Early pioneer describes autologous fat transfers

San Antonio - After three decades, the cosmetic profession is finally starting to sit up and take notice of autologous fat transfers, according to plastic surgeon Tolbert Wilkinson, M.D., F.A.C.S.

"The topic is very popular right now," he says. "In the last several years, we've had presentations at national meetings. Before that, proposals were always turned down."

Why the sudden interest? According to Dr. Wilkinson, it's due to a number of factors. Compared to commercial products, indigenous fat has a significant price advantage. If you run out, you can get more adipose from the midriff or thighs. And the immune system isn't likely to protest the transplant.

Otherwise, the transfers are remarkably durable.

"I have grafts that are still working after 15 to 20 years," says Dr. Wilkinson. "In some patients, the only facial fat they have left is the fat I injected."

Refining the procedure A San Antonio-based plastic surgeon, Dr. Wilkinson has authored several books, including the Atlas of Liposuction, which includes a chapter on fat return surgery. His experience with the procedure dates back several decades.

"Initially," he says, "we couldn't make it work, because we were doing it incorrectly - forcing fat into spaces where it wouldn't fit. Around 1984, we had the first successful grafts, filling large dimples. They were done by Brazilians."

Over the years, as the cosmetic industry became cognizant that atrophy was part of the aging process and that filling could restore a youthful appearance, pioneers were refining their fat grafting techniques.

"We had the procedure pretty much nailed down by 1987, but people didn't get the idea. They thought fat grafts were an injection and forced damaged cells into areas where there wasn't enough space."

Dr. Wilkinson strives to keep the procedure simple. After removing fat from the midriff or jowl, he concentrates it by placing it on a pad to let it drain.

He says, "In the past, we centrifuged. Now we just add 10 percent more fat."

Next, he places the adipose in a delivery gun, and, after undermining, makes three to four tunnels at different depths, injecting as he withdraws. He does not use the micro-droplet or threading technique. It takes much longer, without improving results.

The newest procedural improvement - dating to 1997 - is the use of exterior ultrasound. When directed at the jowl or body to improve extraction, melt fat, or reduce swelling, it produces the incidental benefit of tightening.

"After five years' experience with the exterior ultrasound, we're not seeing the same problems of fat destruction caused by Thermage^®," notes the surgeon. "The energy delivery is deep to the dermis, not to the surface."

Expanding uses Most of the activity is in the expanding list of problems cosmetic surgeons are correcting with fat grafts. Dr. Wilkinson cited small earlobes, crumpled chins, tear troughs, depressions under the cheek bone, nasolabial lines, wrinkles in the chin and between the nose and lip, and frown lines.

In correcting glabellar furrows, he inserts an instrument through a pinhole in the scalp to shred the muscles, weakening but not paralyzing them. He then elevates the furrows to better fill the area.

The main use of fat grafts continues to be for lip enhancement. This constitutes about 70 percent of Dr. Wilkinson's grafting practice. Lips remain lush, soft and natural for a decade or more.