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6 Different Types of Fat Grafting & Their Indications




The widespread adoption of fat grafting in recent years has led to a multitude of novel clinical applications. Particularly within the realm of facial aesthetics, in addition to its conventional role in addressing volume loss within facial fat compartments, fat grafting has garnered significant attention as a potential tissue regenerator and a means to enhance skin quality.


The broadening application of fat grafting in facial areas with thin skin, such as the eyelids, where any irregularities are likely to be visible or palpable, has ignited interest in the advancement and investigation of innovative methods for fat processing. Presently, thinner and smaller grafts are being extracted and injected without compromising their cellular viability.


Traditionally, fat grafting has shown effectiveness as a filler but has not been widely embraced for precise contouring, where conventional fillers like hyaluronic acid remain the preferred choice. Doctors have initially utilized fat injections exclusively through cannulas. In cases involving prominent folds and deep, long-standing central wrinkles, we can see the reoccurrence of wrinkles post-surgery. In these instances, attempts at overfilling did not yield satisfactory outcomes. Similar challenges were encountered with fine facial lines. Today, the development of needle injection techniques has empowered surgeons to enhance precision and perform injections in a more superficial plane, enabling the use of fat grafts as fine fillers.


Advancements in our understanding of the composition of the injected grafts have prompted the proposal of new graft types designed not to augment volume but to enhance skin quality.


Types of Fat Grafting


1. Microfat Grafting


In contrast to the structural fat grafting pioneered by Coleman and similar techniques that utilize 2–3-mm diameter suction cannulas, microfat grafting represents a more refined and minimally invasive approach to fat transplantation. It involves the use of low-pressure liposuction (0.5 atm) with specialized 2.4-mm microport harvester cannulas that are equipped with barbed and beveled 1-mm ports, a notable innovation brought forth by Tulip Medical Products based in San Diego, California, USA. These microport harvester cannulas are instrumental in ensuring precise fat extraction while minimizing tissue trauma, contributing to a smoother and more comfortable experience for patients.

Once the microfat is carefully harvested, it undergoes a meticulous purification process designed to remove any impurities that may compromise the quality of the graft. This purification process effectively eliminates unwanted components, including blood, cellular debris, water, any remnants of the tumescence solution used during liposuction, and the oil byproduct generated as a result of the breakdown of fatty acids during the aspiration process. Practitioners can opt for one of three methods to achieve this purification: centrifugation, decantation, or washing.

Centrifugation, among these purification methods, stands out as a swift and efficient means of separating the desired fat from the unwanted components. However, it's worth noting that this method may lead to the production of more densely packed fat grafts. While compacted fat is advantageous in certain applications, it may not be the ideal choice when part of the harvested fat is intended for injection via a needle. In such cases, centrifugation can result in a fat consistency that is prone to obstructing the needle during the injection process. Therefore, careful consideration and selection of the purification method are essential to achieve the best outcomes based on the specific goals of the procedure.

Microfat grafting, distinguished by its use of cannulas with a diameter ranging from 0.7 to 0.9 mm (always less than 1 mm), is ideally suited for addressing a range of aesthetic concerns in the facial region. This technique is particularly effective in addressing fine lines, wrinkles, and subtle volume loss. The smaller cannula diameter allows for greater precision in fat placement, resulting in a more refined and natural outcome when compared to traditional fat grafting approaches. By targeting these fine details, microfat grafting offers patients a minimally invasive and highly customizable solution for facial rejuvenation, enabling them to achieve a refreshed and youthful appearance with minimal downtime and a reduced risk of complications.


2. Sharp-Needle Intradermal Fat (SNIF)


Needle injection of fat has a rich history in the field of aesthetic medicine, with many authors having recognized its utility over the years. However, it was Tonnard's pioneering group that introduced the term "sharp-needle intradermal fat" (SNIF) to define the precise technique of injecting microfat via a needle. SNIF represents a significant advancement in the realm of facial rejuvenation and has been widely embraced by both practitioners and patients seeking minimally invasive solutions.


