation within the joints.
Polyethylene
Implants: These
implants are bio-compatible and reportedly place no extra stress on the body or
effect it whatsoever. Not saying that Silicone does,
it's just another option for your cheek augmentation. They are
porous and rely on tissue integration instead of titanium screws
for stability. These are more difficult to remove but do produce
excellent results if placed correctly.
Hydroxyapatite
Implants: Medical
Science has come up with a way to alter coral into an even closure
match to bone and that is called Hydroxyapatite or simply, HA.
It has both the porous structure and chemical make-up of bone so
that the body accepts it wholeheartedly and even incorporates normal
tissue integration and not capsulization like synthetic implants.
A patented process converts Calcium Carbonate into hydroxyapatite
while maintaining the three-dimensional integrity of the coral
yielding Coralline Hydroxyapatite (CH). All the proteins are
removed by intense heat. This renders the structure totally non-immunogenic
so it becomes a nearly perfect bone lattice. Closest to bone grafts
but without the bone.
So how exactly is HA
made? "The synthetic material is prepared by heating the
coral-which is essentially calcium carbonate with ammonium
phosphate at more than 200º C for 24 to 60 hours to obtain
about 95% Hydroxyapatite. The material is processed into block or
granular form and sterilized by gamma radiation". (American
Chemical Society)
How long does it last
you ask? "The natural porosity of the material does have the
drawback of reducing its strength, notes David C. Mercer,
Interpore's president and chief executive officer. But the porous
structure provides room for bone tissue to immediately grow into the
pores of the implant. However, the material is only partially
resorbed and replaced by natural bone. The company is now evaluating
in pre-clinical studies a related new product that has a higher
resorption rate". (American
Chemical Society)
*Also available in an
injectable or spreadable, non-porous paste. See
below.
Injectable Tissue
Augmentation Products: These
products offer ease of placement with less downtime although the
permanent micro-implants are not easily removed. Some products
are temporary and could be used to "try on" what cheek augmentation would look like although asymmetry is possible as the
injectable solution is, of course, not pre-formed and subject to
migration within the first few minutes to days.
References
Photo:
Surgiform Technology, Ltd.
Paul
Sabini, MD; Anthony P. Sclafani, MD; Thomas Romo III, MD; Steven A. McCormick, MD; Rubina Cocker, MD -
Modulation of Tissue Ingrowth Into Porous High-Density Polyethylene Implants
With Basic Fibroblast Growth Factor and Autologous Blood Clot
Yale Medical University Core Curriculum
Dept. of Otolaryngology, UTMB, Grand Rounds, Chin and Malar Implants,
September 6, 1995 Resident physician, Michael Bryan, M.D. faculty, Karen
Calhoun, M.D.
Dept. of Otolaryngology, UTMB, Grand Rounds, Chin and Malar Implants,
April 17, 2000; Ravi Pachigolla, M.D. faculty, Karen Calhoun, M.D.
Merriam-Webster Medical Dictionary
American Chemical Society
Silver, WE, Malar augmentation. Facial Plast Surg 1992 Jul;8(3):133-9.
Constantino PD; Freidman CD Synthetic Bone Graft Substitutes. Otolaryngologic
Clinics of North America 1994 Oct; 27(5):1037- 1074.
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