Coleman Fat & Microfat Injections
Coleman fat injections / microfat injections (structural fat grafting)
For some patients a lower lid blepharoplasty can be combined with fat injections to enhance the cheeks or midface where there is hollowing due to loss of fat. Coleman fat injections can also be used as a totally separate aesthetic procedure e.g. for hollowing of the temples, and cheeks. The newer technique of microfat grafting, using finer cannulas, can be used for the outer tear trough areas and lid-cheek junction in suitable patients.
Coleman fat injections / microfat injections (structural fat grafting)
In this procedure, fat is removed from the outer aspect of the flank, buttock or thigh using very light finger suction with a syringe and a special harvesting cannula to avoid damaging the fat. This can be done under “twilight anaesthesia” or under general anaesthesia. A single small “stab” incision is required in the skin and this is closed with a single stitch. The fat is then washed in a closed filtration bag (a “Puregraft®” bag), separating the fat cells from blood and local anaesthetic solution. See photographs below.
Harvested fat has been injected into the filtration bag and washed with Hartmann’s solution. The solution is being drawn off with a syringe.
The pure fat cells are now withdrawn into a series of 1ml syringes ready for injection.
Syringes of fat ready for injection
The fat is then injected conservatively into the cheek area via a small skin incision using a sterile needle, in very small quantities. Several passes of a small blunt tipped cannula are made to ensure an even, smooth distribution and the best chance of the fat gaining a blood supply in the facial tissues and thereby surviving. There is nevertheless a risk of approximately 10% that the fat will not survive this process. The risk of failure is higher in smokers and for this reason this procedure is not advised for such patients. The procedure can be repeated but the fat has to be harvested again as it cannot be stored (stored fat is not viable).
Coleman fat injections (structural fat grafting)
In order to minimize the risk of bruising it is advisable to discontinue the use of Aspirin, Anadin or any anti-inflammatory medicines e.g. Indomethacin, Ibuprofen, Diclofenac, Voltarol, for 2 weeks before treatment provided it is medically safe to do so (please discuss this with your GP or physician if in doubt about this). It is quite in order to take Paracetamol and Codeine before this treatment
You will visit the clinic to have a preoperative consultation with Mr Leatherbarrow. This usually lasts approximately 45 minutes. You will be asked to complete a healthcare questionnaire in advance, providing information about:
- Your specific aims
- Your current and past general health
- Any previous eye, eyelid or facial surgery or treatments including refractive surgery or laser eye surgery
- Any past dermatology history e.g. cold sores, eczema, rosacea, skin cancer
- Any history of a dry eye problem
- Any contact lens wear
- Any previous non-surgical aesthetic treatments e.g. Botox injections, dermal fillers injections, the use of IPL or laser treatments
- Any allergies
- Any medications you take (including over the counter products e.g. Aspirin, Indomethacin, Nurofen, Diclofenac or vitamin supplements)
- Any history of smoking
- Please answer all questions completely and honestly as they are asked only for your own wellbeing, so that your cosmetic procedure can be planned as carefully as possible. The information is treated confidentially. If you are unsure of the names of any medications, bring them with you.
- Your vision in each eye is measured. Your eyes are examined carefully using a slit lamp (a special ophthalmic microscope).
- The rest of your face is then examined. The general state of your skin is assessed and photographs of your face and eyelids are taken before surgery so that the results of treatment can be compared with the original appearance. The photographs are confidential and can only be used for any purpose other than your own records with your specific written permission.
- All our patients are provided with a detailed report following a consultation. This summarises the consultation, the recommendations and also the preoperative and postoperative requirements.
- You will have your blood pressure checked by the nurses. You may also be required to have a physical examination of your heart and lungs by the anaesthetist to make sure it is safe for you to have a general anaesthetic if this is required in your case. You may need to have some routine laboratory tests, such as urinalysis (tests of your urine), a chest x-ray, or a blood cell count. These should reveal potential problems that might complicate the surgery if not detected and treated early. No testing is usually necessary, however, if you are in good health and younger than age 55.
