1 Facial Fat Grafting Facial Fat Grafting For the Ophthalmologist & Oculofacial Surgeon For the Ophthalmologist & Oculofacial Surgeon William W. Ehrlich, M.D., FAACS William W. Ehrlich, M.D., FAACS Baker, Holloman & Ehrlich Baker, Holloman & Ehrlich Oklahoma City, OK Oklahoma City, OK
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Facial Fat GraftingFacial Fat Grafting For the Ophthalmologist & Oculofacial SurgeonFor the Ophthalmologist & Oculofacial Surgeon
William W. Ehrlich, M.D., FAACSWilliam W. Ehrlich, M.D., FAACSBaker, Holloman & EhrlichBaker, Holloman & Ehrlich
Oklahoma City, OKOklahoma City, OK
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Fat Grafting Fat Grafting Technique:Technique:
Patient Selection:Patient Selection:Non-smokers with BMI > 20Non-smokers with BMI > 20
Minimize exposure to airMinimize exposure to airRemove oil & impuritiesRemove oil & impurities
Centrifuge?Centrifuge?Grafting:Grafting:
Within 0.5 mm of blood supplyWithin 0.5 mm of blood supplyTiny aliquots, maximal surface areaTiny aliquots, maximal surface area
Three dimensional placementThree dimensional placement
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Myth vs. Myth vs. FactFactLess than 35% of grafted fat survives.Less than 35% of grafted fat survives.
With proper technique, at least 70-80% of grafted fat With proper technique, at least 70-80% of grafted fat will survive. will survive.
The fat is gone in 6-8 monthsThe fat is gone in 6-8 monthsFat often “lasts” more than 10 years. Fat often “lasts” more than 10 years.
Fat grafts increase the incidence of cancer.Fat grafts increase the incidence of cancer.In 108 years of fat grafting, not a single paper or In 108 years of fat grafting, not a single paper or physician has ever reported that fat grafting is physician has ever reported that fat grafting is
carcinogenic.carcinogenic.Fat grafting success is independent of surgeon Fat grafting success is independent of surgeon
technique.technique.Fat survival is extremely dependentFat survival is extremely dependent upon the surgeon’s upon the surgeon’s
ability to harvest and graft fat cells correctly. ability to harvest and graft fat cells correctly.
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B.S. Zoology, M.D.B.S. Zoology, M.D. University of Michigan University of Michigan
Ophthalmology ResidencyOphthalmology Residency Henry Ford Hospital Henry Ford Hospital
Fellowship Orbital Surgery Fellowship Orbital Surgery Albany Medical Center Albany Medical Center
Preceptorship Orbital Surgery Preceptorship Orbital Surgery Moorfields Eye Hospital Moorfields Eye Hospital
Assistant Clinical Professor of SurgeryAssistant Clinical Professor of Surgery Michigan State University College of Michigan State University College of
Human Medicine 1985-PresentHuman Medicine 1985-PresentCO2 Facial ResurfacingCO2 Facial Resurfacing
Baker 1995Baker 1995True Tumescent Liposuction of Body & NeckTrue Tumescent Liposuction of Body & Neck
Klein 1997Klein 1997Small Incision Facelift Small Incision Facelift Hopping & Zylan 2000Hopping & Zylan 2000
The usefulness of fat grafting is not The usefulness of fat grafting is not limited to the periorbita. Fat grafting limited to the periorbita. Fat grafting
A 48 year old marathon runner after two sessions of facial fat grafting. A 48 year old marathon runner after two sessions of facial fat grafting. 88 cc of total fat was grafted.88 cc of total fat was grafted.
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Natural Breast Natural Breast Augmentation with Augmentation with
autologous fat:autologous fat:
300 cc per breast grafted from 300 cc per breast grafted from the thighs and hips during the thighs and hips during body liposuction : 100 cc body liposuction : 100 cc
intra-pectoral, 200 cc intra-pectoral, 200 cc subdermal. Mammary gland subdermal. Mammary gland
tissue was not disturbed.tissue was not disturbed.
In several studies, MRI In several studies, MRI volume analysis volume analysis
indicated that, on indicated that, on average, 85% of average, 85% of
grafted fat will survive grafted fat will survive beyond 1 year.beyond 1 year.
BeforeBefore2 Months2 Months
AfterAfter
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After a chin implant, Gortex lip implant, rhinoplasty, and facelift After a chin implant, Gortex lip implant, rhinoplasty, and facelift performed “elsewhere,” this 45 year old was unhappy with her “Calista performed “elsewhere,” this 45 year old was unhappy with her “Calista
Flockhart” look. Her facial features were softened with 54 cc of grafted Flockhart” look. Her facial features were softened with 54 cc of grafted fat. No other surgery was done. fat. No other surgery was done.
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48 year old one year after a minimal incision facelift, neck 48 year old one year after a minimal incision facelift, neck liposuction, liposuction,
and facial fat grafting of 54 cc.and facial fat grafting of 54 cc.
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47 year old 47 year old after minimal after minimal incision face incision face
lift, neck lift, neck liposuction, liposuction,
and facial fat and facial fat grafting of 60 grafting of 60
cc.cc.
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Nasal changes, both actual and perceptual, can be both expected Nasal changes, both actual and perceptual, can be both expected and planned.and planned.
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Adult fat cells contains 3-5 million adult Adult fat cells contains 3-5 million adult mesenchymal stem cells (AMSC) per 10 cc of mesenchymal stem cells (AMSC) per 10 cc of
Adipose derived adult regenerative Adipose derived adult regenerative cells (ADRC) and mesenchymal stem cells (ADRC) and mesenchymal stem
cells (ADSC) are much more cells (ADSC) are much more “plastic” than anyone imagined. “plastic” than anyone imagined.
They are autologous cellular They are autologous cellular “building blocks” that are readily “building blocks” that are readily available to produce long lasting available to produce long lasting
functional and cosmetic functional and cosmetic improvements.improvements.
FDA approval is not required to relocate cells removed from, then FDA approval is not required to relocate cells removed from, then returned to, the same person in a single procedure.returned to, the same person in a single procedure.
Presently, there are at least two commercial facilities (Dallas & New Presently, there are at least two commercial facilities (Dallas & New Jersey) that will isolate, cryopreserve, and store patients' adult stem Jersey) that will isolate, cryopreserve, and store patients' adult stem
cells.cells.
In the past 2 years, mesenchymal stem cell isolation, In the past 2 years, mesenchymal stem cell isolation, banking, banking,
and tissue scaffolding/engineering have begunand tissue scaffolding/engineering have begun..
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Final Thoughts on Fat Final Thoughts on Fat Grafting:Grafting:
Is a wonderful, versatile technique for Is a wonderful, versatile technique for peri-orbital and facial rejuvenation. peri-orbital and facial rejuvenation.
Unlike other fillers, adult fat Unlike other fillers, adult fat simultaneously provides volume simultaneously provides volume enhancement, skin rejuvenation, enhancement, skin rejuvenation, longevity, and stem cells.longevity, and stem cells.
The potential functional and cosmetic The potential functional and cosmetic uses of adult adipose tissue and its uses of adult adipose tissue and its mesenchymal regenerative/stem cells are mesenchymal regenerative/stem cells are remarkable.remarkable.
Someday very soon, the much maligned Someday very soon, the much maligned and misunderstood adult fat cell may be and misunderstood adult fat cell may be the principal ingredient of engineered the principal ingredient of engineered tissues that enrich and save lives.tissues that enrich and save lives.
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Fat Injection: From Fat Injection: From Filling to Filling to