Dr. Sam Lam Plastic Surgery Forum

Dr. Lam:

As I've been researching fat grafting, I came across an opinion that one of the factors that determines whether fat stays and lasts is number of "parcels" per oz. of fat. Does this mean that an oz. of fat is separated into many injections? How many do you usually do? Could you elaborate on this when you get a chance?

hi, sure. fat parcels in my opinion have to be injected atraumatically with tiny amounts to survive. think of it this way, if you put a golf ball size piece of fat in the face (which i don't), besides having an unsmooth result, how much blood supply contact from neighboring tissue does the center of that golf ball get? the answer is zero. that is why the fat will die, and it will die unevenly. how big are my parcels? take a granule of rice and cut it into 5 pieces. that is about the size of it.

second, how do you put the fat in matters a lot too. i use only a cannula (a non-sharp object) that allows me to slide the fat in without hurting the tissues. it glides between tissue planes instead of destroying them like a needle would. in fact no anesthesia is even placed with a needle.

third, i use small volumes of fat. that allows plenty of contact between the fat cells and the neighboring blood supply so that the fat lives. how do i get away with smaller volumes? because instead of making some horrifically large cheek or chin, i blend it across multiple small facial areas. by doing so, i can create a much more seamless process. it also allows me to create what i call the 5% rule for successful fat grafting. watch this video to understand my concept better.
http://www.lamfacialplastics.com/galler ... rgery.html
while your at, watch these too:
http://www.lamfacialplastics.com/galler ... s.flv.html
http://www.lamfacialplastics.com/galler ... avity.html
there are a lot more on my site as you know. i pulled some of these from my vlog section on fat transfer:
http://www.lamfacialplastics.com/galler ... uvenation/
best,
dr. sam lam

It's very interesting (watched the videos). I'm wondering whether there is a correlation between the number of parcels and bruising. I am learning that some people are bruised severely for two weeks, whereas others are not. Why is that, except for individual differences?

1. gentleness of the physician
2. all my local anesthetic goes in with no needles to minimize bruising.
3. less fat injected.
4. smaller cannulas (i have moved to very very tiny cannulas for injection)
5. i use a laser to eliminate almost all bruising at a week so long as it is not immediately close to the eye.
6. good old fashion luck.
best,
dr. sam lam

Hi Dr. Lam:
How many oz. of fat (approximately) do you need to take from a donor site to do facial fat grafting?
It sounds from your videos (and in this thread you actually mentioned that an average parcel is as tiny as 1/5 of the grain of rice) that you make multiple injections to deliver fat. How many roughly: a dozen, a hundred per face?
Also, cannula vrs. needle. You're saying that needles hurt tissue more, but I have a hard time understanding it, because to me, a dull object seems to hurt more and leave more scarring; needle, on the other hand, seems to be the tiniest and shouldn't leave any mark. Could you say a couple of words about it?
Thanks!

1. i take about 40 to 60 cc (ml) of fat to do my work on average. i don't always use all of it. i tend to put in between 20 to 50 cc on average. the rest i throw out if i don't need it.
2. i inject yes hundreds and hundreds of micropasses.
3. if a cannula is used over and over and over again, it can build up more scarring in the tissues over time. however, one or two times, that does not happen. in fact, scarring is another way to express collagen growth, which is actually favorable. i plan on doing a fat transfer only 1 to 2 times in a lifetime so i am not worried about it.

needles are more problematic in many ways. they create shearing through tissues that can lead to more bruising and even risk intravascular (inside vessel) injection of fat as an embolus. with more bruising and more swelling, there can be less fat take and prolonged recovery. fat does nto fall into natural tissues planes but into artificial planes created by a needle lancing through tissues. also, there is no control with a needle. as i inject the orbital rim, i use my non-dominant hand's index finger to perfectly guide placement and depth. i would hurt my finger if i used a needle doing that. for all of those reasons, a cannula is a thousand times better than a needle.
hope that is clear. thanks again for the question.
best,
sml