One of the distinguishing features of SNIF is its versatility in addressing a spectrum of aesthetic concerns. By employing 23-gauge sharp needles, skilled surgeons can meticulously target specific layers of the skin, working within either a superficial subdermal plane or a deeper intradermal plane. This flexibility empowers the practitioner to tailor the treatment to the unique needs of each patient, ensuring the most appropriate and effective approach for their individual goals.


The advantages of SNIF extend beyond its versatility and include the ability to minimize the appearance of fine lines and wrinkles. This technique's precision in fat placement allows for targeted correction of specific facial areas, resulting in a more youthful and refreshed appearance. Unlike more invasive surgical facelift procedures, SNIF offers a subtler enhancement that is often preferred by patients who wish to maintain a natural and authentic look while addressing signs of aging.


Furthermore, the popularity of SNIF can be attributed to its non-surgical nature. Patients increasingly seek out less invasive alternatives to traditional facelifts, and SNIF fits this demand perfectly. It offers a way to rejuvenate the face without the need for extensive surgery, reducing downtime, and potential complications.


In summary, the introduction of sharp-needle intradermal fat (SNIF) has transformed the landscape of facial rejuvenation. It combines precision, versatility, and subtlety to create a highly attractive option for individuals seeking to address fine lines, wrinkles, and age-related volume loss in a minimally invasive and natural-looking manner. As the demand for non-surgical alternatives continues to grow, SNIF represents a significant advancement in the field of aesthetic medicine, offering patients a safe and effective means to achieve a more youthful appearance.


3. Emulsion and Sharp-Needle Intradermal Emulsion (SNIE)


The process of preparing microfat for injection via the Sharp-Needle Intradermal Emulsion (SNIE) technique involves a meticulous series of steps that ensure both safety and effectiveness. Once the microfat has been harvested through low-pressure liposuction, the subsequent mechanical emulsion preparation is a critical phase that elevates the overall quality of the fat graft.


In this step, the harvested microfat is subjected to a unique emulsification process to enhance its suitability for injection. This is accomplished by repeatedly passing the microfat through a set of 10-cc syringes that are connected using a Luer-Lock connector. The mechanical emulsion process involves approximately 30 repetitions of this transfer between syringes, transforming the microfat into an emulsion with a discernibly lighter yellowish color. This emulsification step is vital as it contributes to the uniform distribution of fat particles and optimizes its integration with the target tissues.


Following the emulsification process, the emulsion is carefully decanted to separate it from any remaining impurities and debris. It is then meticulously washed with a sterile saline solution to ensure the highest level of purity and safety in preparation for injection. This thorough purification process guarantees that the final product is free from any potential contaminants, including remnants of the tumescence solution and other unwanted elements.


What makes the SNIE technique particularly noteworthy is that it has been the subject of rigorous scientific inquiry. A recent study sought to understand the impact of the mechanical emulsification process on the viability of tissues, the microscopic structure of the fat, and the stromal vascular fraction (SVF) contained within the fat graft. The results of this study demonstrated that the mechanical emulsification of the microfat had no adverse effects on these critical parameters. This finding underscores the safety and effectiveness of the SNIE technique and reinforces its position as a reliable and well-established approach to facial rejuvenation.


In practice, the injection of the microfat emulsion can be accomplished using cannulas, which are often favored for specific applications. However, for addressing fine lines and achieving precise fat placement in a superficial plane, 27-gauge needles are frequently employed. This approach enhances the safety and accuracy of the procedure, allowing practitioners to target specific areas with greater precision.


The SNIE technique is highly regarded for its ability to improve skin quality, providing a rejuvenated and refreshed appearance. By offering a non-surgical means of enhancing the skin's texture and tone, SNIE has garnered significant interest among both practitioners and patients seeking natural and subtle facial rejuvenation options. Its meticulous preparation process, supported by scientific investigation, makes it a compelling choice for those looking to achieve a more youthful and radiant appearance without the need for more invasive surgical procedures.


