Expert guide: Cosmetic & Plastic Surgery 2015 40 June 2015 June 2015 41 The American Society for Aesthet-ic Plastic Surgery (ASAPS), is host-ing a panel discussion today on the fast-evolving practice of fat grafting, and how surgeons are discovering best practices to produce the most natural looking results. Physician members of ASAPS concur that less is more when it comes to utilising a patient’s own fat to enhance cer-tain anatomical regions including the breast and buttocks. Further, they agree that fat grafting is prov-ing to be a novel technique for body sculpting previously neglected areas including women’s and men’s shoul-ders, pectorals, legs and stomachs to create definition. “Fat grafting is a relatively new way to literally sculpt the body and it is revolutionising 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,” explains ASAPS member, Dr. Con-stantino Mendieta. “Further, there is a lot of flexibility with using fat to contour the overall body shape be-cause fat takes on the physiologic component of whatever it is adja-cent to. If you inject fat near bone it takes on the characteristics of bone, and the same applies to muscle,” he states.Fat is an artistic sculpting tool that can fill in defects, contour and re-shape, whereas implants are used exclusively for augmentative pur-poses. Dr. Ashkan Ghavami, a fellow ASAPS member agrees but notes that fat grafting can actually comple-ment implants, especially when a pa-tient seeks a dramatic augmentation or enhanced cleavage, that fat or an implant alone cannot create. “The fat can help to create a natural look around the edges of the implants, or when replacing larger implants with smaller ones and the pocket size in-evitably changes. It is a solid option for smoothing out and contouring the breast with implants, and should be tailored to the individual patient. It can also accompany a breast lift,” explains Ghavami.Daniel Del Vecchio, MD Ashkan Ghavami, MD Constantino Mendieta, MD As Fat Grafting Evolves, Aesthetic Plastic Surgeons Discover That Less Can Be More, It’s Not Just For The Breasts And Buttocks, And Fat Doesn’t Always Act Like Fat By Daniel Del Vecchio, MD; Ashkan Ghavami, MD; Constantino Mendieta, MD USA When fat cells are removed from one area they are gone from that area forever, but can live indefinitely in whatever location they are trans-ferred to. The fat retention rate var-ies from one body part to another averaging 40% in the breast, 60% in the buttock and 60% in the calf or legs according to panellists, when performed by an experienced plastic surgeon certified by the American Board of Plastic Surgery (ABPS).“The concept of beauty today is about shape and proportion - not necessarily size. More patients are requesting to shift fat from one area to another to look prettier and perk-ier, but not necessarily larger. This includes men who have lost body fat in the derriere region when they’re typically in their 40s,” notes Dr. Mendieta. For patients who don’t have enough body fat to be graft-ed, Mendieta will recommend he/she gains anywhere from 10 to 15 pounds for extraction. He notes that patients who can’t gain weight are limited to implants.Ghavami explains, “Fat grafting can be limited by multiple factors, includ-ing bone structure, the quality of the skin itself and how much a patient’s tissue can actually stretch. Addition-ally, too much fat in a particular area can cause it to rupture and explode the surrounding ligament borders, so there is no need for excessive large volume of body fat transfers in everyone. As with breast implants, the volume has to match each pa-tient’s tissues. Patients also need to have realistic expectations of what can be achieved. Fat alone can’t per-fectly smooth out cellulite (but can improve its appearance in some) as shown in widely-circulated photo-shopped images in the media, nor can it increase a woman’s cup size by more than a letter or two at most,” he explains.While it has its limitations, fat graft-ing holds significant promise for the future of aesthetic plastic surgery, as it is already changing the landscape by offering patients a natural option for subtle enhancement. If properly placed, fat can change the contour