Fat grafting by injection is an ever expanding technique in plastic surgery. But it remains far from a perfect method because so little of the science of fat transplantation is well understood. What happens to the fat cells that are injected, do stem cells really survive and convert to fat cells after injection and what is the best method for ensuring survival of both fat and stem cells? These are the major clinical issues of interest. In lieu of not yet understanding the science, the most practiced technique is to overfill…knowing that some percentage of the transplanted fat will not survive and be resorbed.

While fat grafting has few complications, other than an occasional infection, the variability of take remains a vexing one. For some problems, injecting fat is done because it is simpler than other volumetric methods and because it is natural and not an implant. It is generally agreed, whether it is on the face or the body, that small volumes of injected fat survive better than larger volumes. This is believed to be so because the fat is closer to a blood supply to re-establish nourishment sooner but also because it is being asked to do less. Larger injected volumes presumably resorb more because many of the cells are more distant from a blood supply and have a longer period of oxygen deprivation.

A simple technique to one element of the hypoxia problem is to have the shortest time between harvest and injection with the shorter the better. Get the fat and stem cells back into normal body temperature near a blood supply as soon as possible. If fat can be harvested and injected in less than 30 minutes, it would be logical that there is a greater potential for more volume survival.

There are considerable biologic differences between the face and body recipient sites for fat grafting. The face is considerably more vascular and the injected volumes are comparatively smaller. But much of the face has considerable movement and this does not appear to have a favorable effect.

By and large, larger volumes of injected fat are limited to the breast and buttocks and are well known to have significant volume survival issues. But these two body sites are significantly different. Breast injections are done into breast tissue only while buttock injections are also placed into gluteal muscle as well as subcutaneous fat. This is why fat injection breast augmentation has been shown to work best with pre-expansion of the breast tissue prior to fat injections. Using an external vacuum that pulls on the breast tissue, it prepares the recipient bed tissues. This appears to have a stimulatory cellular effect through fibroblast growth and neovascularization. This is useful because fat does not work well to significantly ‘push’ tissues outward or expand them. It does not act like a synthetic implant. Compression on fat grafts induces resorption and cell death.

The buttocks, therefore, poses a conundrum. There is no known method of pre-expansion of the buttock tissues and patients usually have to immediately sit on them afterwards compressing the injectate. The saving grace may be that some of what is injected is placed intramuscular which has the best chance of rapid revascularization. But buttock augmentation by fat remains the one area where overfilling is not just advised but routinuely done.

Over the past ten years, a considerable amount of laboratory and clinical research has been done by plastic surgeons in many aspects of fat grafting. From techniques in harvesting, purification and injection to the assessment of potential recipient sites, some basic biologic behaviors have been revealed. Fat is not like food as leftovers is not appealing. Freshly harvested fat has been shown to survive much better than frozen fat. While it is tempting to save and refrigerate for later use with large volume extractions, it simply doesn’t do well. Fat grafting also appears to work better in younger than older patients. At what age fat survival is adversely affected is not clear but suffice it to say there would be an expected difference between a teenager and a 70 year-old. An overfilling technique should be more reserved for older patients.

Dr. Barry Eppley

Indianapolis, Indiana   

Breast augmentation is consistently achieved through the use of an implantable synthetic fluid-filled device. While effective, it is not without its risk of complications and the need for revisional surgery. For these reasons, some patients would prefer an alternative approach. This limited need has been addressed by the use of fat injection grafting which is enjoying increasingly popularity and acceptance.

Fat grafting by injection for augmentation is now widely used and is believed to have fairly predictable survival in many facial locations as well as the buttocks. Its success is attributed to the small volumes of injectate that are distributed through the tissues, ensuring maximal blood flow and oxygen to as much of the fat as possible. Conversely, fat injection into the breasts have not been as well received and still may be called controversial. Because of the high incidence of cancer and other benign diseases of the breasts, concerns remain about fat necrosis and how that will impact detecting various breast pathologies.

In the past few years, however, fat transfer to the breasts has become more accepted and in 2009 The American Society of Plastic Surgery lifted the ban on performing it. This has kindled an interest in elective breast augmentation with fat that is performed by a limited number of plastic surgeons currently. Success with the procedure has been modest and results are limited due to how much fat survives and how much can be injected in a single session. That combination makes for only very small amounts of breast size improvement by fat injections.

