[Fat Grafting Duhan Plastic Surgery] - [Side Effects of Fat Grafting]

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COL-FAT fat grafting, developed by Director Shin Duhan of Duhan Plastic Surgery, is a new technology that can be used to solve problems by strengthening collagen self-regenerative activation factors with the tunneling technique.

It also uses highly concentrated autologous fat to increase the survival rate, offering the advantages of improved skin elasticity and long-lasting results.

Micro fat grafting allows fat to survive after it is transplanted as capillary formation occurs around the grafted fat.

The survival process takes at least three months. During that time, because vascularization does not occur, some of the fat may melt away and disappear, and some may be crushed by pressure from surrounding tissue and disappear.

Therefore, because volume increase cannot always be achieved with fat alone, Col-fat fat grafting helps the fat survive while encouraging the body to generate collagen on its own, creating youthful, elastic skin and contours.

​http://www.duhans.com​

What is 3D fat grafting?

Micro fat grafting using a syringe includes planar fat grafting and three-dimensional fat grafting.

When fat is transplanted in only one layer, it is 2D planar fat grafting.

On the other hand, when fat is transplanted into multiple layers of tissue, it is 3D three-dimensional fat grafting.

In most fat grafting procedures, performing 3D fat grafting is effective for creating smooth contours and achieving a high survival rate of the fat.

3D fat grafting refers to transplanting small amounts evenly across multiple layers in each area.

The advantages of 3D fat grafting are that it can achieve a high fat survival rate and create uniform, smooth contours.

If a large amount of fat is transplanted into one area, the fat cells do not receive enough nutrients, so a significant portion is absorbed, making it difficult to expect a good result.

Therefore, even if the same amount is transplanted, distributing it evenly in small units across multiple layers maximizes the fat survival rate and makes it possible to achieve smooth contours.

What is 2D planar fat grafting?

2D planar fat grafting means transplanting fat into only one layer of tissue, which limits how much fat can be transplanted and also creates the problem of a high absorption rate because a large amount of fat is placed in one area.

However, there are exceptional areas where 2D planar fat grafting must be performed.

For example, in cases of sunken upper eyelids, fat should be transplanted into the fat layer beneath the muscle layer to achieve good functional and cosmetic results.

The advantage of 2D planar fat grafting is that by transplanting a thin layer of fat in areas with thin tissue, a smooth contour can be achieved.

What happens when a large amount of fat is transplanted into one area?

Thinking that transplanting a large amount of fat at once is more effective and forcing too much fat into one area is not a good method.

Blood vessels cannot grow into the center of the fat, so the fat tissue becomes necrotic.

In other words, it is absorbed and disappears.

Therefore, distributing fat evenly across multiple layers and multiple areas is the effective method of fat grafting.

Of course, good results should be achieved after fat grafting, but

depending on the surgeon’s skill and technique,

sometimes unavoidable problems can occur.

Poor results due to a low survival rate, awkward shapes, asymmetry, severe swelling, inflammation,

fat necrosis, calcification, irregular contours, sagging, and pigmentation may occur.

Shin Duhan, MD

How to solve the side effects of overinjected fat grafting?

If fat grafting is performed by someone without experience and against the principles, or if the amount of fat grafting is misjudged and too much fat is transplanted, the treated area may swell severely, or even after the swelling goes down, the treated area may remain too protruding and the shape may look awkward.

This problem mainly occurs when a large amount of poorly refined fat containing many impurities is forcefully injected.

Usually, it subsides over time, but if the swelling is too severe, hyaluronidase to reduce swelling may be injected into the treated area to bring the swelling down more quickly. In cases of excessive fat injection, a microcannula may be inserted and the transplanted fat may be suctioned out again to remove it.

Overinjected fat can be removed more easily if it is suctioned out again before three months have passed.

In some cases, if the transplanted fat becomes necrotic and calcified and turns hard, it also needs to be removed by suction.

However, if fat grafting is done properly, these problems almost never occur.​

Inflammation	Occurs when bacteria enter during the procedure and the fat fails to survive and melts away during the survival process
Necrosis	A state in which fat that failed to survive due to insufficient blood supply during the survival process has decayed and melted away, leaving behind remnants
Calcification	A phenomenon in which fat that failed to survive due to insufficient blood supply during the survival process hardens and calcium deposits, forming a firm lump
Irregular contour	A phenomenon in which fat is not transplanted evenly or is concentrated in only one area, resulting in an uneven, lumpy appearance rather than a uniform shape
Sagging	If too much fat is transplanted or transplanted in the wrong position, sagging of the face may occur
Pigmentation	In cases of severe bruising and swelling, the iron component left in the bruise may deposit in the skin and oxidize, turning brown depending on the person’s constitution; this may occasionally occur after under-eye procedures depending on the individual
Asymmetry	Occurs when the left and right survival rates differ, or when the amount transplanted is not properly adjusted during the initial procedure, causing left-right imbalance
High absorption rate	A phenomenon in which the fat does not survive enough to create the desired contour, and much of it is absorbed, so the appearance before and after the procedure does not change much
Awkward shape	A phenomenon in which fat survives excessively or is transplanted to an inappropriate area, disrupting the overall balance of the face

What are the side effects of fat grafting?

