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THE POWER OF ADIPOSE TISSUE


Dr. Kisu Sung is the Director-in-Chief of the LiLac Academy of Body-Sculpturing Surgery for Cosmetic Surgeons. He graduated from Kyungpook National University and has attended body contouring-related conferences, training courses, and symposia around the world including lipomatic liposuction in Portugal, Vaser liposuction in Brazil and liposuction, lipofilling, liposhifting workshops in Washington. Dr. Sung has presented at international conferences and has even produced a publication called LipoSculpturing Surgery: The Art of Body Contouring. He is currently a member of the American Academy of Cosmetic Surgery, American Society of Liposuction Surgery, International Academy of Cosmetic Surgery and International Federation for Adipose Therapeutics and Science.


Many doctors and physicians are now interested in adding fat grafting and stem cell elements into their practices. In my opinion, adipose tissue transfer and adipose-derived stem cells are continually growing in popularity as fat is abundant and easy to retrieve. Moreover, many soon discovered the rejuvenative properties of adipose tissue, that, if used wisely, offers superior filling and reconstructive results. Adipose tissues contain great numbers of mesenchymal stem cells and as explained, it didn’t take long for doctors to find out that fat grafting can do so much more than simply filling depressions. Apart from improving volume, fat grafting and its associated stem cells can lift, rejuvenate, lighten the skin and even improve scars brought upon by acne and burns. Although fat grafting may be a great treatment form in both cosmetic and reconstructive procedures, it is a double-edged sword in effects and complications. Apart from poor results and the need for multiple treatments due to low retention rates, fat grafting can cause dangerous complications including infection, oil cysts and necrosis. Despite some levels of absorption and unavoidable minor problems, doctors should have responsibility to their patients and make sure that grim complications should be avoided. In other words, doctors and physicians who are interested in adding fat grafting elements to their practices should firstly understand the true nature of adipose tissue and get themselves informed before attempting the procedure.

As a faculty member of the FATS Academy of Procedural Medicine, I must stress the importance of education before practice, as safety is a doctor’s number one priority. Before fat transfer is even an option, physicians should have the basics such as tumescent solution and fat aspiration. First and foremost, understanding placement of tumescent solutions is vital. Apart from concentration and suctioning, doctors must learn issues related to delivery and where target areas and layers are, to control pain and bleeding. Doctors must remain vigilant as patients can sometimes experience discomfort even after local anesthesia. While the skin is controlled by the anesthesia, deeper regions such as the bony fascia are both resistant and hard to reach. Moreover, the volume of local anesthesia will make it difficult for doctors to determine how much fat tissues are needed for good results. Because of this setback, I recommend that patients undergo deep sedation for further pain control during grafting. Along with basic tumescent solutions, doctors will then learn fat aspiration. Fat can be harvested from multiple regions. The lateral thighs are a popular region for harvesting, but other areas can also provide tissues. The selected regions will depend on ease, patient comfort and better recovery. If novice physicians would like to add fat grafting elements into their practice, it’s best they start small and harvest only 100 to 200ccs before moving on to larger volumes. While quantities rely on situations, such amounts should be sufficient for facial filling or stem cell treatments. To ensure that patients undergo efficacious procedures, physicians should possess good understanding of facial tissues and its anatomies. Depressions in the face can be caused by multiple factors including degeneration, loose skin and muscle activity. As such, doctors should be well acquainted with dermal structures to target different layers.

Like previously explained, minor hiccups are sometimes unavoidable, and the chance of trauma to fragile adipose tissues can be common during the harvesting, processing and grafting processes. Furthermore, fat necrosis and bleeding can be uninvited possibilities and certain precautions must be taken to avoid severe complications. For example, harvested fat tissues should be free from fibrotic materials and red blood cells as tainted grafts can be absorbed and this could affect in more bleeding, hematomas and pain on donor sites. A doctor’s goal should always revolve around successful treatments with good survival rates and minimal complications. Because adipose tissue is living material that should survive within recipient sites, even distribution is of upmost importance as this increases chances of contact with host tissue surfaces, which provides an ideal delivery of oxygen and nutrients.


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