Fat transplantation to the buttocks and legs for aesthetic enhancement or correction of deformities: long-term results of large volumes of fat transplant.

[BACKGROUND] A comprehensive review of the history of free fat transplantation reveals that since 1893 when Neuber used small pearls of fat taken from the arm to fill out depressed facial scars after trauma and underlying bone loss, free fat graft has been used with success in facial surgery, brain and nervous system surgery, various orthopedic uses, general surgery, craniofacial surgery, and cosmetic surgery.

[OBJECTIVE] To present the author's hypothesis that a fat graft in cosmetic surgery responds like other kinds of tissue grafts. This article was written as a result of the author's search for a way to avoid the most common complications of doing a buttock or leg augmentation with silicone prostheses and to find a better surgical procedure that is simpler, complementary with liposuction, and better able to deal with subtle body irregularities that do not justify a large and complicated procedure.

[METHODS] Over a period of 6.5 years, a total of 1350 liposculptures were performed. Eight hundred and seventy-nine patients had buttock augmentation. One patient had facial hemiatrophy and her face was treated twice with fat grafts. Four hundred and seventy patients had fat grafted onto their ankles and their legs for cosmetic reasons. One patient with polio sequelae and one male patient with agenesia of the gemellus muscles over his left leg were treated. The patients selected were not obese, but had moderate to severe lipodystrophy. The patients ranged in age from 18 to 65 years.

[RESULTS] The results of the buttock augmentations showed that there was a 0.5-1.0 cm reduction at 2 months. This persisted until the sixth month and until years later. These findings were seen in patients that had 3-5 kg less body weight after surgery than before or had 3-5 L of fat removed from their bodies. Patients who underwent ankle or leg augmentation experienced a 0.5 cm loss in diameter over the treated areas after the 1.5-month postoperative period. No more volume was lost after that. The areas kept the same parameters until the sixth month and also into later follow-ups. The few complications that our patients experienced appeared between days 2 and 15. The complications of 6.5 years occurred in 14 patients (1.037%). One case of erysipelas appeared on the 10th postoperative day. This patient reported that she was riding a bicycle and had a scratch over the left ankle, producing an infection with edema, erythema, and pain. Twelve patients got skin vesicles because of contact with micropore over the skin of the ankles. We treated those patients with local antibiotics, obtaining healing of the skin in about 5 days, with dryness and absence of the vesicles. No damage to the graft was observed.

[CONCLUSION] The hypothesis that applied fat grafts are real grafts was demonstrated. Not only are the grafts real, they are able to live and persist with the patients, growing if the patient gained weight over the gluteus area, and not losing circumference when reducing weight.