Fat Transfer

Preoperative Considerations

Consent:

Asymmetry: There is a risk of asymmetry in the distribution of fat, leading to an uneven or lopsided appearance in the face.
Overcorrection or Undercorrection: Achieving the desired level of correction can be challenging, and there is a risk of either overcorrection (excessive volume) or undercorrection (inadequate volume), resulting in unnatural or suboptimal outcomes.
Fat Resorption: After the fat transfer, some of the transferred fat may be reabsorbed by the body over time, leading to a gradual loss of volume in the treated areas. This can necessitate additional touch-up procedures to maintain the desired results.
Infection: As with any surgical procedure, there is a risk of infection at the donor or recipient sites, which can lead to complications such as inflammation, pain, swelling, and delayed healing. H
Hematoma or Seroma: Collections of blood (hematoma) or fluid (seroma) may form at the surgical sites, causing swelling, discomfort, and potentially requiring drainage or additional treatment. S
carring: While facial fat transfer involves minimal incisions, there is still a risk of scarring at the donor or recipient sites, particularly if proper wound care is not followed or if the patient has a predisposition to keloid or hypertrophic scarring. N
Nerve Damage: There is a small risk of injury to nerves during the fat transfer procedure, which can result in temporary or permanent sensory changes, numbness, tingling, or motor dysfunction in the affected areas of the face.
Bruising and Swelling

Anesthesia/Positioning:

Other:

Highlight and document pre-existing asymmetries
Useful to mark volume deficient areas in preop with patient upright

Armamentarium:

SUPPLIES:

1 Basic Pack
1 Split Sheet
1 Mayo Cover
1 Raytec
1 Specimen Cup
1 Lipovage Set
2 Pack Sterile Towels
3 Gowns
1 Yankeur (HOLD)
1 Tumescent Tubing
1 Bed Cover
2 Gloves (8)
2 Gloves Scrub
1 BSS
1 4x4 Gauze
1 Blue Pad
1 Bandaid
4 Carpules
1 Dental Needle 30g
1 Spinal Needle 22g
5 Syringes 1 cc
2 Syringe 5cc
1 Blade #11
2 Donuts

PREP:

Tumescent Handle
Tumescent Tubing
Spinal Needle 22g
4x4 Gauze
Specimen Cup
Small Bowl
Carpules (4)
Gloves (8)
Dental Syringe
Dental Needle 30g

MAYO:

Deans
Browns
Knife Handle #7
Small Needle Driver
Large Bowl
Fat Transfer Cannulas

SUTURE:

1 Plain Gut 5-0 P-3

DRESSINGS:

Bandaid
Bacitracin Ointment

INSTRUMENTS:

Light Handle
Tumescent Unit
Fat Transfer Set
Soft Tissue Set

EQUIPMENT:

Tumescent Unit

Notes:

If the patient is a woman, take fat from thigh.
If the patient is a man, take fat from abdomen.
If fat transfer ONLY, ensure to pull a knife handle #7, needle driver, scissors, and stat.

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Technique

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Postoperative Considerations

Immediate:

Follow Up:

Operative Note

Surgeon(s): ***

‍Assistant Surgeon(s): ***

‍Preoperative Diagnosis: ***

‍Postoperative Diagnosis: Same

‍Procedure(s): ***

‍Anesthesia: General

‍Implants: None

‍Specimen:***

‍Drains: None

‍Fluids: See anesthesia record

‍EBL: Minimal

‍Complications: None

‍Counts: Correct x2

‍Indications: ***

‍Findings: As expected

‍Procedure in Detail:

‍The patient was seen in the preoperative holding area with a H&P was updated, consents were verified, surgical site marked, and all questions and concerns related to the proposed procedure were discussed in detail. The patient was transferred to the operating room by the anesthesia team. The patient underwent general anesthesia with endotracheal intubation. Tegaderms were placed over the eyes. The patient was prepped and draped in the standard fashion for maxillofacial procedures. A time-out was performed and the procedure began.

Tumescent solution mixture was prepared by combining 50cc 2% lidocaine, 10cc TXA, 1cc of 1:1,000 epinephrine in 500cc of 0.9% normal saline. This preparation was injected into the left lateral thigh in the subcutaneous plane (500 cc); in the subperiosteal and subpericranial space of the forehead and scalp to the vertex and in the superficial temporal spaces bilaterally (500 cc); subcutaneous plane of the face and neck (500 cc); subcutaneous plane of the face and neck (500 cc). The surgical sites were again prepped with Chlorohexidine scrub and draped in the standard sterile fashion.

Autologous fat transfer:
An #11 blade was used to make a 7 mm access incision in the left lateral thigh. Liposuction was performed using a 3 mm single hole blunt cannula attached to the LipiVage syringe. Liposuction was completed with minimal pressure on the cannula ensuring parallel movement in all directions and staying in the subcutaneous plane. Increments of 5 cc were harvested, cleaned, compressed, and transferred into 1 cc syringes. A total of 15 cc of fat was harvested and the access port was closed with 4-0 plain gut.

Next, an #11 blade was used to make access incisions in the nasal alar bases bilaterally. The harvested fat was injected in a submuscular plane using a 1.2 mm two hole luer lock blunt tipped cannula into the bilateral midface, nasolabial folds,

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The patient's face was then cleaned and the posterior pharynx was suctioned. An OG tube was used to suction out the contents of the stomach. Tegaderms were removed from the eyes. Dressings were placed. The patient was then transferred back to the care of the anesthesia team for extubation and recovery.

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Coding

‍15769 - This code is used for grafting of autologous soft tissue, other, harvested by direct excision (e.g., fat, dermis, fascia). It covers the harvesting part of the procedure, such as taking fat from the thigh.‍
20926 - This code represents tissue grafts, other (e.g., paratenon, fat, dermis). It typically is used for the actual transplantation or injection of the harvested fat into the facial area.