Time to rethink fat

Plastic surgeon Stephen Gilbert tells us about fat and why, after years of battling it, it may be our best friend in the fight against ageing.

Sagging jowls, temples, tear troughs and cheeks, thinner lips and fine lines are typical concerns of men and women over the age of 40. A face begins to look old due to the loss of fat. When we’re younger we tend not to like our fuller face. And when we’re older, we lament the loss of this youthful fat.

Plastic surgeons have been transferring stem cells as part of a multivector SMAS facelift for years. However, more and more people are wanting a rested, youthful look without undergoing a facelift, especially those who are dissatisfied with the short-term benefits of dermal fillers or who want to delay having a facelift for several years.

We are fortunate that scientists have discovered that fat carries a large number of stem cells which have the ability to refresh the underlying collagen and improve the quality of the skin. The ultimate way of injecting fat to rejuvenate the face is to use freeze dried fat containing stem cells taken when you are a teenager and then injecting them when you are older. The problem with this technique is the cost of storage and risk of contamination.

Earlier this year at the Vienna Conference of world experts in Plastic Surgery, we determined that currently the best practical way of restoring youth to the ageing face is to aspirate some of your own fat from an unwanted area, centrifuge it for three minutes to separate out the stem cell rich fat cells from the unwanted blood and oil and then inject it with a fine cannula in multiple tunnels to build up contour and refresh the skin.

This procedure can be achieved almost painlessly by local anaesthetic combined with oral sedation, which relaxes you but does not usually put you to sleep. Fat can be applied to the temples, brow, under the eye, the cheek mounds, the cheek folds, the lips and along the jaw line to give you a fuller, smoother, more youthful face. But in looser faces this has to be combined with a mid face lift to give the best result. In older faces with a loose neck fat, injecting is combined with a face and neck lift to get the best result.

The SNIF (Sharp Needle Intradermal Fat grafting) technique was introduced at the Asian-Australasian Fat Grafting Summit earlier this year. This involves injecting only the stem cell rich component of fat more superficially into the deep layer of the skin to smooth out thin wrinkles. This shows promise but time will tell how effective it will be, especially for fine lines on the upper lip.

CoolSculpting is the new non-invasive method of fatty bulge reduction that we have had great success with over the last two years.

This technique involves applying a pad to the bulging areas and cooling the fat to a controlled temperature, which disrupts fat cells resulting in a 20-30 per cent reduction in the unwanted bulge over a period of six months.

Virtually pain-free, CoolSculpting was devised by Harvard University scientists in conjunction with the Massachusettes General Hospital and is FDA approved. It is particularly useful in reducing those diet-resistant, hard-to-get-rid-of bulges in the abdomen, love handles, inner and outer thighs and inner arms. In younger people the skin’s natural elasticity will cause it to adapt to the new contour and older people may see their skin become tighter too.

Traditional liposuction has also become less invasive and smaller areas can be done under local anaesthetic with oral sedation. This applies to areas that are not suitable for CoolSculpting, such as the wobbly bit under the chin or where a more complete fat removal is needed. For more extensive body contouring a general anaesthetic is much better, combined with the skills of an experienced plastic surgeon. In many cases the best result can only be obtained by removal of excess skin such as in an abdominoplasty, thigh or body lift.

The ultimate use of fat is to remove unwanted fat from the body and place it in areas of deficit in the face within the one procedure. This doubly empowers the patient as their body is sculptured into a healthier, more youthful shape and at the same time their face is rejuvenated.