Autologous fat transplantation (or lipofilling) is an excellent technique that uses the patient's own body fat as a natural, living filler to achieve precise structural modifications wherever they are placed. Fat is usually harvested using a Luer-Lok syringe attached to a two-hole harvesting cannula. After refinement, the fat is transferred to a smaller syringe and then placed in the recipient site using blunt infiltration cannulas.
On several occasions in our department, we needed a huge quantity of fatty tissue to correct severe defects. An alternative means of harvesting autologous fat was found to reduce operative time and to preserve the integrity of fatty tissue parcels. We adopted a closed suction drain attached to a two-hole harvesting cannula (Fig. 1) to obtain a continuous, nonmanual, low-power negative pressure to move adipocytes, through the cannula and the tube, into the drainage bottle. Because the power suction of the drain of –675 mmHg has been demonstrated experimentally to result in the breakage and vaporization of fat cells, destroying their ability to be successfully transplanted,1,2 the drain is opened and a new, lesser negative pressure of –75 mmHg is obtained by accelerator liposuction machine (Figs. 2 and 3). This pressure is maintained until the cannula is beneath the skin. As soon as the operator needs to change the donor region, the drain is closed at the distal end of the tube (near the drainage bottle) to preserve suction pressure and opened again once the cannula is pushed through the new harvest site to restart the suction. As the quantity of fatty tissue reached is enough, the draining bottle is cut and the fat prepared for the refinement. The procedure (refinement, transfer, and placement of fatty tissue) goes on as usual.3
This one-step harvesting modification is an extremely useful and time-saving method that can be used to ease routine technique in high-volume replacement lipofilling. Furthermore, fat harvested with an atraumatic, low-negative-pressure drain method preserves as many intact and viable lipocytes for transfer as does the manual method using a Luer-Lok syringe, and certainly more than the continuous active suction machine (liposuction). Therefore, it seems reasonable to believe that even when high quantities of fatty tissue are necessary, our method would allow successful long-term graft take anyway, providing durable and predictable cosmetic outcomes in the recipient sites.
Davide Lazzeri, M.D.
Giordano Giannotti, M.D.
Livio Colizzi, M.D.
Plastic and Reconstructive Surgery and Burn Center Unit
Hospital of Pisa
The authors are grateful to Gustavo Di Gaeta for help in performing this study.
The authors have no financial interest in any of the products or devices mentioned in this article.
1.Witort EJ, Pattarino J, Papucci L, et al. Autologous lipofilling: Coenzyme Q10 can rescue adipocytes from stress-induced apoptotic death. Plast Reconstr Surg.
2.Coleman SR. Structural fat grafting: More than a permanent filler. Plast Reconstr Surg.
3.Kaufman MR, Bradley JP, Dickinson B, et al. Autologous fat transfer national consensus survey: Trends in techniques for harvest, preparation, and application, and perception of short- and long-term results. Plast Reconstr Surg
Viewpoints, pertaining to issues of general interest, are welcome, even if they are not related to items previously published. Viewpoints may present unique techniques, brief technology updates, technical notes, and so on. Viewpoints will be published on a space-available basis because they are typically less timesensitive than Letters and other types of articles. Please note the following criteria:
Authors will be listed in the order in which they appear in the submission. Viewpoints should be submitted electronically via PRS’ enkwell, at www.editorialmanager.com/prs/. We strongly encourage authors to submit figures in color.
We reserve the right to edit Viewpoints to meet requirements of space and format. Any financial interests relevant to the content must be disclosed. Submission of a Viewpoint constitutes permission for the American Society of Plastic Surgeons and its licensees and assignees to publish it in the Journal and in any other form or medium.
The views, opinions, and conclusions expressed in the Viewpoints represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the Journal. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such correspondence.