FAT GRAFTING BY PUREGRAFT
WHAT IS PUREGRAFT?
Puregraft is a recently developed fat purification system from the US used in fat grafting surgery that has been shown in clinical studies to produce higher survival and retention rates of donor fat cells than previously used and studied techniques.
The Puregraft system is a technologically well developed filtration system that purifies harvested fat by effectively removing more than 95% of unwanted components such as blood, oil, and the saline solution that is injected into the fat before harvesting. The filtration system is very gentle and does not traumatize the fat cells. The result is very purified, condensed fat that has been shown to have high long term survival rates of sixty to seventy percent.
What this means is that using the Puregraft system will result in a smaller loss of grafted fat cells and therefore a smaller loss of volume from the fat grafting procedure than in the past. The cosmetic results are therefore satisfying for patient and surgeon alike.
Puregraft is indicated in any fat grafting case, and it has become an integral part of our fat grafting protocol.
The fat in the previously identified donor sites is first injected with saline solution containing adrenaline and local anesthetic to expand and loosen the fat. This facilitates subsequent removal by vacuum suction. The adrenaline included in this solution causes blood vessels to constrict, thus minimizing bleeding. This first step is known as tumescent infiltration.
The fat is then harvested from with a fine cannula (suction tube) using gentle liposuction technique, usually without any prior treatment of the donor fat with any form of energy (e.g. ultrasound energy), which may damage the fat cells. The fat is then processed and purified using the Puregraft system, transferred to small syringes, then slowly and carefully injected into the recipient tissues.
The amount of fat harvested and injected depends on the needs of the recipient site and the amount of available fat in donor areas. For the face, relatively small amounts of fat are required (less than 100 mls), whereas body recipient sites such as the breast or buttocks require much more fat (several hundred mls).
The incisions made for harvesting and injecting are typically very small (several mm) and are smaller than liposuction incisions. The procedure can be done under local anesthesia, intravenous sedation or general anesthesia, depending on its magnitude. It is usually a day surgery procedure.
In general, fat grafting using the Puregraft system is safe, as long as safety protocols are properly observed. Safety during the harvesting part of the procedure is achieved by first ensuring that the patient has a normal and healthy blood count before even proceeding with the surgery. Second, blood loss during harvesting is achieved by including adrenaline in the tumescent solution that is pre-injected into the fat before harvesting commences.
Third, the total amount of fat removed from all the donor sites is planned carefully beforehand so that is it not excessive in relation to the patient’s body weight and blood count. This ensures that any blood loss that occurs is well within safety limits for the patient.
Safety during the injection part of the fat grafting procedure is maintained by injecting the fat very slowly and in small parcels at a time. This greatly minimizes the risk of inadvertent injection of fat into a blood vessel, which could cause blockage of the vessel either at the point of entry or further down the blood vessel network. Such blockage, if it occurs, can be harmful to the tissues that are supplied by the blood vessel that got blocked. Fortunately, with good injection technique, such complications are rare.
Other risks of fat grafting include infection and uneven contours in both the donor and recipient sites. The risk of infection is minimized by attention to sterility during the surgery, antibiotic coverage, and the use of disposable surgical instruments. Uneven contours can be avoided by good and careful harvesting and injection techniques, as well as the use of fine cannulas for both harvesting and injection.