Fat grafting in cosmetic surgery is becoming more widely used in facial rejuvenation. It has actually been used since the 80’s for procedures that repaired soft tissue defects such as post-traumatic facial deformities from accidents, nerve paralysis or burns. It wasn’t until fairly recent that fat transfer became the ideal choice for breast augmentation and as a facial filler. 

Previously used substances were synthetic with infection and rejection and being an issue along with the fact that a filler only lasts 6 months to a year. Using your own body fat is natural, less stressful on your body, and permanent. The FDA is weighing in on the use of fat grafting in cosmetic surgery, and this article from the Cosmetic Surgery Times discusses the details of the impact of their decision. 

Fat grafting and the FDA | Cosmetic Surgery Times

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The cosmetic surgery industry is watching closely as the Food & Drug Administration is considering the way it regulates autologous fat tissue. At stake: Will plastic surgeons be allowed to use fat grafting broadly for purposes that include shaping and contouring of the body and face?

Dr. Reisman“Most physicians would rather see a broadened use allowed that represents an increased knowledge of how fat is used safely,” says Neal R. Reisman, M.D., JD, FACS, chief of Plastic Surgery at Baylor-St. Luke’s Hospital and past president of the Aesthetic Surgery Education and Research Foundation. “But I don’t think anyone has a full handle about whether they’ll go beyond what we envision as protecting the patient.”

Dr. Reisman spoke about legal issues regarding fat at this year’s The Aesthetic Meeting in Las Vegas, the annual meeting of the American Society for Aesthetic Plastic Surgery.

The FDA issued draft regulations about the use of adipose tissue in December 2014, and they have yet to be finalized. “They’ve been wise to let them be out there for a long time,” Dr. Reisman tells Cosmetic Surgery Times. “They sought and have received a lot of input.”

At issue is how the FDA’s final regulations will define the appropriate use of autologous fat, given that the use of fat injections has evolved. They’re now a major tool for plastic surgeons in areas like the face, hands, buttocks and breasts.

“I’ve been reluctant to put it in breast tissue until recently,” Dr. Reisman says. “But big studies have proven the safety and efficacy of fat injection throughout the body.”

Dr. Amir Karam Performing a Facial Fat TransferThe FDA draft rules say that autologous fat should be similar to the fat it replaces, and it defines adipose fat as “structural.” Under this perspective, the grafted tissue should serve a structural purpose. The uncertainty comes in with what is defined as “structural,” and therefore allowed under the FDA’s interpretation vs. what is “functional.”

Some things are clear, at least from Dr. Reisman’s perspective. On the “functional” front, “it certainly would be not following the guidelines to use fat to replicate or replace breast tissue with gland function and milk production,” he says.

But will the FDA go beyond that and impose additional limits that could affect the use of fat grafting in cosmetic surgery? “Hopefully the FDA will look at the studies showing the benefits of fat in a cosmetic patient,” Dr. Reisman says. Fat grafting and the FDA | Cosmetic Surgery Times

It is also becoming more mainstream for using fat grafting with breast reconstruction following a mastectomy. 

This video shows Dr. George Solomon discusses the use of fat transfer as opposed to fillers. He makes it clear that there is a place for both in the cosmetic surgical field, but that use of fat grafting is much more cost effective when there is a larger amount of volume loss due to aging or weight loss.