The science and techniques of biologics like nanofat continue to emerge, according to an expert who presented yesterday at The Aesthetic Show.
“Fat grafting is becoming the wave of modern aesthetic surgery,” Jon Grazer, M.D., told attendees. “It allows us to use natural tissue, without the drawbacks of allergic reactions or viral transmission,” he said. He is an assistant clinical professor of plastic surgery at the University of California, Irvine.
Fat also has a higher concentration of stem cells than bone morrow, he added. However, stem cell injection is not approved by the FDA.
“Therefore, you need to be part of an institutional review board (IRB),” Dr. Grazer said. “But with nanofat, anyone can process the fat for use because the FDA considers it fat without being biologically modified.”
Nanofat is injected intracutaneously to help improve the tone and texture of skin.
“Because the fat is highly processed, you can actually inject it through a 27- to 30-gauge needle for true intradermal injections,” Dr. Grazer said.
Dr. Grazer uses nanofat for most of his facial procedures to treat fine lines, wrinkles, dyshcromia and areas of hyperpigmentation.
“I do my traditional fat grafting for correction of deeper lines and wrinkles,” he said. “But if I want to improve the neckline, decolletage, perioral rhytides, crow’s feet and intraorbital region, I will use nanofat because I can go directly intradermally and help improve those areas.”
Before nanofat, it was difficult to inject fat into the neck to achieve an acceptable result, according to Dr. Grazer. He typically harvests nanofat from the knees because it is the most comfortable for the patient, the fat is easy to harvest and contour, and, usually, there is minimal to no bruising.
Dr. Grazer’s second and third areas for harvesting are the flanks and periumbical.
Dr. Grazer first performs fat grafting, followed by a facelift and, if needed, laser resurfacing. Next, he injects platelet rich plasma (PRP) and finally nanofat. The nanofat portion takes between two to four months for maximum outcomes.
With one treatment section of combined therapy, “I believe the tone and texture of the skin really improves,” Dr. Grazer said. “But it takes three to four months to really start to see the true stem cell/biological effect.”
Between 20% and 30% of Dr. Grazer’s patients schedule a second combination treatment at up to one year.
Dr. Grazer said there are some off-the-shelf devices that make it easier to prepare nanofat for injection.
“And by injecting intradermally, there is minimal risk of embolization,” Dr Grazer said. “We are also using the science of our own bodies to renew from within.”