In the May 2012 issue of Plastic and Reconstructive Surgery, a ground breaking article appeared that reported a clinical study using a combination of fat injections and external breast stimulation. In a prospective clinical study involving 81 patients over a six year period, the results from a combined device and fat grafting approach to breast augmentation was reported. This includes Brava device use  (external bra-like vacuum) for four weeks prior to surgery, fat injections of approximate 250cc per breast, followed by an additional week of Brava device stimulation. Before and after breast volumes was assessed by MRI.

At one year after surgery, the average retained fat volume in the breasts was just over 225cc. This was twice the amount of volume retained compared to another study in which fat injections were done without the use of the Brava device. (just over 125cc) Graft survival was calculated to average 82% in the Brava-assisted group compared to an average of 55% in the study were the Brava device was not used. The three before and after patients presented were impressive with very visible breast enlargement. MRIs showed an incidence of 16% fat necrosis at one year after surgery.

This study shows that the use of external stimulation by the Brava device before and after fat injection breast augmentation produces measureable retained volume improvement. The stimulation that it provides to the breast makes for a better recipient site to receive the injected fat. As the authors of the study point out, ‘fertilizing the field enhances how well the seeds will grow’, to paraphrase their comments. One of the reasons that fat injections may do poorly is the pressure to which they are exposed by trying to push the breast tissue outward. The Brava device overcomes this obstacle by preoperatively stretching the skin and breast tissue outward. It may also stimulate a variety of other tissue factors not yet identified which improves blood flow and causes transplanted cell stimulation.

For those women considering breast augmentation by autologous fat injection, this study provides strong evidence that external device stimulation would be an excellent way to ensure the highest incidence of injected fat survival.  

Dr. Barry Eppley

Background: The size and shape of the buttocks is an important part of the aesthetics of one’s body. The importance of size and shape varies amongst different cultures and ethnic groups. This has led to the popularity of buttock augmentation procedures, using either the insertion of an intramuscular implant or fat injections. Fat injections, known as the Brazilian Butt Lift, is the more popular due to its use of one’s own body tissues and the generous availability of donor material in most patients.

But regardless of one’s ethnic or racial background, a completely flat buttocks is not viewed as aesthetically desireable. Such a flat buttocks, and sometimes even an indented one, is prone to occur in those that are thin and lean. To no surprise, a thinner overall fat distribution in one’s body can lead to minimal fat over the buttocks as well. While the gluteal muscles are not small, much of buttock volume comes from the amount of fat between the skin and the muscles.

In the thinner woman who desires a buttock augmentation, specifically a Brazilian Butt Lift technique, the lack of sizeable donor material is a limiting factor. For very thin women, this procedure is an impossibility and an implant is the only treatment option. But moderately lean to average-size women may have a fat injection buttock technique if they recognize that the buttock size obtained will be more modest and always less than they ideally desire.

Case Study: This 31 year-old female had long been bothered by her flat buttocks. She had tried to build up her buttock size through different exercises but without success. She did have some excess fat on her stomach and around her waistline and wondered if this would be enough for a Brazilian Butt Lift. On feeling her stomach and flanks, it was felt that maybe a liter of fat aspirate could be obtained but not much more. She wanted to proceed with surgery as she did not want to have synthetic implants.

Under general anesthesia she first underwent liposuction harvest of the entire abdomen and flank regions in the supine position. A total of 1,150cc of aspirate was obtained after initial Hunstad infiltration. She was then turned over into the prone position where additional liposuction was done across the top of the buttocks, in the sacral triangle and below the buttocks in the infragluteal fold. This brought the fat aspirate to 1,275ccs.

The fat aspirate was processed by passing it through a sieve and draining off the excess fluid. This brought the concentrated fat amount to 450cc. Using an injection cannula, 225cc of the concentrated fat was injected into each buttock. The injection amount combined with surrounding buttock liposuction fat reduction gave her a visible amount of buttock enhancement.

When seen at her three month follow-up, her final result showed a slightly more rounded buttock shape and size. Her overall buttock shape was more pleasing even if it was not dramatically bigger.