- The nurses are also happy to answer any further questions and to show you the facilities at Face & Eye, including the operating theatre if it is not in use. They can also advise you about additional non-surgical treatments and long term skin care which may enhance and help to maintain the results of surgery. If you have any specific skin problems, we may refer you to our clinic dermatologist for help and advice.
- You will be told whether or not to stop any medications at this preoperative clinic visit. For example, if you are taking aspirin-containing medicines or anticoagulants, they may need to be temporarily withdrawn or reduced in dose for two weeks before the procedure as long as these are not medically essential. You might need to check this with your GP. Any anti-inflammatory medicines e.g. Ibuprofen, Nurofen must be discontinued at least 2 weeks before surgery. These medicines predispose you to excessive bleeding. You will be given a leaflet advising you on what medications, foods, and vitamin supplements to avoid prior to surgery. Your blood pressure should also be under good control if you take medications for hypertension. This is very important.
- If you can, try to stop smoking at least six to eight weeks prior to surgery. Smoking has an adverse effect on healing and damages your eyelid skin and supporting tissues and your eyes (it can result in premature cataract formation and age related macular degeneration with a loss of central vision).
- Your vision in each eye is measured. Your eyes are examined carefully using a slit lamp (a special ophthalmic microscope). Your tear film status is determined and the back of the eyes (called the retina) are examined as well as the eyelids themselves.
- The rest of your face is then examined. The general state of your skin is assessed and photographs of your face and eyelids are taken before surgery so that the results of surgery can be compared with the original appearance. The photographs are confidential and can only be used for any purpose other than your own records with your specific written permission.
- All our patients are provided with a detailed report following a consultation. This summarises the consultation, the recommendations and also the preoperative and postoperative requirements.
- We much prefer that our patients return to see us in clinic before proceeding with their surgery so that we can have the opportunity to answer any queries and so that a consent form for surgery is completed in advance and not on the day of surgery. If a patient is traveling a long distance however, this second consultation can be omitted and instead queries can be addressed by email and a copy of the consent form sent in advance so that this can be checked by you.
What are the possible complications of Coleman fat injections (structural fat grafting)?
Complications in the hands of a trained and experienced oculoplastic surgeon are very rare and all precautions are taken to minimize any risks.
Most complications of eyelid surgery are amenable to successful treatment.
Complications from this surgery include:
- Blurred or double vision, lasting mainly for a few hours, and sometimes up to a day or two after surgery. This may occur for several reasons – ointment put in the eyes immediately after the operation, local anaesthetic used in the operation, swelling of the muscles that control eye movement or swelling of the normally clear covering around the eye (the conjunctiva). Swelling of the conjunctiva (this may mimic a severe hay fever reaction) is referred to as “chemosis” and in some patients can take a few weeks to resolve. If blurring persists for longer than 48 hours, it is important to inform your surgeon. Blindness, a stroke, or skin loss from facial fat injections are extremely rare complications reported in the medical literature. Mr Leatherbarrow has undertaken facial fat injections for over 20 years with no serious complications.
- Bleeding. A collection of blood around the eyelids or in the face is called a haematoma. A haematoma usually needs to be drained in the operating theatre.
- Infection. An infection following this surgery is extremely rare but it is important to follow postoperative wound care instructions to help to prevent such a problem. These should be given to you in writing for you to take home following surgery.
- Under or over-correction of the grafting. This may necessitate further surgery.
- Atrophy of the transplanted fat. This affects a small percentage of patients and is the reason why the procedure is not advised in smokers who have a poor microvasculature. The failure rate also increases in patients over the age of 60. The procedure can be repeated if necessary.
- Asymmetry. It is impossible for any surgeon to achieve perfect symmetry although an oculoplastic surgeon strives to achieve this. A cosmetically unacceptable degree asymmetry is always possible (but rare) and further surgery may be required to address this.
