Enhance Fat Grafting Results: Centrifugation or Filtered Techniques?
Fat grafting has emerged as a staple in facial rejuvenation, but mastering the intricacies of fat processing methods is key to achieving optimal, long-term outcomes. Two primary methods dominate the conversation: centrifugation and filtration/cleansing of fat. Both approaches offer unique benefits, as demonstrated by the studies of Botti et al. (2011), which compared filtered and washed fat versus centrifuged fat, and Xiong et al. (2019), which reviewed new advancements and techniques in fat grafting. Understanding the latest techniques, based on these research findings, is critical for plastic surgeons looking to refine results and minimize complications.
Study Overview and Results
In a prospective, double-blind study, Botti et al. (2011) compared two fat processing techniques—filtration and washing versus centrifugation—in patients undergoing facial fat grafting. The study involved 25 patients, where one side of the face was treated with filtered and washed fat and the other with centrifuged fat.
The results, analyzed over a 12-month follow-up, showed no significant difference in the long-term outcomes between the two methods. Both techniques yielded comparable levels of volume retention and patient satisfaction. However, centrifuged fat offered smoother consistency in delicate areas such as the periorbital region, helping to avoid irregularities and nodules.
Advantages of Centrifugation
Centrifugation has become widely accepted due to its ability to separate and concentrate adipocytes, especially when spun at 3000 rpm for three minutes. This method increases the density of viable fat cells while removing excess fluids, debris, and ruptured adipocytes, reducing inflammation post-injection. Moreover, it enhances retention rates by preserving a higher concentration of stem cells (adipose-derived stem cells or ADSCs), particularly in the lower layers of processed fat. This is especially valuable in facial rejuvenation procedures, where long-term volume retention is crucial.
According to Xiong et al. (2019), centrifugation maximizes viable fat by concentrating ADSCs and stromal vascular fractions (SVFs), which support angiogenesis and fat graft survival. However, the results are not without controversy. The Coleman technique, which popularized centrifugation, has demonstrated reliable outcomes, but some argue that this method may introduce unnecessary complexity.
Benefits of Filtration and Washing
Filtration provides a simpler approach by washing fat with saline to remove impurities, resulting in a cleaner, more homogeneous graft. Botti et al. (2011) presented a compelling case for this method in their prospective double-blind study comparing the long-term effects of centrifuged fat against filtered fat in 25 patients. Surprisingly, both techniques yielded comparable volume retention and patient satisfaction, suggesting that filtration might suffice in many cases.
While centrifugation offered smoother consistency in sensitive areas like the periorbital region, nodules were more frequently reported with filtered fat, though without significant complications. Ultimately, the findings indicate that for surgeons seeking an efficient process with less equipment, filtration is a valid option that can produce excellent results, allowing for flexibility in surgical techniques.
Choosing the Right Method: When to Use Filtered/Wash vs. Centrifuged Fat
Selecting the appropriate fat processing method—whether filtered/wash or centrifuged—depends on factors such as the treatment area, desired outcome, and specific patient considerations. Both methods are effective, but certain situations favor one technique over the other.
When to Use Filtered/Wash Fat
Filtered/wash fat is a simpler, more time-efficient technique that can produce comparable long-term results to centrifugation. Surgeons may prefer filtered fat in cases where the procedure is less complex, and the patient needs moderate volumization.
Large Volume Augmentation: For patients needing substantial volume restoration in areas like the cheeks, jawline, or nasolabial folds, filtered fat works well. These areas tolerate more fat per injection, and the simpler process minimizes the time and cost of the procedure.
Quick Procedures: When time is a concern, such as in a busy clinic setting or with patients who prefer shorter procedures, filtered fat offers a faster and less cumbersome option.
Patients Prone to Complications: In patients who may be prone to irregularities or complications like nodule formation, filtered fat can help reduce risks, particularly in large-volume areas.
Cost-Efficiency: This method is resource-efficient, requiring less equipment and technical expertise compared to centrifugation, making it ideal in resource-limited settings.
When to Use Centrifuged Fat
Centrifugation, which separates fat at 3000 rpm for 3 minutes, allows for more refined fat grafts by concentrating adipocytes and removing excess fluids and contaminants. This is particularly advantageous in areas where precision and smoothness are critical.