An important question when considering the Brazilian Butt Lift is how much fat will end up being injected into the buttocks. As a general rule, expect only 1/3 to ½ at best ending up being the concentrated amount of fat available for injection. This means that one has to have at least a mimimum of 1,000cc to 1,200 available for removal. It is better that 1,500cc to 2,000cc can be harvested. When only 150cc to 250cc of fat is available for each buttock, the patient needs to appreciate that the buttock size gain will be modest. Some improvement will also come from the buttock sculpting obtained by the liposuction. It is the combination of both that creates the final result. In thinner women, the Brazilian Butt Lift is more of an overall buttocks reshaping effort than exclusively an augmentation outcome.

Case Highlights:

1) The results of fat injection buttock augmentation is limited by the size of the donor harvest areas. These come primarilyfrom the abdomen and hip rolls.

2) In thinner women, the enhancement of the buttock is contributed to as much by the surrounding fat reduction as the buttock size achieved by fat injection.

3) The Brazilian Butt Lift in thinner women is better thought as buttock reshaping than buttock augmentation.

Dr. Barry Eppley

Indianapolis, Indiana

The proven and effective method for buttock augmentation is through the use of soft flexible synthetic implants or fat injections. While each of these two approaches is not perfect and has their own advantages and disadvantages, they are safe medical therapies. But like in every other cosmetic procedure, patients do seek easier and less expensive methods that are not surgery to get more instant results. Buttock augmentation is no exception.

The past few years has seen the rise of non-surgical buttock augmentation procedures in the news, all using different non-medical filler materials. The recent arrest of Philadelphia’s Black Madam highlights this disturbing practice which is seen most commonly in major metropolitan areas and in susceptible African-American and Latino female populations. Some of these news reports have involved caulking compounds obtainable at the local hardware store which should suggest to even those most medically naïve that this would be problematic. But many other unreported buttock injection shops involve the use of silicone oil. On the surface this seems less risky but silicone oil is not FDA-approved for use as an injectable filler in the U.S. and its risk of granuloma, lumps and skin pigmentation changes are well known.

The use of any form of injectable filler for large volume body augmentation, such as the buttocks and breasts, is not under study in the U.S. Fat remains the gold standard for such uses even if it is far from yet perfected. But outside the U.S., other countries have been exploring and developing medical-grade fillers for body contouring. These materials are different formulations of those that are commonly used in the face, usually of the hyaluron-based family or hydrogel compounds.

Recognizeable by such names as Juvederm or Restylane, hydrogels are synthetically-created sugar-like compounds that are chemically similar to what our bodies already have and are very familiar. Thus they are well tolerated and is why they are more biocompatible than any collagen-based injectable filler to date. But their other interesting feature is that they attract water, hence the hydrogel name, and through this sponge-like effect is why they last as long as they do.

While the use of hydrogels for injectable buttock augmentation would seem to make sense, the sheer volume of material needed makes it too expensive. This expense combined with their short duration of effect has led to the development of more concentrated hydrogels. The higher the concentration of a hydrogel the longer it will last. Such international hydrogel materials like Aquamid are being tested but their long-term results and what side effects may exist as body fillers is not yet known.

No matter what is done in different countries, including the use of hydrogel injections, there is no good evidence of their effectiveness and safety. This certainly applied to silicone oil as well. Patients considering buttock augmentation should only consider what is medically proven and remember…you often do get what you pay for. There is no cheap and easy method to larger buttocks that is not fraught with significant risks of potentially unsolveable complications.

Dr. Barry Eppley

Indianapolis, Indiana

The face ages with a classic set of findings including the development of wrinkles, loose skin, fat atrophy and age or brown spots. The rest of the body ages as well but most of it does not have the amount of sun exposure to which the face is exposed. Therein lies the differences in appearance that occurs in skin that has a long history of being covered than the skin that hasn’t. The one place on the body that ages similarly to that of the face due to sun exposure is…the hands.

It is a well known observation that you can look at many female facelift patients in their mid-50s and beyond whose hands do not match their face. The hands look a lot older than the face who has had rejuvenative treatments such as surgery and  numerous topical skin care products. The hands undergo an identical aging process which includes the loss of skin elasticity, the development of wrinkly skin, near complete fat volume loss and the development of numerous brown spots and patches. What is unique about the hands is that as the thin fat layer absorbs with thin skin over the back of the hands, the veins and tendons become very apparent. This is known as the skeletonization of the hands. While one is not looking at the bones, the hands become so thin that it looks like it.