- Scarring. Most small eyelid and facial wounds heal with scars that are barely perceptible although full maturation of the wounds can take some months. Poor scarring can follow infection or wound disruption but this is very rare. Poor scars can be treated with steroid injections or with the application of silicone gels e.g. Kelocote.
- Eyelid lumps. Lumps can very occasionally occur as a reaction to the injected fat. These usually resolve with time and postoperative massage. Rarely steroid injections are required. Because the eyelid skin is so thin, only microfat is used for the eyelids and this is usually done in the outer aspect of the eyelids, at the eyelid cheek junction. If fat is needed to improve eyelid hollowing in the inner and central areas of the lower eyelids, it is better to undertake fat pearl grafting instead.
- Reoperation. Further surgery within the first few weeks to address any asymmetries may be required. This should be borne in mind. There are a number of factors beyond a surgeon’s control, which can have an impact on postoperative progress e.g. postoperative swelling affecting one side more than the other, which in turn can necessitate re-intervention.
What happens after Coleman fat injections (structural fat grafting)?
After surgery, the eyes are initially covered with pressure dressings for approximately half an hour to reduce postoperative swelling and the wounds are treated with antibiotic ointment. The dressings are then removed and replaced with cool packs. Activity is restricted for 2 weeks to prevent bleeding.
You will be asked to clean the eyelids and face very gently using clean cotton wool and Normasol (sterile saline) or cooled boiled water and repeat the application of antibiotic ointment (usually Chloramphenicol or Soframycin) to the small wounds 3 times a day for 2 weeks.
A realistic period of recovery must be expected. Postoperative bruising usually takes at least 2-3 weeks to subside completely. Swelling takes much longer. Most of the swelling disappears after 3-4 weeks but this can vary considerably from patient to patient as does the extent of the swelling. The final result is not seen for at least 3-4 months. This should be taken into consideration when scheduling the operation. You should arrange this surgery after holiday periods or important professional or social events and not before so that you are available for postoperative review and just in case any surgical adjustments are required. You should be aware that swelling and bruising can sometimes create quite an initial psychological impact for some people and you should prepare yourself and your relatives for this.
The very small skin scars gradually fade to tiny fine white marks within a few months.
You are advised to sleep with the head raised approximately 20-30 degrees. It is preferable to raise the head of the bed if possible.
A period of postoperative massage is often advised following this surgery. You will be shown how to do this. It is usually undertaken after applying some Auriderm cream to the eyelid/cheek skin. The massage helps to reduce swelling. It is usually undertaken for 3 minutes 3 times a day in a side to side direction.
Twilight Anaesthesia
Conscious sedation, also known as “twilight anaesthesia”, is a type of anaesthesia which is preferred by many patients for most of our surgical procedures. It is a very comfortable and gentle type of anaesthesia which is far less invasive than the typical general anaesthesia but at the same time highly effective. It is also of advantage for very nervous or anxious patients undergoing quite minor procedures. Typically patients sleep most of the way through their procedure and have no or very little recollection of it at all. You are looked after throughout the procedure by a specialist consultant anaesthetist who has many years of experience of this type of anaesthesia, so that your surgeon can concentrate fully on your operation.
Shortly before moving to the operating room, a small tube (cannula) is placed into a vein in the back of your hand by the consultant anaesthetist and the anaesthetic drugs are given through that. These are Midazolam (a short acting type of Valium) and Propofol, a drug which is also used for general anaesthesia but, for conscious sedation, much lower doses are used. With conscious sedation there is no breathing tube or breathing machine, just a gentle flow of oxygen given through a plastic tube within a soft sponge protector inserted into one of your nostrils. Once the sedation has been commenced a local anaesthetic solution (a mixture of Marcaine and Lignocaine) is injected into the operative area to ensure a painless procedure. Typical side effects of general anaesthesia including a sore throat and nausea are avoided. Waking up takes only a few minutes at the completion of the surgery and is usually free of any “grogginess.” This type of anaesthesia has been used safely and successfully for our surgical procedures for over 20 years.