Delicate and Complex Areas: Centrifuged fat should be used in delicate facial regions, such as the periorbital area, tear troughs, and lips. These areas require smoother consistency to prevent nodules, irregularities, or visible fat clumps, which Botti et al. (2011) highlighted as a risk with filtered fat.
High Retention Requirements: Centrifuged fat, with its higher density of adipose-derived stem cells (ADSCs), is ideal for patients who require long-term retention of grafts in areas like the malar region or for precise contouring. This method is preferable when retention and precision are priorities.
Patients with Thin Skin: For patients with thinner skin, especially in the under-eye area, centrifugation produces a finer, smoother graft that integrates better into the surrounding tissue without causing irregularities.
Volume Conservation: Centrifugation is beneficial when surgeons want to maximize fat retention and minimize resorption, making it ideal for small-volume grafts or in reconstructive surgeries where every millimeter counts.
Donor Site Selection and Harvesting Techniques
The choice of donor site is critical to fat grafting success. Areas like the abdomen and inner thighs are preferred due to their high concentration of adipose-derived stem cells (ADSCs), which support better fat graft retention and regenerative properties.
Best Donor Sites: Fat from the lower abdomen and inner thigh has been shown to yield higher concentrations of ADSCs, improving fat graft survival rates. These areas are particularly suitable for facial fat transfer.
Harvesting Techniques: For facial fat grafting, syringe aspiration is the preferred technique, using gentle negative pressure to minimize damage to adipocytes. Harvesting from the superficial layers of subcutaneous fat is recommended, as it contains a higher concentration of stromal vascular fractions (SVFs), which contribute to graft longevity.
Optimizing Fat Graft Survival
Ensuring long-term survival of the fat graft is paramount to achieving the best results. Several key techniques can enhance fat graft retention:
Small-Volume Injections: Regardless of the fat processing method used, the key to graft survival is injecting small amounts of fat in multiple passes. This approach allows for better vascularization, which is crucial for the survival of transplanted fat cells. Studies suggest that injecting no more than 0.1 mL per pass reduces the risk of complications like fat necrosis, oil cyst formation, or calcification.
Post-Processing Techniques: For centrifuged fat, separating the middle and lower layers (which contain the most viable cells) ensures the highest quality fat is used for grafting. This technique is particularly effective in retaining volume and ensuring better integration into the recipient tissue.
Enhancing Graft Survival: Emerging techniques, such as combining fat grafting with platelet-rich plasma (PRP) or platelet-rich fibrin (PRF), are showing promise in enhancing graft retention and improving overall outcomes. These methods promote faster neovascularization and help integrate the graft into the surrounding tissue.
Microneedling: Pre-treatment of the recipient site with microneedling has been shown to enhance fat graft retention. The microneedling process triggers a cascade of growth factors that stimulate new blood vessel formation, providing better nourishment to the grafted fat.
Conclusion
Both filtered/wash and centrifuged fat techniques are invaluable tools in the arsenal of a plastic surgeon. Filtered fat offers an efficient, low-cost option that works well in large-volume procedures or when speed and simplicity are important. In contrast, centrifuged fat is best suited for more delicate, high-precision areas where smoothness, consistency, and long-term retention are paramount.
Incorporating the latest advancements in ADSC-enriched techniques, nanofat, and SVF-gel can further enhance fat grafting outcomes, offering surgeons more versatile options for volumization and skin rejuvenation. By understanding the strengths of each method and carefully tailoring the approach to each patient’s needs, surgeons can deliver exceptional, lasting results in facial fat grafting.
Reference:
Botti G, Pascali M, Botti C, Bodog F, Cervelli V. A clinical trial in facial fat grafting: filtered and washed versus centrifuged fat. Plast Reconstr Surg. 2011 Jun;127(6):2464-2473. doi: 10.1097/PRS.0b013e3182131d5d. PMID: 21617480.
Xiong S, Yi C, Pu LLQ. An Overview of Principles and New Techniques for Facial Fat Grafting. Clin Plast Surg. 2020 Jan;47(1):7-17. doi: 10.1016/j.cps.2019.08.001. Epub 2019 Oct 21. PMID: 31739899
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