Dr. Rui Lima

Plastic Surgeon

Facial rejuvenation with fat transfer.
How and why?

HPA Magazine 18

We are born with fat in almost every part of our body. This does not happen by accident. The fat that we store at an early age is essential for the healthy growth of our body, because in addition to serving as a huge storage of stem cells for the growth of skin and other organs, it is an important energy reservoir that serves as a parachute in situations when our lives are endangered. 

As we grow and age, fat is one of the tissues that undergoes the most changes. Sometimes it appears, or disappears from places we might like more or in places we dislike. This is determined by our genetic heritage, but also by our health condition and lifestyle. The relationship between the size of our fat deposits and diet, physical inactivity and stress is well known. But less is known about the effect of our genetics. Why do I eat so little and am so fat? Or, why does he eat so much and not gain weight? Or, why is it that whenever I lose weight, I lose breast size and my face ages 10 years? The answer is complicated: each one of us is different because we are the result of many different things. There are people who “age” a lot in the face, not only because they have more wrinkles on the skin or more grey hair, but above all because they lose a lot of the facial volume they had when they were young, that is, they lose fat from the face and the face sags, all this associated with a skin quality that also decreases with age. The same phenomenon happens in the breast: loss of volume and sagging breasts. How many people look in the mirror, stretch the skin of their face near the ears, or the skin of their breasts above the areolas, and think: I look perfect!
This is exactly what plastic surgery is all about, and one of the best ways to help restore “things to their original place” is to “transplant” our own fat.
The concept is very easy to understand: you remove fat from an area where you don’t need it and have an abundance of, and place it in an area where fat has been lost. Of course, this simplistic view does not explain the specialized medical procedure behind it. Transplanting our own fat is called fat grafting.
This is the effect that is intended when hyaluronic acid fillers are used, which are an excellent test for a future fat graft, as they last between 6 and 12 months while a fat graft lasts for many years and adapts to the constant face changes that we are subject to during our natural aging process. Fillers that are not fat are far from being able to do this, however it is important to note that the survival of fat in an initial stage is between 40 and 60%, and a touch-up may be necessary. The aging process, especially facial ageing, is complex from an anatomical point of view and the “same solution for everything” does not always result in an improvement, and in most cases after the age of 50, where the intervention is more complex, the result can even be worse. That is why we see so many “touched up” faces that are frightening and make us think: rather old and natural than “young” and artificial.
Facial rejuvenation with fat grafting has become a gold standard treatment. That is, if we want to produce facial rejuvenation, we needs to be done by the fat graft method. This technique offers clinically proven results that have a long duration (years). The “material” that is used is almost free of side effects, because the “material” is the body’s own tissue. It will not cause rejection, is easily accessible and abundant leaving the donor area in better shape than before as a small liposuction is performed to harvest the necessary fat. 
An article on fat grafting was first published in the early 20th century and became popular worldwide in the 1990s by Sidney Coleman, a North American plastic surgeon who described an optimized surgical method that would revolutionize the technique of fat grafting, especially facial fat. 
The initial goal was to treat lack of volume resulting from illness, trauma or aging. 
 

However, the technique has evolved considerably, and today fat grafting focuses on improving and restoring facial volume, but also on its ability to regenerate facial tissues, especially skin quality.
Each type of fat graft requires different size fat lobes. For example, on the buttocks, lobes of 3mm2 are used, on the breast of 1,5mm2, and on the face between 0.1 to 1mm2 approximately.
These microscopic size lobes on the face permit a great versatility and predictability when filling different parts of the face that have lost volume such as cheekbones, periocular region, dark circles, labial furrows, lips and temporal region, among others. For this purpose, we use Macro or Microfat. But it is also used on the most superficial layers of the skin to induce its regeneration, which is achieved using Micro and Nanofat.
How does fat have the ability to regenerate the skin?
Adipose tissue (fat) contains cells that can be divided into two major groups: mature fat cells (adipocytes) and a heterogeneous stem cells. The latter have the ability to promote the production of more and better collagen, to create new blood vessels, an immunomodulatory effect and to differentiate into new tissue cells. Clinically, its effect results into improved elasticity, hyperpigmentation normalization, de-inflammation, aesthetic improvement of scars and rapid healing. Adipose tissue is one of the body's tissues with the highest concentration of stem cells, and for plastic surgery, an easily accessible and extremely safe source.
Each of these techniques has very specific indications, and can be used in combination to enhance their effects.
Taking into account all the scientifically proven benefits of Facial Rejuvenation using Fat, Up Clinic has launched a new treatment called “ALL FAC3” that is available at the HPA Health Group through UP HPA.
This treatment prevents and treats facial aging and can be combined with surgical facelift procedures in the most severe cases.
· ALL - because it treats the entire face and neck, regardless of age & the different phases of facial aging.
· FAC3 because it acts on the 3 depths of the facial tissues: in the most superficial layer (the skin), in the subcutaneous cellular tissue immediately below the skin and in a deeper layer (deep fat compartments).
· ALL FAC3 is an innovative, differentiated and complete treatment that guarantees the best results in terms of prevention and facial rejuvenation.
This treatment begins with an evaluation consultation, where the doctor performs a clinical evaluation of the skin and other facial tissue, complemented by the enormous novelty of being able to carry out genetic tests that will allow the specialist to create a highly personalized plan, taking into account the patient’s  genetic heritage and reaction to different factors: genetic evaluation of the skin makes it possible to analyse the skin’s ability to form collagen; tolerate sun exposure, oxidation and skin inflammation.
After the initial evaluation, a personalized facial treatment plan is proposed, focused on rejuvenation procedures with different types of fat grafts and complemented by other conventional treatment, such as Radiofrequency, PRP's, Laser, Microneedling or/and Botulinum Toxin.