Fat Grafting Using a Hair Transplant Model for Understanding Part 1:  Graft Growth

Looking at my fat grafting results I was puzzled initially as to why I saw results continue to improve in patients somewhere between 6 months to 2 years after a procedure.  Being a very careful student of my own work by photographing patients after fat transfer every time they would come to my office, I worked to understand the long-term effects of a fat-transfer procedure.  Unlike traditional thinking that argues that a fat graft is similar to a temporary filler like Restylane or Juvederm, I have come to see that a fat graft is a superior long-term filler for overall facial rejuvenation.

When I was studying for my board certification in hair transplant surgery, I was reading Walter Unger’s book, Hair Transplantation, and I became fixated on one particular image.  The image was of how a hair-transplant graft would slowly start to grow after 6 months to a year as it went through stages of neovascularization, or attainment of new blood supply.  The tiny, free hair graft would gain formal, new blood supply and it would start to grow, as I would see in my own clinical practice between 6 months to a year.  I thought to myself, “How is a fat graft and a hair graft similar or different?”

I started to see how the two were actually more similar than different in many ways.  First, they were both tiny micrografts that were about the same size.  Second, they were transplanted from one remote area into the face or head region.  Third, they were “free grafts”, i.e., not sewn into place like a microvascular graft.  Fourth, there were thousands of these little grafts all placed near each other in the same region, or recipient area.

Looking at my fat results, I started to understand why I would almost invariably see improvements in the majority of my patients if I simply waited long enough.  The fat grafts like the hair grafts were going through the same process detailed in Unger’s book:  plasmatic imbibition, primary then secondary inosculation, and then finally neovascularization.  Suffice it to say that these earlier processes are ways that the body keeps the micrograft alive until the blood supply can more formally “attach” onto the graft.  By truly understanding how a hair transplant works, I believe I have now more precisely grasped how to counsel my patients about how fat grafting works in a similar fashion.  The next article in this series talks about what I call “the dip” and how I have matured my thinking about it.

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