Comparison of the Commercial Medical Filling Materials and Adipose Tissue
A few decades ago aesthetic treatment of aging was only focused on the wrinkles and sagging of the skin of the face. Today we have learned that aging is also progressing with deflation and resorption of the soft tissues of the face. To treat the sunken face the depressions in the below the eye areas, in the cheeks and in both sides of the chin, some material should be added into these areas. With the availability of commercial fillers many things have changed in aesthetic procedures and numbers of some older aesthetic operations have dropped considerably. Because these fillers provided the necessary material to treat the hollowed face areas and hide the wrinkles.
Types of the fillers
Currently commercial fillers can be classified as to main groups.
- Body friendly (somehow organic) but resorbable materials: They are safe to use but the body eliminates (absorbs) them by time. This “time” may be some months or rarely a few years. They have an advantage that if the final shape is not satisfactory some chemicals may eliminate them.
- Inorganic and non resorbable (permanent) materials: They stay forever in the body so if some reaction may occur it is very difficult to remove or eliminate them.
Advantages of commercial fillers
- They are available in the medical markets
- They can be stored on the shelf
- Their application is easy and safe. Usually there is no need for any kind of anesthesia, operating room or special facility.
- The patient (or person) can return to normal activities immediately after injection
- Usually don’t cause serious complications
- They are relatively cheap.
- They are usually sold as 1 ml ready to use injectors. If a large amount of material is needed the cost will be pretty high and their safety for large amounts are not sufficiently enough.
- Although it is rare, allergies and reactions to these materials may be seen with various severity.
- Reliability of commercial fillers is usually decided with their FDA (Food and Drug Administration) approval. Only a small percentage of commercial fillers have FDA approval in the world and it is not easy to check it for lay people.
Autologous tissue (fat) filling
There is a second option to fill the depressed areas. Own tissues of the individuals. Although many tissues like muscle, fascia, dermis, can be used for filling, the most abundant and easy to harvest material in the body is fat tissue. Fat can be harvested from the abdomen, from the waist, from the inner thighs and inside of the knees. But like the others, fat tissue is also under the skin and reaching and harvesting this tissue is painful and needs an operating room. The procedure should be done under local anesthesia, or sedation with some intraveineuse drugs, or under full general anesthesia. Harvesting the fat is relatively easy. Some round tipped tubes with holes on their distal ends are inserted from tiny holes into the skin and fat can be suctioned with vacuum force. After harvesting, the fat tissue is processed for better survival before being injected. This processing takes 15 to 20 minutes and is done when the patient is on the operation table. The fat is injected by small syringes with ordinary needles or small blunt injecting cannulas over their tips. Most target areas are in the face. Infra orbital areas, eyelids, tear through areas, nasolabial areas, laterals and inside of the chin, lips, lateral corners of the mouth and some very deep wrinkles. Fat also can be used to augment breasts, buttocks and any body areas that need fullness.
Durability of fat grafts
Survival of the fat grafts after injection is well researched. Depending on the injection technique and area, the survival rate of the fat grafts may be up to 80% or more. If any fat resorption is expected, it happens usually in the first 3-4 months. So we can say that fat stays 4 months after injection can be considered permanent. Depending on the resorption rate, 4 months or later another fat injection over the same area can be done and better and permanent filling can be obtained.
Preserving the fat
Fat tissue also can be preserved in refrigerators under minus 60-80 degrees for many months and even a few years. When needed it is melted and injected under local anesthesia.
On the other hand fat filling is not a cheap procedure. Most of the time harvesting is done with liposuction procedure in an operating room. Injection is usually done at the same session. However injecting the deepfreeze-preserved fat can be done in office conditions with local anesthesia, but doing it in a regular operating room is much better and safe.
Prof. Dr. Ege Ozgentas prefers autologous fat injections when the volume is 10 ml or more. He uses commercial resorbable fillers for lip augmentation and for small volumes of face fillings. He never uses permanent fillers.