Because fat grafting uses autologous fat, it has almost no side effects, unlike commercial filler materials.

Except for a little swelling and bruising after the procedure, it can be said that there are no side effects.

Therefore, it can be considered a safer procedure than any other cosmetic surgery.

However, this is based on cases where fat grafting is done properly. If the procedure is performed against the principles, side effects may sometimes occur, including a lumpy shape, fat necrosis and hardening, inflammation, or an awkward appearance due to excessive injection.

This is determined by the practitioner’s experience and skill, and is absolutely not a general problem with fat grafting.

Therefore, if the procedure is performed according to the principles, these side effects almost never occur.

How to perform fat grafting without side effects?

1. Perform the procedure in a sterile state

As with all surgeries, fat grafting must also be performed with completely sterilized instruments and materials.

After the procedure, the inside of the suction tube should be thoroughly cleaned with a brush and sterilized with a high-pressure steam sterilizer so that no fat residue remains inside the suction tube or grafting tube, and anesthesia medication, saline, and other materials must also be carefully managed to prevent contamination.

Thorough sterilization and material management can prevent bacterial infection and inflammation.

2. Several stages of fat refinement

Fat refinement must remove impurities completely through several stages to maximize effectiveness.

The harvested fat usually contains about 80% impurities, and only about 20% is actually usable.

If the remaining impurities (blood, serum, anesthesia medication, oil, moisture, etc.) are not removed, the result will be poor no matter how well the grafting is done.

3. Pre-conditioning before fat grafting

A high survival rate should make it possible to achieve a satisfactory result with a single procedure whenever possible.

The fine fat must be planted evenly across multiple layers, and before that, space should be secured at the grafting site so that the previously transplanted fat is not compressed by the surrounding tissue, allowing it to survive well without pressure.

4. Precise and even transplantation across multiple tissue layers

Expressing soft and natural contours is the key to fat grafting.

For smooth contours, it is better to use a 3D method that distributes the fat evenly across multiple layers.

The transplant sites include the subcutaneous layer, muscle layer, and fascia layer. The fat should be spread through the tissue as if scattering seeds evenly, so that a smooth contour without irregularities can be achieved.

What is the process for a second fat grafting procedure?

Fat grafting does not always end with a single session.

The survival rate varies by area, and there are individual differences as well.

On average, about 50% of the transplanted fat is absorbed, so although the shape may look good at first, it is gradually absorbed over time, and in some cases a second procedure may be needed.

▷ Three to ten months after the first fat grafting, you visit the plastic surgery clinic again to check the progress.

▷ If a second fat grafting procedure is judged necessary, the frozen fat stored during the first procedure is thawed and, after local anesthesia, fat is injected again.

▷ Since the harvesting process is omitted compared with the first procedure, the procedure time is much shorter, and the cost is about half of the first fat grafting procedure.

▷ If the first procedure shows good survival and the shape is satisfactory, no further fat grafting is needed.

In other words, a second procedure is performed only when necessary, and the patient can judge it by looking at the shape.

Fat grafting usually involves one to two procedures.

If a second procedure is needed, it is performed between three and ten months later.

On average, two procedures can produce a satisfactory effect for facial contour correction.

What are the pre- and post-procedure steps and post-procedure care tips for fat grafting?

These are the pre- and post-procedure steps for undergoing fat grafting surgery.

① Make a consultation reservation by phone or online.

② Visit at the scheduled consultation time and receive a consultation.

③ If you wish to proceed with the procedure, make a surgery reservation immediately after the consultation and leave.

You can also make a surgery reservation later by phone or online.

④ Arrive 30 minutes before the surgery reservation time, hear an explanation of the fat grafting procedure, and have the design markings made.

⑤ After the design is completed, change clothes and receive an intravenous injection for painless sleep anesthesia.

⑥ The procedure time for fat grafting differs by area, and if multiple areas are treated at the same time, it may take longer.

On average, it takes from 30 minutes to as long as 2 hours.

⑦ After the procedure, you will receive antibiotic and anti-inflammatory injections and rest in the recovery room for about 30 minutes.

⑧ You will be given post-procedure precautions and a follow-up appointment date will be reserved.

⑨ Visit two days after the procedure to check the progress of the fat grafting area, and the fat harvest site will be disinfected.

