Dr. Sam Lam Plastic Surgery Forum

Dr. Lam
When you extract the fat for grafting do you have to liposuction or can you use a needle when small amounts are needed? Also I read you mentioned that the survival rate has more to do with blood supply. Do you mix any blood with the fat when you inject? One last question. When fat is injected does it do anything for pigmentation if the area is a little hyperpigmented under flourescent lighting.

Thanks for your input

When you extract the fat for grafting do you have to liposuction or can you use a needle when small amounts are needed? NEITHER ONE. I USE TINY CANNULAS TO DRAW IT UP BY HAND, NO MACHINES AND NO NEEDLES. Also I read you mentioned that the survival rate has more to do with blood supply. Do you mix any blood with the fat when you inject? NO, YOU MISS THE POINT. ALL BLOOD SHOULD BE REMOVED SO THAT THE FAT PARTICLES THAT ARE VERY TINY CAN BE CLEAN AND ADJACENT TO BLOOD (IN THE FACE) TO HAVE GOOD BLOOD SUPPLY. One last question. When fat is injected does it do anything for pigmentation if the area is a little hyperpigmented under flourescent lighting. MOST LIKELY NOT. HOPE THAT HELPS.

Dr. Lam
Thanks for your quick response. In what area do you extract the fat? Also once the fat is injected can you dermabrade the area right after or do you have to wait? Will the fat help with the texture of the skin? I had a wirebrush dermabrasion 5 years ago and the doctor went to deep. I have tried other procedures but I believe that he went deep into the fat layer.

thanks for your help

In what area do you extract the fat? TYPICALLY THIGH AND BELLY. Also once the fat is injected can you dermabrade the area right after or do you have to wait? YES, I HAVE DONE THE TWO AT THE SAME TIME. NO PROBLEM. Will the fat help with the texture of the skin? DIFFICULT TO PROMISE THAT. I had a wirebrush dermabrasion 5 years ago and the doctor went to deep. I have tried other procedures but I believe that he went deep into the fat layer.

Dr. Lam,
The combo with fat injected and dermabrasion what conditions were you treating? How did the combo turn out. Wouldn't the fat be destroyed or harmed from combining them at the same time. I have also heard of using a 30% TCA peel over areas that fat was injected (same time) any experience with that combo. I am looking to add volume with autolgous material and even out texture and pigmentation under certain lighting.

Thanks

the person had fat transfer to the face for aging and also had dermabrasion around the mouth for wrinkles. i do plasma skin resurfacing and fat grafting together all the time with no damage to the fat. you can look at my video diaries to see that or my results in my before and after section to see that with my fat technique i do not see compromise. the TCA should be fine. i don't do that anymore because my plasma gets me better results by far.
best,
sml

Dr. Lam
I know you have gone over this probably a million times but if an area of the face has lost volume (my case) aggressive dermabrasion could fat be used in an isolated manner only to treat a linear defeciency and volumize a dime in size? YOu mention fat is to soft but if fat has been lost how does one build up fat? I know you have mentioned that if you gain weight but besides that have you experienced just isolated areas. Also In the future I was thinking about augmenting rest of cheeks but first the isolated area. Any viewpoint?

yes, i have a strong viewpoint on this. i do not use fat to fill a small defect for many reasons:
1. it is metabolically active and acts like body fat so you can't just fill a little in there because it could change with body weight and become uneven. that is why i use fat very carefully and blend in the various areas of the face.
2. if the take in that one tiny area is poor, then all the work of sedation, harvesting, processing, centrifugation, injection leads to nada, that makes no sense. that is why i talk about the 5% rule meaning that a good fat transfer is about total face blending so that if any one 5% area does not look as good as possible the face still looks amazing.
3. fat, as you mentioned and as i have mentioned, is too soft to make a difference in a little area. too unpredictable in both directions, too little or too much.

if it is very small like a dime size and you want a permanent correction, i would most likely treat it like an acne scar and use silicone micro injections.
best,
sml