Lipofilling (FAT TRANSFER)
Fat grafting — also referred to as free fat transfer or lipofilling — is a procedure to fill up facial features or breasts or buttocks with your own body fat instead of using a chemical filling or an implant. This is a highly efficient procedure as it is not very invasive and produces natural results.

Candidate / Indication
The fat used for fat transfer can be extracted from any part of your body like the abdomen or thighs by liposuction and it will be injected where needed. This cosmetic procedure can be used to rejuvenate the face, enhance the cheeks or lips, or correct problems, such as hollowness around the eyes or scars or augment the breasts or the buttocks.

Procedure
Fat grafting is usually performed under local anaesthesia. If it is combined with other procedures it will mostly be done in general anaesthesia. The method used by Dr. Bart van de Ven is called the Coleman method.

Liposuction: The fat used to re-inject in the face can be taken through means of a liposuction from any part of the body having a sufficient amount of fat, in most cases from the abdomen or the upper legs. After injecting local anaesthesia, which minimises bleeding in this particular area, a very small incision is made and fat is aspirated using a blunt needle with multiple perforations and a special aspirator. The small incision is closed with one stitch.

Filtration: This fat is filtered to separate blood, oil and local anaesthetic from the fat cells.

Fat Injection: The place where more volume is required is injected with a minimal amount of local anaesthesia after which the fat cells are injected with very fine canulas.

The trick of the fat transfer is to inject only a very small amount of fat with each pass of the canula. This way the grafted fat will be in direct contact with the surrounding tissues and will make it possible for the fat to grow in the vessels really fast. Thus, the fat can survive. About 70% of the fat stays forever. Therefore a little overcorrection is done during the operation. After six months, if necessary, another fat graft may be performed until the desired effect has been obtained.

Results
Swelling: Immediately after the surgery the cheek will be quite swollen and bruised. In about three weeks time, approximately 80% of the bruising and swelling will have disappeared. After four months you can get a good impression of what the final result after six months will be. About a week to ten days after surgery you will feel confident about going out and resuming a normal social life. If any bruises have developed, they might remain visible for a little longer but you can hide them reasonably well with a good concealer.

Exageration: In the beginning the correction may still look rather exaggerated as more fats cells are injected than actually required. This is done because 25 to 30% of the transplanted fat cells do not survive. The final result is assessed after six months.

Correction: A second session may be scheduled to top up any shortfall in volume. There are many factors that determine how long a fat grafting lasts. Your body naturally absorbs fat, so the surgeon must over-inject initially, and success rates can vary considerably. However, some fat is reabsorbed by the body and sometimes only a certain percentage is permanent although newer techniques are showing an increased longevity.

Liposuction
Liposuction (also known as lipoplasty, liposculpture, suction-assisted body contouring, suction lipectomy and lipo suction) is a surgical procedure that involves the use of an instrument known as a cannula and a vacuum pump machine to remove unwanted fat from a specific area. The cannula is connected to the pump by a tube and is inserted into the areas of fat to be removed through small incisions. The surgeon then moves the cannula tip back and forth to break up the fat, which is then sucked out through the tube.

Candidates / Indications:
Liposuction is an ideal procedure for improving contours of the body, which are out of proportion with the overall form, just by removing the excess fat deposits. Even after efforts to tone up the body through exercise and slim down through a healthy diet, sometimes a fat deposit remains stubbornly in place despite overall weight loss. However, under the guidance of a specialist, this can be expertly sculpted by doing away with the unwanted fat, thereby, improving your figure and confidence.

You should be at a steady weight and within about 20% of your ideal body weight, although some surgeons say you can be anywhere from 15 to 30% of ideal weight. Liposuction is not a way to lose weight. Except for rare instances, it is for people who are close to their ideal body weight and who have areas of fat that resist diet and exercising.

The skin plays a role in whether you are a good candidate. You should have healthy skin with good elasticity, so that your skin is able to bounce back to its former tightness once the fat is removed. If you are having liposuction over a larger area, excess skin removal may also be necessary. If you have excessive stretch marks in areas where you gained weight or over your abdomen if you were pregnant, this may be a good indication of poor elasticity.

Liposuction can also remove pockets of fat or other tissue that are caused by medical conditions or medications. The ‘buffalo hump’ caused by anti-HIV drugs can be removed with liposuction.

Common Treatment Areas
Ankles and Calves Neck, Cheeks and Chin Inner Knee Thighs, Hips and Buttocks Waist and Abdomen Back and Chest Area Upper Arms

Procedure
Liposuction is a relatively simple procedure. The excess fat is removed by either:

• Liquefying fat through ultrasonic energy applied to the specified area of treatment and then removing it with suction
• Or by injecting a solution of saline and adrenaline prior to the removal of fat, thus, saturating the fat deposit
• Or with traditional liposuction that involves insertion of a suction device into the subcutaneous fat (underneath the skin) without primary chemical or ultrasonic measures

Liposuction may be combined with Abdominoplasty as part of a Mommy Makeover, where a set of procedures are designed to restore the body to pre-baby condition.

Result
Following the procedure the treated area will experience bruising and mild swelling. Results are noticeable within two to four weeks with the final desired appearance seen in two to six months.