Showering is allowed from two days after the procedure.

Visit on day 7 to check the progress and have the stitches removed from the fat harvest site (navel).

If you live too far away and it is difficult to visit the clinic, you do not necessarily have to come in.

⑩ If a second procedure is needed, you will visit and undergo the procedure between three and ten months later.

Let’s look at some incorrect information about fat grafting~

Question) Effect of fat grafting in the buttocks or breast area

Answer) Fat grafting is sometimes performed to correct buttock hollows or enlarge the breasts.

However, there are problems with this.

In the case of the buttocks, it is an area that must keep moving, so the survival rate of fat is extremely low, and if transplanted incorrectly, side effects such as pigmentation may occur.

Fat grafting to increase buttock volume inevitably involves difficulties.

For breast enlargement with fat grafting, at least about 1000 cc of fat must be harvested, and it is difficult to harvest that much fat.

The reason is that people with underdeveloped breasts are usually not very heavy, and therefore there is often not enough fat in the lower abdomen, waist, or thighs from which to harvest, making it difficult to obtain the desired amount and also difficult to transplant the desired amount.

In addition, if a large amount of fat is transplanted into the breast area, some of the fat may necrose, causing abscesses or calcification, which can harden.

If an abscess forms and pus collects, healing can be very difficult, and even after healing it may leave major aftereffects.

Also, calcification can become a critical problem because it may prevent breast cancer from being detected in future breast cancer examinations. Therefore, breast fat grafting is, in principle, not a procedure that should be performed.

There are principles in plastic surgery.

Because both good and bad outcomes must be considered, if the probability of a bad outcome after surgery is even 1 in 10,000, it is a procedure that should not be performed.

Breast fat grafting falls into the case above, so deciding to perform breast augmentation with fat should be done very carefully.

Question) The theory that fat harvested from the thighs survives better

Answer) The harvest site for fat is not fixed.

If anything, the thigh is not a preferred harvest site.

The problem is that fat contains a lot of oil.

Oil is an impurity, so it does not help survival.

There is a lot of bruising and swelling after the procedure, and you should not walk more than necessary until the bruising goes down, which can make daily life inconvenient. If too much is harvested, problems such as changes in the shape of the thigh or pigmentation may occur.

The choice of fat harvest site is not determined solely by survival rate.

You must consider whether there is enough fat, the convenience of harvesting, post-procedure swelling and pain, the degree of bruising, how easily daily life can resume after harvesting, the survival rate of the harvested fat, and also the shape of the harvested area and possible future aftereffects.

To perform fat grafting, fat must first be harvested from an appropriate area.

The harvest site is determined by considering the amount of fat that needs to be suctioned, and when only a small amount is to be transplanted, such as for the under-eye area, nose, or nasolabial folds, the lower abdomen is usually the most common harvest site.

The reason the lower abdomen is good is that it is easy to harvest from, the post-procedure swelling and pain are mild, and it is more convenient for daily life.

If a large amount of fat must be transplanted, such as for the cheeks or forehead, you should check whether enough fat can be harvested from the donor area.

If there is a lot of excess fat in the lower abdomen, the fat is harvested from there. If there is no fat in the lower abdomen, or if the elasticity of the abdominal fat has decreased significantly due to aging or childbirth, harvesting may not be possible even if there is fat.

This is because the abdomen may sag after fat harvesting.

In such cases, the fat is harvested from the thighs. The thigh is divided into the inner, outer, and back areas when determining the harvest site, and the area with the most excess fat is selected for harvesting.

Fat is harvested with careful suction so that no deformity or hollowing occurs at the harvest site.

Depending on the case, if the patient has a particular area they want, fat may be harvested from that area as much as possible.

Because each person has different areas with excess fat and different constitutions, the most suitable fat harvest site must be determined according to the body’s characteristics and constitution.

Which area the fat is harvested from does not determine the survival rate.

To achieve good results with fat grafting, careful harvesting, a proper refinement process such as oil removal, pre-conditioning of the procedure site, evenly transplanting an appropriate amount of fat into the procedure site, and transplanting in a way that makes the shape look natural are all necessary for good results.

In other words, good results can only be achieved when the entire series of procedure steps is performed properly from start to finish.

Question) The misconception that transplanted fat flows downward or moves

Answer) Fat transplantation involves transplanting solid cells.

They either survive and remain as one’s own cells, or they melt away and disappear.

Solid cells do not move or flow downward. That never happens.

In unauthorized procedures, industrial silicone or paraffin is sometimes injected carelessly into the face. Since these are liquid substances, they usually flow downward in the direction of gravity.

Liquids can move by seeping between cells.

Some people develop bias after seeing or hearing about the side effects of unauthorized procedures and mistakenly believe that fat grafting can also cause problems. But solid fat cells remain in the place where they were transplanted and can never move to another area.

