Fat Autografting Muscle Injection (FAMI): Autologous Fat Grafting

In autologous fat grafting (synonyms: Fat Autografting Muscle Injection/Facial Autograft Muscle Injection (FAMI), autologous fat grafting) is a plastic or cosmetic surgery procedure in which fat tissue is removed from one area of the body and transplanted into another area of the body. Due to the multiple body parts on which autologous fat transplantation can be performed, the possible applications of the transplantation procedure are almost unlimited. Furthermore, it should be noted that in autologous fat transplantation, on the one hand, vital (directly removed) fat tissue can be used, on the other hand, frozen preserved tissue can be used. The use of the frozen autologous (body’s own) fat tissue causes an inflammatory reaction in the surrounding tissue, so that a reduced rejection of the used autologous fat in the adjacent tissue occurs. Historically, the first fat tissue transplants were performed as early as the end of the 19th century. However, the use of the procedure as practiced today is largely based on the physicians Dr. Pierre Fournier and Dr. Sydney Coleman, who helped make autologous fat grafting widely known.

Indications (areas of application)

Autologous fat grafting can be performed in the following body regions:

  • Face: cheek area, cheekbone area, lip and chin area.
  • Body trunk: chest and buttocks area
  • Extremities: Hands and muscle contours

Indications

  • Scar correction
  • Lipodystrophy of the face (in HIV patients).
  • Rejuvenation of the face

Particularly strict indication for mammary augmentation (breast augmentation) with autologous fat grafting:

  • BRCA1/2 mutations or positive family history of breast cancer.
  • After breast-conserving therapy (BET) of ductal carcinoma in situ or mucin-like cancer associated antigen (MCA) if free of recurrence (no recurrence of the disease) at the earliest two years after local therapy (under controlled study conditions!).

Contraindications [modified according to]

  • Inflammation in the injection area
  • Acute infections in the donor or recipient site.
  • Active malignant (malignant) underlying disease in the donor or recipient site.
  • Severe nicotine abuse
  • Breastfeeding
  • Pregnancy
  • Immunosuppression
  • Anticoagulation (blood-thinning medications associated with an increased tendency to bleed).
  • Lack of compliance (lack of cooperation from the patient).

Before surgery

Before surgery, an intensive medical history discussion should be conducted that includes the patient’s medical history and motivation for the procedure. The procedure, any side effects, and the consequences of the surgery should be discussed in detail. Note: The requirements of the explanation are stricter than usual, since courts in the field of aesthetic surgery demand a “relentless” explanation. Furthermore, you should not take acetylsalicylic acid (ASA), sleeping pills or alcohol for a period of seven to ten days before an autologous fat transplant. Both acetylsalicylic acid and other painkillers delay blood clotting and can lead to unwanted bleeding.Smokers should severely limit their nicotine consumption as early as four weeks before the procedure to avoid jeopardizing wound healing.

The surgical procedure

The principle of autologous fat grafting is the redistribution of fat tissue through autologous transplantation (donor and recipient are the same person). A periumbilical (located next to the belly button) adipose tissue-rich region is often used for fat harvesting. The following is the description of adipose tissue harvesting:

  • Before the actual procedure, local anesthesia is performed (local anesthesia). In this case, an application of tumescent local anesthesia (TLA – procedure whose principle of action is based on the use of a large-volume administration of a solvent, which is mixed with the local anesthetic and injected into the subcutaneous fat tissue) is indicated. Moreover, the use of tumescent anesthesia leads to a decrease in the firmness of the tissue (tumescere: Engl. swelling).
  • Following local anesthesia, the adipose tissue is harvested by manual aspiration (suction) through a syringe that holds between 10 to 20 ml. After injection of the TLA, the fatty tissue is to be removed through narrow cannulas as a result of the emollient effect. This form of extraction is called microlipoextraction in plastic surgery. As a salient feature of microlipoextraction is the small amount of unwanted connective tissue during fat removal.
  • After fat tissue removal, the preparation of the material to be used for transplantation can be done by two different mechanisms. Closed fat harvesting is considered the preferred method. In this method, the fat can be freed from possible blood contamination. There is the possibility of purification via the addition of saline or Ringer’s solution (aqueous infusion solution).
  • By decanting the removed autologous fat via Luer-to-Luer connectors (the Luer-Lock system is a standardized connection system for cannulas, syringes and infusion tubing) into small syringes, the transplantation process takes place without further processing of the removed fatty tissue.
  • Furthermore, there is the possibility of using open fat harvesting. In this method, more connective tissue is removed from the body by the previous fat tissue removal by means of larger cannulas. Due to this, it is necessary to perform filtration. The purified fat can now be transferred to small syringe and returned to the body tissue during transplantation.

Below is the description of autologous fat transplantation:

  • If the fat tissue is frozen material, it can be thawed or used in the frozen state. After determining the puncture points, the injection can be made into the subcutis (superficial layer of the skin).
  • About additional cooling of the surrounding tissue, the effect of the anesthetic can be enhanced.
  • If there are uneven skin dimples, they can be compensated by different injection depths.

After the fat grafting is done, a tissue massage follows to promote blood circulation and to ensure an even distribution of fat. If the fat is to be removed only in the context of liposuction (“liposuction”), this is not achieved using syringes, but by special vacuum pumps.

Possible complications

  • Redness and swelling in the injection areas.
  • Sensory disturbances in the graft area
  • Infections – e.g. erysipelas (acute skin infection often accompanied by fever and chills).
  • Hypertrophic scarring
  • Contour irregularities and pigmentary disorders in the recipient area.

Benefit

Autologous fat grafting is a recognized and virtually complication-free method of redistributing fat tissue. In long-term studies, the effect has been demonstrated by sonography (ultrasound) even decades after the procedure was performed. As a result of the easy to perform therapy, the quality level of the procedure can be considered high. According to new studies, successful application in skin treatment of irradiated patients (condition after radiotherapy) is also possible. With autologous fat grafting in the forehead and temples, the aging face can be corrected without causing severe side effects, The procedure changed the eyebrow height only minimally, but had an effect on the slope of the brows. According to the authors, the rejuvenation can last up to three years.