4. Nanofat Grafting


Nanofat grafting, a relatively recent innovation in the field of aesthetic medicine, has gained prominence as an exciting and promising technique for facial rejuvenation. This method, introduced by Tonnard and colleagues, represents a paradigm shift from traditional fat grafting approaches, as it emphasizes the injection of stromal vascular fraction (SVF) cells to improve skin quality rather than solely focusing on adding volume. While the evidence supporting this technique is still emerging, the preliminary results have been quite promising.


The essence of nanofat grafting lies in the preparation of a unique graft that holds great potential for enhancing skin health and texture. In a groundbreaking procedure, Tonnard and his team created a mechanical emulsion of a microfat graft sample. This was achieved by passing the harvested microfat through a specially designed nylon membrane, a process that was conducted with meticulous care and precision. The remarkable outcome of this procedure was the preservation of a significant portion of the SVF cells contained within the fat graft, including stem cells capable of proliferation and differentiation. What is particularly noteworthy about this achievement is that it occurred without the presence of viable adipocytes, the fat cells that are typically associated with traditional fat grafting.


The unique aspect of the mechanical emulsion technique employed in nanofat grafting is its deviation from the conventional methods for obtaining SVF cells. In more traditional approaches, such as those involving collagenases or other digestive enzymes, the process often requires complex and time-consuming steps to isolate the desired cellular components. In contrast, the mechanical emulsion method used in nanofat grafting streamlines this process by transferring the fat between syringes and filtering it through non-absorbent nylon membranes. This innovative approach efficiently separates the valuable SVF cells from connective tissue remnants, ensuring a purer and more concentrated solution.


Following the meticulous preparation of nanofat, the emulsion is primed for injection. Typically, 27-gauge needles are used to deliver the nanofat into the superficial dermal plane of the skin. This application allows for precise and controlled placement of the nanofat, with the added benefit of enhancing skin quality. Patients often notice a subtle but noticeable improvement in their skin texture and tone after the procedure. One common observation is that the skin takes on a slightly lighter and more refreshed appearance, signifying the rejuvenating effects of nanofat grafting.


As the evidence supporting the benefits of nanofat grafting continues to accumulate, it is expected to become an increasingly valuable option for individuals seeking non-surgical methods to enhance their skin quality and achieve a more youthful and revitalized appearance. The technique offers the advantage of harnessing the body's own regenerative potential, making it a compelling choice for those who desire a natural and holistic approach to facial rejuvenation.


5. Superficial Enhanced Fluid Fat Injection (SEFFI)


Superficial Enhanced Fluid Fat Injection (SEFFI) represents a refined and innovative approach to fat transplantation that has gained significant attention in the field of aesthetic medicine. This technique is characterized by its ability to deliver subtle yet noticeable enhancements to facial features, making it an attractive option for individuals seeking natural and rejuvenating outcomes.

The SEFFI procedure commences with the careful acquisition of fat through liposuction, employing a specialized 2-mm diameter cannula featuring a side-port size of 0.5–0.8 mm. This precision instrument facilitates the extraction of fat with meticulous control, ensuring that the harvested fat is of the highest quality and purity.


Following the fat extraction process, the harvested fat undergoes a brief centrifugation step. The centrifugation is conducted at 2000 revolutions per minute (rpm) for a duration of one minute, effectively separating the fat from any unwanted components. This step is crucial in optimizing the quality of the fat graft and eliminating any impurities that may compromise the final result.

A distinguishing feature of SEFFI is its incorporation of platelet-rich plasma (PRP) into the fat graft. This addition of PRP is carried out with precision to achieve a final PRP concentration of 10% of the total harvested fat. PRP is known for its regenerative properties and has been widely utilized in various medical and aesthetic procedures to enhance tissue rejuvenation.


6. Fat Autograft Muscle Injection (FAMI)


Fat Autograft Muscle Injection (FAMI) is a distinctive and innovative approach to facial rejuvenation, notable for its departure from conventional fat grafting techniques in terms of the site of fat tissue deposition. FAMI is characterized by the direct injection of fat into the facial muscles and beneath the periosteum, with the specific aim of improving graft retention and achieving more predictable and symmetric outcomes.