Sometimes, in other hospitals, fat is transplanted in excessive amounts or into the wrong area, causing the shape to look awkward or sagging. Looking at such results, one might think the fat has moved, but that is not because the fat has flowed or moved; it is because the transplantation itself was done incorrectly, or because too much was transplanted and the weight of the fat makes it appear saggy.

Question) The theory that the fat refinement process must block exposure to air

Answer) Fat grafting cannot afford to neglect any step, and the refinement process is no different.

The purpose of fat refinement is to remove all unnecessary impurities other than fat cells.

The impurities removed during centrifugation include moisture, anesthesia medication, serum, and red blood cells.

What cannot be refined away during centrifugation is the oil component within the fat cells themselves.

Oil is one of the impurities that must be removed from fat cells and makes up a significant proportion.

It is distributed both inside and outside the fat cells, and the fat cells can be seen as being intertwined with oil.

The only way to remove the oil is to wrap the fat after centrifugation in sterile gauze and remove it through natural absorption, and at that time the fat is exposed to the outside.

Some claim that exposing fat to air increases the risk of infection or damages the fat through oxidation, but in reality such effects are almost nonexistent.

Under a microscope, fat cells are surrounded inside and out by a thick oil film, so the fat cells themselves cannot directly contact the air.

Also, because diluted antibiotic is applied to the fat during the gauze refinement process, bacterial infection can be prevented even more effectively.

Question) The myth and truth about the lasting effect of fat grafting

Answer) Although there are many hospitals that perform fat grafting, only a few can produce proper results.

If fat grafting is not done properly, the result is worse than not doing it at all.

In principle, fat grafting can produce good results only when performed accurately.

The procedure method differs from hospital to hospital, and there are major differences depending on experience.

The survival period of fat is about three months.

Fat that survives beyond that point remains permanently as your own fat cells.

It is commonly misunderstood that transplanted fat disappears after one or two years and returns to the original state, but once fat has survived, it does not disappear for no reason.

Also, the reason a second procedure is performed after three months is to wait until the first transplanted fat has fully survived and settled, and then perform the procedure after seeing the shape.

Up to about three months, some fat is absorbed during the survival process, but fat that survives beyond three months is no longer absorbed and remains permanently as your own tissue.

However, the shape of the transplanted area does not last forever.

As a person ages, the skin sags, wrinkles form, and age-related changes in the skeleton occur, so even the area that received fat grafting is not exempt from aging.

For that reason, the effect of fat grafting is sometimes described as semi-permanent, and sometimes as effectively permanent.

Although the wording differs, it can be said that the effect lasts until aging progresses significantly with age.

Surgical procedure at Duhan Autologous Fat Grafting Clinic

① Before visiting, make a consultation reservation by phone or online in advance.

If you make a reservation in advance before visiting, you can receive a more convenient consultation.

② After making a reservation, visit for the consultation, and if you decide to proceed with surgery, set a surgery date.

Surgery reservations can also be made later by phone or online.​

③ Pre-surgery precautions

Once the surgery date is confirmed, those taking steroids or anticoagulants (aspirin), etc., should temporarily stop taking the medication starting 7 days before surgery.

You should avoid drinking alcohol as much as possible the day before surgery.

Alcohol reduces the effect of local anesthesia, so anesthesia may not work well during the surgery or may wear off quickly.

For women, try to avoid the menstrual period as much as possible.

It may not matter for a simple procedure, but for a large-scale surgery, be aware that bleeding during the procedure may increase.

④ On the day of surgery

• Arrive 30 minutes before the scheduled surgery time and listen to the explanation of what to be careful about during the surgery.

• Change into surgical clothes and receive an IV injection for preoperative preparation.

For local anesthesia, an intravenous injection is administered for painless anesthesia.

About 5 minutes after the intravenous injection, you enter a sedated state, and for patients undergoing double eyelid surgery or nose surgery, local anesthesia is administered to the surgical area while in that sedated state.

After about 5 minutes, you wake from the sedated state and the anesthesia is fully completed.

The patient does not feel any pain at all during anesthesia.

• When the surgery is finished, you will receive intramuscular injections of antibiotics and anti-inflammatory medication, and rest in the recovery room for about 30 minutes.

For double eyelid or nose surgery, you will receive cold compresses with a cool pack.

• For those who underwent surgery under general anesthesia, they will rest in the recovery room for about 1 to 2 hours and go home once the dizziness from the anesthetic has completely disappeared.

• When going home, you will receive post-surgery instructions from the surgeon in charge, reserve a follow-up date, receive your prescription, and buy the medicine at the pharmacy to take it.

⑤ Return on the scheduled date to check the post-surgery progress and receive an examination.

​http://www.duhans.com​