As a plastic surgeon, I certainly am asked and do treat a lot of fat concerns. Whether it be liposuction treatments for fat removal or fat injections for adding volume somewhere, plastic surgeons probably handle more fat than any other medical specialty. Yet, we still do not understand much of its physiology and its response to treatments that we routinuely do.
In looking around at a lot of fat in the body, we do know that it is not all the same. Nor is its functions similar. Most patients think of fat as an unnecessary evil and that its only purpose is to store excess fat and be a source of annoyance and embarrassment. While many fat areas in the body are indeed ‘depot’ areas. Many other fat areas, however, are not. For example, fat in the cheek and temple area (the buccal fat pad) is not a depot area but is intended to serve as buffer between the jaw muscles and allow them to glide smoothly and not interfere with each other. Why the buccal fat pad, for example, goes away in the HIV patient due to the antiviral medications (and fat forms on the back of the neck…the buffalo hump deformity) is not understood at all. For the sake of simplicity in patient consultations, I divide fat into depot and non-depot sites. (although not entirely scientifically accurate) So when a patient asks me, for example, during a liposuction consult if the fat will come back, my answer is…..if it is removed frm a depot site such as the stomach, then if you gain weight after surgery it may most likely come back….if fat is removed from a non-depot site, such as the inner knees or neck, it is much less likely to do so.
Fat transplantation, or fat injections, also remain a somewhat unpredictable procedure. The procedure is very appealing because it is your own natural tissue but, unfortunately, that does not mean that it always survives well (and maintains volume) after surgery. Much effort has been put into doing the obvious, such as minimizing the trauma to the fat by the way it is extracted and prepared to be injected as well as how it is placed. But, yet, how well it works is still unpredictable. We know even less about whether where it comes from (stomach vs. knee, for example) makes any difference in how well it works.
Fat, despite its preponderence and ever-presence, still has mysteries that remain to be unlocked. Fat is a hot research topic now because of the stem cell load that it carries. It is better than bone marrow in this regard as there is more of it and it is easier to get out. No one has ever thought of fat before as being a healing tissue. I frequently wonder as I watch a cannister of fat fill up during a liposuction procedure…..as to what potential benefits we may be throwing away.
Dr Barry Eppley
Indianapolis, Indiana