The FAMI procedure begins with the meticulous harvesting of fat through syringe aspiration, ensuring the highest quality of the fat graft. The harvested fat is then subjected to a rigorous refinement process, typically involving centrifugation. Centrifugation separates impurities and unwanted components from the fat, yielding a purified and concentrated fat graft that is primed for injection.


A defining feature of FAMI is the targeted injection of the purified fat graft into the muscles of facial expression. This is achieved through the skillful use of specialized curved cannulas, which allow for precise placement of the fat within the muscular tissue. The technique involves the retrograde injection of 1–3 cc of fat, which is carefully deposited from the muscular insertion to its origin. This strategic approach to fat placement within the facial muscles is designed to enhance muscle tone and support, leading to subtle yet lasting improvements in facial aesthetics.


The core concept of FAMI is to harness the potential of fat tissue to not only restore volume but also to engraft and rejuvenate the facial muscles. By doing so, the technique aims to improve the longevity and predictability of the results. The injection of fat into the muscle tissue provides a supportive framework for the overlying skin, creating a harmonious and youthful appearance.


FAMI stands out as a unique and exciting approach to facial rejuvenation, offering a distinct focus on muscle enhancement and providing subtle yet enduring improvements to facial aesthetics. Unlike traditional fat grafting techniques that primarily target volume restoration, FAMI's emphasis on muscle engrafting represents an innovative shift in the field of aesthetic medicine. As patients increasingly seek natural and long-lasting solutions for facial rejuvenation, FAMI's approach aligns with this demand, making it a valuable option for individuals looking to achieve a more youthful and harmonious facial appearance.



In conclusion, the expansive array of fat grafting techniques available to practitioners and patients represents a treasure trove of options for tailoring facial rejuvenation to meet individual needs and preferences. These methods collectively cover a spectrum of aesthetic concerns, encompassing fine lines, wrinkles, volume loss, and enhancements to skin quality. While they share a common goal of delivering natural-looking and enduring results, the unique characteristics of each technique allow for a nuanced and personalized approach to facial rejuvenation.


The selection of the most appropriate fat grafting technique hinges on several pivotal factors, each of which contributes to the customization of the treatment plan. First and foremost, the specific aesthetic goals of the patient play a central role in determining the technique that best aligns with their desires. For individuals seeking to diminish fine lines and wrinkles, techniques such as Sharp-Needle Intradermal Fat (SNIF) and Nanofat Grafting provide targeted and precise solutions. On the other hand, patients with concerns about volume loss may find Microfat Grafting or Superficial Enhanced Fluid Fat Injection (SEFFI) to be more suitable options. Those looking to enhance skin quality often gravitate toward Superficial Enhanced Fluid Fat Injection (SEFFI) or Nanofat Grafting.


Moreover, the patient's unique anatomy and facial characteristics must be carefully considered when choosing the appropriate fat grafting technique. The surgeon's expertise in each technique is essential in assessing the patient's facial structure and determining the approach that will yield the most harmonious and natural-looking results. Additionally, the surgeon's familiarity with the intricacies of each technique ensures that the procedure is conducted with precision and the utmost attention to detail.


Ultimately, the availability of this diverse range of fat grafting techniques empowers both patients and practitioners to collaborate in crafting a personalized and tailored approach to facial rejuvenation. This not only serves to meet individual aesthetic objectives but also emphasizes the importance of patient satisfaction and overall well-being. As the field of aesthetic medicine continues to evolve, these techniques play a pivotal role in offering non-surgical and minimally invasive options for those seeking to achieve a more youthful and refreshed appearance.


Reference:

Variants of Fat Grafting: From Structural Fat Grafting to Microfat, Sharp-Needle Intradermal Fat (SNIF), Nanofat, Emulsion, SNIE, FAMI, and SEEFI (2019)

Liftand-fill face lift: integrating the fat compartments (2014)

Nanofat grafting: basic research and clinical applications (2013)

Sharp-needle intradermal fat grafting (SNIF) (2012)

Effects of intersyringe processing on adipose tissue and its cellular components: implications in autologous fat grafting (2015)

 

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