There are now a variety of hand rejuvenation procedures that are available. Sometimes called ‘hand lifts’, this term lends an erroneous impression that skin is removed like in a facelift. This is never done as the scars would be visible and would not look very good as widening of them is inevitable. The hand lift concept is really about plumping them up which lifts and fills them out to create a less skeletal look. Various synthetic filler materials are used of which the most common are Juvederm or Radiesse. Just like injectable fillers in the face, they are placed in a simple office injection session lasting about 15 minutes. They will last about as long as that of the face until they are naturally resorbed and depends on the filler material used. (about one year for Juvederm and Radiesse)

The other filling option, and my preferred approach, is the use of fat. Like the buttock procedure, the Brazilian Butt Lift, fat is taken from elsewhere on the body and injected into the back of the hands. Placed right under the skin at the wrist level, fat injections are massaged into the subcutaneous space between the fingers. This technique avoids injuring the large prominent veins which would cause a lot of bruising. Fat is a natural material so rejection or inflammation to it does not occur. Like when it is injected elsewhere in the body, how much fat is retained and is permanent is variable. Between the fat harvest and injecting into the hands, I prefer to perform this procedure in the operation room under either local anesthesia or with a little IV sedation.

Besides the introduction of volume into the aged hands, the skin can also be treated. The brown spots can be very effectively treated with high intensity pulsed light therapies such as IPL or BBL. As a quickly done office procedure, brown spots can be remarkedly reduced or completely eliminated. Many hand rejuvenation patients choose to do this brown spot reduction alone. The skin can also be smoothed and some wrinkles reduced through fractional laser resurfacing. Just like on the face, fractional laser us much better at skin tightening and wrinkle reduction than traditional full surface laser resurfacing. Sun protection, using a combined UVA/UVB product should be generously used after these light and laser treatments to prevent brown spot recurrence with ongoing sun exposure.

There are also treatments for hand veins such as sclerotherapy and stripping out some of the prominent veins. But there are risks in so doing including prolonged swelling, bruising and thrombophlebitis. As a result, they are less popular and often unnecessary with good dorsal hand filling.

Complete hand rejuvenation includes a combined approach of an injectable filler, BBL for brown spots and fractional skin resurfacing. All of these can be done in a single procedure. Expect the hands to take up to two weeks to recover and show the full benefits.

Dr. Barry Eppley

Indianapolis, Indiana

Fat grafting to the face, done by injection, has become incredibly popular in the past decade. The recognition that most faces lose fat volume as they age has led to fat grafting done alone or in conjunction with other facial lifting procedures. One such area of volume addition in the aging face is that of the eyebrows. Adding fat not only fills them out but can create a lifting effect as well.

In the January 2012 issue of Aesthetic Surgery Journal, a study is reported that looks at this issue of volume loss in the eyebrow as one ages. With the underlying tenet that the eye brows and the eyebrow fat pads are vulnerable to age-related changes, this study looked at the eyebrow region through 3D volumetric analysis. Over a five year period at an Eye Institute, patients that had undergone orbital CTs for medical purposes were evaluated. This included 52 CT scans that were fairly equally divided between men and women. 3D reconstruction techniques were used to calculate volumes of the retroorbicularis oculi fat (ROOF), galeal fat (ROOF and subcutaneous fat), and soft tissue muscles.

The study showed that overall eyebrow volume does not change appreciably with age. However, the contribution of fat and soft tissue to total eyebrow volume does seem to change. This pattern differs between males and females. As women age, the fat volume increases and the soft tissue volume decreases. In men, the shift from soft tissue volume to fat volume is less pronounced.

While fat injections are popular become because of the recognitoion that Although many fat volume deflation is a key component in facial aging, this study does not support this aging phenomenon in the eyebrow fat pad. This may be due to the reality that this is true or could be a reflection of how the study was done. After all, these were not serial CT scans done on the same patient over many years (which would be a near impossibility) but were random points of information on different patients at one point in time. They were all then collectively compared which could be misleading.

Does this mean that fat injections into and around the eyebrows is a flawed aesthetic approach? My answer would be no. I have seen too many patients who were quite pleased with their fat injection results even if research does not indicate that they were really down in fat volume to begin with. Whether it is an eyebrow lifting effect, creating a better skin tone by expansion, or even some purported effect of skin rejuvenation by fat or stem cells, judicious placement of fat into the eyebrow can produce a rejuvenative effect in their appearance.

