A MALAYSIAN PIONEER

Trends in plastic surgery have evolved over the rends in plastic surgery have evolved over the years and many patients are now choosing more subtle procedures with natural-looking outcomes as opposed to dramatic changes. Apart from facial procedures where patients don’t want to look overly nipped, tucked and filled, many are also looking for bodily treatments that affect in natural appearances. A good example of this would be mammoplasty, which is divided into implant augmentation, fat grafting and a combination of both. Fewer patients are now looking for large, voluptuous balloons that look and feel like two balls popping out of the chest. Despite breast implant augmentation being the cheapest option, with some clients actually benefitting from its results, patients are required to have sufficient tissue envelopes to support its mass. Should patients seek alternatives that enhance natural outcomes, they may opt for teardrop implants as they are designed to mimic the natural contours and fullness of an anatomical breast. Nevertheless, patient selection is key and despite teardrop implants’ curves and contours, underlying breast tissue may still be a deciding factor as extremely flat chested patients may still end up looking unnatural despite the implant’s design. At the end of the day, patients have options, and should they desire

fuller breasts that look both pleasing and natural, they can either opt for smaller, round implants or the aforementioned teardrop implant depending on essential factors including foreign body concerns, patient costs and sufficient tissue envelope. Moreover, there are some patients who actually prefer implant-related projections and volume. Should that be the case, doctors should respect their wishes. In cases where patients desire breast augmentations that look and feel exactly like natural breasts, fat grafting may be the best option. However, patients who undergo said procedure cannot expect projections similar to that of implants because surgeons are only able to transfer a limited amount of adipose tissue. In general, the flatter you are, the less soft tissue you will have. For example, if a patient has 200ccs of soft tissue, surgeons will only be able to transfer an equivalent of only 200ccs of fat. I always warn patients that they can only go one cup higher with fat grafting and shouldn’t have expectations of big B cups if they were previously very flat chested. Once patients understand this limitation and still prefer this method of augmentation, we can move forward with the procedure. In spite of fat grafting’s limitations, patients can still have the best of both worlds by amalgamating both adipose tissue transfer and implants. A combination of both procedures can bring about impressive outcomes as fat grafting reduces contour irregularities while enhancing volume size and projections. Patients who choose this method can either have the procedures done in single sittings or sequentially where patients undergo fat grafting first and implant insertions later.

Before adipose tissues are transferred to the breasts, fat is first harvested from the abdomen and thighs utilising the Lipokit machine. In situations where patients are extremely thin, I may harvest fats from other bodily regions including the flanks or the lateral and posterior thigh. After fats are harvested, the Lipokit device will manage fat processing where adipose tissue centrifugation and condensation will take place, Last but not least, the device also comes with an instrument which aids in fat injection as well. In my personal opinion, the Lipokit machine is a complete device, which aids in each and every procedural requirement. Apart from making a surgeon’s work much simpler, the Lipokit device is additionally able to process higher amounts of tissues as well. For instance, Dr. Coleman’s open technique is only able to process 60cc of fat while one load of the Lipokit machine has capacities of processing 240cc of tissues.

Common post-procedural side effects include swelling and of course, bruising which lasts two weeks. In addition, patients can also expect rapid decreases in volume after one month, with volume stabilisation only occurring after the 6-9 months mark. Volume decreases happen due to a combination of reasons including swelling reduction and dead cells. After swelling subsides, dead adipose tissues will convert into liquefied fat, which is naturally drained away by the body. This process can take a long time and patients can sometimes find final stabilisations a year after the procedure. Although sizes do decrease, I do not over inject as the breasts can only support a limited amount of transferred tissues. If doctors do over-inject, they will limit vascularisation and blood supply and cause tissue death.

Despite fat grafting’s inability to offer greater volumes, I very rarely perform follow-up procedures. This is mainly due to budget constraints and because I tend to filter out patients who want bigger breasts. Should patients prefer larger sizes, it’s best that we opt for implants instead. Other types of patients who could benefit from fat grafting are those who undergo liposuction. As opposed to simply wasting or throwing away the adipose tissue, I can always re-inject the fats into the breasts or buttocks for volume improvement, the face for filling and rejuvenation, and scars for deformity reconstruction.

Due to fats’ notorious tendency for expiration and volume loss, patients will have the added option of combining fat grafting with stromal vascular fraction (SVF). Along with centrifugation and condensation abilities, the Lipokit device also comes with an added incubator, which has the capabilities of separating stem cells from the tissues. In my opinion and based on clinical findings, SVF or cell-enriched fat grafts have improved fat retention rates when compared against non cell-enriched fat grafts. In regards to facial fat grafting however, I choose to amalgamate adipose tissue with platelet-rich plasma as opposed to SVF as grafted volumes are much smaller.