Embracing Fat for Contour

Dr. Constantino Mendieta has a mantra: “The fat you love to hate, is the fat I love to take.” His practice, based in Miami is seeing a sharp increase in a procedure called Fat Grafting. Although it sounds too good to be true, fat grafting, or fat transfer literally takes fat from one area of the body where it is unwanted, and puts it into another area where more volume is desired.

by Isabel Bolt
and Constatino Mendieta, MD

A short history of transferring fat

The first evidence of fat transfer was recorded in the 18^th century, but never became widely accepted until modern liposuction techniques were developed. Complications including infection and the viability of how much fat would “live” through the transfer deemed it unpredictable at best. This began changing when in the early 1990’s Dr. Sydney Coleman, a New York City Plastic Surgeon, began publishing papers describing standardized techniques for fat extraction, processing, and injection. Since that point in time the procedure’s popularity has increased along with a wider variety of clinical applications.

Recent History–The American Society of Aesthetic Plastic Surgeon’s Meeting 2015

The ASAPS meeting held in Montreal, Quebec last May hosted a panel discussion on the evolution of fat grafting, and how surgeons are discovering best practices to produce the most natural looking results. Dr. Mendieta was a panel member. “Fat grafting is a relatively new way to literally sculpt the body and it is revolutionizing plastic surgery. Fat is the ‘liquid gold’ that enables us to reshape, change and augment patients’ body parts in ways diets, exercise and creams simply can’t. A patient’s own body tissue is used, so there is no chance of rejection,” explained Dr. Constantino Mendieta.

Plastic surgeons around the world agree that fat grafting is proving to be a novel technique for body sculpting previously neglected areas including women’s and men’s shoulders, pectorals, legs and stomachs to create definition.

The Fat Grafting Process

The process of fat grafting involves three steps: extraction of the fat from the donor area with liposuction; decanting, centrifugation, and processing of the fat; and finally reinjection of the purified fat into the area needing improvement. Fat is taken from the donor area (stomach, hips, and thighs) using special liposuction techniques with thin cannulas. The fat is either “decanted” or “washed” to separate out the viable adipose fat cells to be used in the graft.

In the first step, fat is extracted from a donor area using liposuction techniques. This is best accomplished by manual methods using thin liposuction cannulas with small holes. Laser or ultrasonic liposuction should not be used for the extraction as it may destroy the fat cells. In the final step, the fat is reinjected in small droplets throughout the subcutaneous tissue of the recipient area. This is to ensure good blood supply to every fat droplet so that the fat graft can survive.

The amount of fat injected is measured in cc’s and ultimately varies according to patient specifics and the area of the body where the processed fat is being injected. 10 cc’s is roughly 2 teaspoons. How much fat is necessary for different areas? In general, 10-100 cc’s might be used for the face, while buttocks can use from 200-1300cc’s in each cheek. Patients must have enough fat to harvest to accomplish their desired result.

Common Areas of Fat Grafting

Simply put, fat can be used anywhere dermal fillers or implants would be used. Dr. Mendieta uses it for facial rejuvenation to restore a more youthful appearance by adding volume to the areas below the eyes or nasolabial folds, the cheeks, nose and even the jawline. The breast can be enhanced by one or two cup sizes using fat. It can also correct breast symmetry, repair radiation damage and correct deformities from lumpectomies or breast reconstruction. The demand for buttock enhancement, also known as a Brazilian Butt Lift is skyrocketing with an 84% increase in the last year. Buttock augmentation can change the size and shape of the buttock while sculpting the hip-waist ratio for a more feminine (or masculine) silhouette. Hand rejuvenation is becoming more popular to not only plump up the volume and padding on the hand, but also improve the texture and appearance of the skin.

According to Dr. Mendieta, fat is really the clay that allows him to “reframe and reshape different body parts.” “What is fascinating is as you age you lose fat from hands, face, breast and buttock and you don’t lose it where you want to lose it from– waist, inner outer leg and love handles. So I am removing fat from where it will never disappear and putting it where you need it. I think fat genetically has a predisposition…and that fat should live forever.”

An Uncommon Area–Men’s Torso

Dr. Mendieta is known for performing something he calls “the Adonis procedure” where he augments a man’s torso–shoulders, chest, abdomen using the man’s extra fat in the love handles or waist. “Not only are we augmenting the butt, hands, and face but now men’s upper bodies.” “Fat clinically takes on properties of where I put it. There’s a lot of flexibility with using fat to contour the overall body shape because fat takes on the physiologic component of whatever it is adjacent to. If you inject fat near bone it takes on the characteristics of bone, and the same applies to muscle. When I put in a muscle, it becomes a bigger muscle. It expands to re-sculpt and contour the chest and shoulders giving a man a nice “V” cut.”

High Demand, Few Experts

It is important to note that extracting fat is a very technique dependent procedure. Applying the fat is the ultimate artistic procedure. Few practitioners are considered experts, so it is critical that a prospective patient choose a plastic surgeon with the experience, training and eye of a sculptor. Demand is high, but the results are definitely not mainstream. Techniques have really improved across a wide range in the industry, but it’s still important for patients to choose a board-certified plastic surgeon with extensive experience in this particular procedure. A conservative approach may involve multiple fat grafting sessions over several months to get the desired results.