Dr. Barry Eppley

Indianapolis, Indiana

Buttock augmentation has become a part of mainstream body contouring plastic surgery. Creating a larger buttock has become desirous of those who have a normal size and just want to become bigger (ethnic buttock enhancement) to those who simply have never had one or ‘lost’ it at some point. Its popularity is largely due to the use of fat injections which offers a safe and natural method of increasing one’s buttock size even if fat survival is unpredictable and not everyone has enough fat to do the procedure.

But in increasing the buttock size with fat, we are only adding volume to the smallest component of what makes up a buttock. The greatest contributor is not fat but muscle, specifically the trio of the gluteus maximus, minimus and medius muscles. The gluteus maximus, as the name suggests, is by far the biggest of the three and occupies the lower 2/3s of the buttock. The medius is a pork chop-shaped muscle that is near the top of the hips and the minimus is sandwiched between the medius and the maximus. This composite large muscle mass is what keeps us upright as we walk, the bipedal feature which separates us from our primate ancestors.

The shape of the buttocks is largely a function of genetics which determines the size of the muscle and the amount and distribution of the overlying subcutaneous fat. Women almost always have more buttock tissue than men, regardless of race. One’s buttocks will also change with time as fat loss occurs with aging due to hormonal changes and a shift of where fat is preferentially stored. While exercise can certainly help shape and even slightly enlarge the gluteal muscles (up to a ½ to 1 inch), it can not simulate the size effect of a surgical buttock enlargement.

Despite what shape and size the gluteus muscles contribute to the buttock contour, it is fat that makes up the round or fuller buttock. Specifically this is a form of fibrofatty tissue and not the typical more gelatinuous fat that one finds in the stomach for example. The fibrous component is needed to keep the fat suspended over the buttocks not unlike that of the breasts.

With buttock augmentation by fat, most of the injectate goes into this subcutaneous fat layer. While the gluteus maximus muscle is a vascularized bed which more ideally supports fat survival, it is not possible to put all the injected fat into it. Most of the time the bulk of it goes into the fatty layer under the skin. The thicker the fat layer, the more fat that can be injected into it. This is why a really flat buttock has less of a chance for successful enlargement than a more full one. Without a certain amount of subcutaneous buttock fat, one may be better off considering a buttock implant as opposed to fat injections that does not have a sufficient reservoir in which to be placed.  

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana

‘Fat in the Face’ has become a topic of great interest in plastic surgery in the past few years. Understanding where the fat compartments and layers are in the face and how they influence the outward shape of the face has undergone a lot of anatomic study and descriptions recently. The main emphasis of these fat studies is to better understand how the face ages and what causes the many classic findings in the aging face. With this knowledge has come innovations in facial aging management such as fat resuspension and volumetric addition by fat injection.

As another anatomic study of facial fat, a recent paper in the January 2012 issue of Plastic and Reconstructive Surgery looked specifically at midfacial fat compartments. While most facial fat studies use injectable dye techniques, this study out of Germany used computed tomographic scanning. From twelve cadaver heads from two different age groups (aging age 54 to 75 and old age 75 to 10 years), CT scans were evaluated of the various midface fat compartments. (nasolabial, medial cheek, middle cheek, deep medial cheek, sub-orbicularis and buccal fat)

The study finds that the midfacial fat is arranged into two and paranasally into three independent anatomical layers. The superficial layer is composed of the nasolabial fat, the medial cheek fat, the middle cheek fat, the lateral temporal cheek compartment and three orbital compartments. The deep midfacial fat compartments is composed of the sub-orbicularis fat and the deep medial cheek fat. Three distinct fat compartments are found laterally to the pyriform aperture including the buccal extension of the buccal fat pad from the paramaxillary space to the subcutaneous plane. This study showed that an inferior migration of all of the midfacial fat compartments and an inferior volume shift within the compartments occurs with aging.

While such anatomic studies can seem overly detailed and one can easily get lost looking for the forest in the trees, there are a few points of good clinical relevance. As is well recognized, loss of the buccal extension of the buccal fat pad can lead to lack of support to the overlying medial cheek and deep cheek fat compartments causing an outward hollowing effect. Augmentation of this area by fat injections can restore support. Another good point is that the best method of nasolabial fold reduction is by augmentation of the deep medial cheek fat and the deep fat compartment known as Ristow space which sits just above the bony pyriform aperture.

The further detailing of the various facial fat compartments furthers the concept of site-specific augmentation by fat injection. It is now becoming more obvious that deeper levels of fat injections are important for not only increased survival but for better outward volume effects as well.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana

Fat grafting by injection continues to grow in popularity and in number of applications. Whether it is for cosmetic or reconstructive purposes, it offers a very focused method for filling soft tissue defects. While fat injections are fairly simple, this does not mean they are without complications. How well the fat survives and does it go on to take and integrate into the surrounding tissues plays a role in an uneventful outcome. Since their use is fairly new, any long-term reports of fat injections in a large number of patients is informative.

In the November 2011 issue of Plastic and Reconstructive Surgery, a study out of Boston reported on the use of fat injections for contour deformities of reconstructed breasts after cancer. They looked at 49 patients (68 breasts) who underwent fat injection grafting. On average, 67ccs of fat was injected into each breast at a single time. They did 111 fat injections which meant that more than one injection was needed in over half the patients. The average follow-up was more than two years. Complications occurred in just over 6% of the patients including such problems as fat necrosis, oil cysts and infection. Of the three, infection was the most infrequent complication, occurring in1% of the patients. The aesthetic results was judged as improved in all cases.

Using fat injections in secondary breast reconstruction is a fairly favorable application for its use due to the low volume of material needed. This gives the fat the best chance to survive with the lowest risk of complications, although many of the injections may have been placed into irradiated breast tissues which may have exactly the opposite healing effect. This study did not detail how many irradiated sites were injected and if their complication rate was higher. That would have been useful information.

The most useful piece of information in this study is the type and low number of complications. Fat injection necrosis and infection are the expected complications and they were fairly low. Again, this may a reflection of the low volume of fat injected. Larger fat injection volumes, such as may be used in breast or buttock augmentation, may have higher rates of complications.

As this study demonstrates, fat injections are both safe and very useful as a secondary contouring method in breast reconstruction. It demonstrates the growing number of proven areas in which injected fat has a high percentage of survival.   

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana

Fat grafting has become very popular in plastic surgery with the face and buttocks being commonly injected sites. While the availability and harvesting of fat has always been easy through well established liposuction techniques, it is the understanding of fat aspirate concentration and injection technique that has made it a more reliable soft tissue filler. Its popularity has been further enhanced by being an inadvertent carrier of large quantities of stem cells.

Fat injections would be even more popular if they were not largely done in an operating room most of the time. The sterility needed for harvest and preparation of the fat and the comfort of doing so under anesthesia make many fat injection treatments similar to actual surgery. If fat became an off-the-shelf product, it might be a more competitive analogue to synthetic injectable fillers in an office setting.

For some patients and their plastic surgery problems, repeat fat injections are needed. This is true for such cosmetic procedures as facial volume enhancement, buttock augmentation and breast reconstruction. For these procedures patients often have an initial surgical procedure where fat is harvested and injected. If unused harvested fat could be safely stored from this first encounter, repeat injections could then be done as a less involved office procedure.

This is a fat technique that is currently being studied and evaluated. This involves the freezing of fat in a cryogenic chamber, placing it in suspended animation to be thawed and used later. There are now numerous companies, such as Cryo-Lip in Indianapolis that offer this service on a commercial basis. There are a few plastic surgeons who are currently using frozen autogenous fat.

The pertinent question is whether one can get equivalent results from frozen fat compared to fresh fat. Will frozen fat survive with anywhere near the predictability of the immediate injection of fresh fat? While the verdict is far from conclusive, the existing science does not yet support the effectiveness of frozen fat. Most clinicians currently believe that fresh fat better retains the viability of the injected adipocytes and stem cells better than when it is processed through a freezing process and then thawed again.

Some patients do ask if their fat can be frozen and used later. Historically this was an irrelevant question since plastic surgeons had no access to a method of fat storage, short of their own freezer. But the emergence of commercial options makes this now a question that can be addressed. While the science of frozen fat is not well defined, the leading answer is now an economic one. If a patient is willing to pay for fat storage, it can be now be safely done and used later.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana