Introduction to the top five tertiary - level private and public hospitals for autologous fat facial rejuvenation in New York City!

1. Understanding Autologous Fat Facial Rejuvenation

Autologous fat facial rejuvenation is a technique in which harvested adipose tissue is injected underneath the skin for both reconstructive and cosmetic purposes, especially facial rejuvenation. This process involves three main stages: fat harvesting, fat processing, and fat transfer.

1.1 Anatomy and Physiology Considerations

As the human body ages, the face undergoes significant changes. Gravity causes the descent of facial soft tissues, leading to the formation of unflattering folds and shadows, such as nasolabial folds, tear troughs, and marionette lines. Additionally, there is a decrease in facial volume due to dermal thinning, muscular atrophy, fat volume loss, and reduction in bone thickness. Understanding facial anatomy and the relationships of various structures to fascial planes is crucial for achieving good results and minimizing the risk of complications during autologous fat facial rejuvenation. The major fat compartments of the face are the superficial and deep fat spaces, separated by the superficial musculoaponeurotic system. The superficial fat space contains the nasolabial fat pad, orbital fat pads, temporal and forehead fat pads, jowl fat pad, and cheek fat pads. The deep fat space is composed of sub - orbicularis oculi fat pads, sub - orbicularis oris fat pad, deep cheek fat pads, and buccal fat pad.

1.2 Indications for the Procedure

Autologous fat grafting for facial rejuvenation can address a wide range of age - related changes in the face, including forehead hollowing, deep rhytides (especially on the forehead and glabellar area), temporal hollowing, supraorbital hollowing, increased vertical length of the lower lid, tear trough deformity, malar bags, nasolabial folds, marionette lines, jowls, poor jawline contour, thin lips, and retruded chin. It can also be used to treat other problems such as nasal contour irregularities, scars, burns, radiation dermatitis, human immunodeficiency virus - associated lipodystrophy, facial deformities (congenital, acquired, or traumatic), facial asymmetry, and flap augmentation.

1.3 Contraindications

There are several situations where autologous fat grafting may not be suitable. It may be contraindicated if there is a high likelihood of instability in the fat's volume, such as in cases of planned weight loss or ongoing weight gain, or if the patient has a prior history of complete or subtotal resorption of prior grafted fat. Patients with local, regional, or systemic conditions that may affect blood flow or wound healing, such as histories of extensive burn scarring, radiation therapy, keloid scarring, coagulopathies, the need for immunosuppressive medications, and other metabolic or chronic diseases, are also at risk of complications or suboptimal outcomes.

2. Equipment and Personnel Requirements

2.1 Equipment

Autologous fat grafting requires specific equipment. This includes a wetting or tumescent solution, usually consisting of 500 ml normal saline, 25 ml of 1 to 2% lidocaine, and 0.5 ml epinephrine (1:100,000 or 1:200,000). Local anesthetic (lidocaine or bupivacaine) is also needed. Infiltration needles or cannulas are used to administer local anesthesia and the wetting/tumescent solution. Fat harvesting and donor cannulas, such as the Coleman type 2 (side - port cannula), are essential. For facial injections, the cannula should be no more than 5 to 9 cm in length. Luer - lock syringes, with large ones (10 ml or 20 ml) for harvesting and several 1 ml syringes for injecting, are used. A closed suction machine can be an alternative for harvesting large volumes of fat. Other equipment includes a #11 or #15 blade scalpel, an 18 ga needle, sterile skin markers, gauze, compression garments, and luer to luer connectors for micro - fat and nano - fat processing. Depending on the fat processing method (sedimentation, filtering, washing, and centrifugation), additional items like 1 ml syringes with absorbent material, commercial fat grafting preparation kits, strainers, saline, and a centrifuge (3,000 rpm for 3 min) may be required.

2.2 Personnel

The team performing the autologous fat facial rejuvenation procedure typically includes a surgeon (such as a plastic surgeon, facial plastic surgeon, or otolaryngologist) or a dermatologist, an anesthesia provider, nursing staff, and operating room technicians.

3. Procedure Preparation

3.1 Informed Consent

Before the procedure, informed consent must be obtained from the patient. The patient should understand the risks, benefits, and alternatives to the procedure. Managing the patient's expectations and addressing any questions about the procedure are important aspects of this process. The potential need for future revision procedures should also be discussed, as a significant portion of patients may require augmentation in the future due to the resorption of some of the injected fat.

3.2 Pre - procedure Evaluation

A pre - procedure evaluation and consultation with a physician are necessary to obtain clearance for the procedure. Medical conditions like bleeding disorders, anemia, and certain medications like non - steroidal anti - inflammatory drugs (NSAIDs) and anticoagulants may affect the outcome of the procedure. Patients on aspirin or NSAIDs may need to stop taking these medications two weeks before the surgery. Pre - procedure photographs should be taken, and the selection of potential fat donor sites should be discussed. The recipient site also needs to be carefully examined to determine the amount of fat required for the procedure.

3.3 Site Preparation

Before the procedure, the necessary donor and recipient sites must be prepared. In men, facial hair may need to be shaved to improve visualization. Zones of adherence within the planned harvest region, which are areas of fibrosis, should be marked in advance and avoided as liposuction in these regions increases the risk of trauma and/or contour irregularities. Many of these procedures are performed under general anesthesia. When using local anesthesia, nerve blocks are preferred over local infiltration because lidocaine can decrease the viability of the harvested fat and add volume to the recipient site, making it more difficult to track the progress of the fat injections.

4. The Procedure Stages

4.1 Fat Harvesting

Fat is usually retrieved from donor sites with rich fat reservoirs, such as the abdomen, periumbilical area, buttocks, medial, lateral, and anterior thigh. In some cases, if neck or submental liposuction is performed in conjunction with a facelift and autologous fat grafting, the fat from the neck can be used, but other donor sites generally provide higher - quality fat. The first step in harvesting is to use a wetting or tumescent solution for adipose tissue suspension. After allowing the anesthetic to take effect for 15 minutes, a stab incision is made with a scalpel, and a blunt fat harvesting cannula attached to a luer lock syringe or a closed suction machine with low negative pressure is inserted into the donor site. The fat is removed by a gentle back - and - forth movement, and care is taken to minimize bleeding as blood can negatively affect the fat's viability.

4.2 Fat Processing

After harvesting, the fat solution contains additional components like oil, dead adipocytes, blood, and local anesthetic, which can compromise graft uptake. To improve the viability of the transferred fat, processing can be carried out by sedimentation, centrifugation, or washing and filtering. Sedimentation involves placing syringes upright for 45 minutes to allow gravity to separate the different components. Centrifugation, recommended by Coleman, uses 1 to 3 minutes at 3,000 rpm to obtain condensed fat. Washing and filtering use a strainer or gauze and saline to clean and refine the fat. Sedimentation and centrifugation result in the formation of three layers, with the middle layer containing graftable fat.

4.3 Fat Transfer

The processed middle layer is transferred to multiple 1 ml syringes and then injected into the recipient sites. A stab incision is made with an 18 ga needle to provide access to the recipient area. Multiple passes of 0.1 ml are used to deliver the fat parcels, and the fat is delivered with withdrawing movements to deposit it with minimal resistance and prevent intravascular injection. The passes are performed three - dimensionally along different vectors and at different levels for better aesthetic outcomes. Most fat is injected deep to the superficial musculoaponeurotic system but superficial to the periosteum. Overcorrection (approximately 20%) is a common practice to account for future fat resorption, but the evidence on definitive survival rates is conflicting. The use of platelet - rich plasma (PRP) and platelet - rich fibrin (PRF) is an emerging technique to improve the chances of graft survival.

5. Consideration of Facial Aesthetic Units

5.1 Forehead, Brow, and Temple

Injections in these areas are subcutaneous, intramuscular, or submuscular, usually accessed via stab incisions in the hairline or lateral brow. Any ridging encountered after injection should be massaged until smooth. Severely hollow temples may require 8 to 15 ml of fat.

5.2 Glabella / Nose

The most common features addressed in this region are glabellar vertical rhytids and a deep radix to camouflage a dorsal hump. The cannula entry point can be in various locations, and different cannulas may be used. Regarding the glabella, it is important to remain superficial and avoid intravascular injection to minimize the risk of blindness and/or stroke.

5.3 Periorbital Region

This area is technically challenging, so a conservative approach is recommended for novice fat grafters. Care should be taken not to place too many fat parcels at a time. Initial infiltration should be deep along the orbital rim, followed by a more superficial layer. Injections should be performed deep to the orbicularis oculi muscle to avoid palpable or visible nodules.

5.4 Lips

Fat injected into the lips should be placed very superficially, just beneath the mucosa, to avoid injuring the orbicularis oris muscle and labial arteries. Smaller cannulas are preferred for lip injections.

5.5 Cheek

Placement of fat in the malar, zygomatic, and infraorbital regions superior to a ptotic cheek can help lift the soft tissue into a more youthful position. Two stab incisions are often required, and the location of the infraorbital nerve should be marked to avoid nerve injury.

5.6 Nasolabial Fold

This area is accessed via stab incisions in the lateral chin or near the oral commissures. Grafting can be performed both deep (periosteal) and superficial (subcutaneous), but it should remain medial to the nasolabial fold to avoid trauma to the facial artery or deepening of the fold.

5.7 Mandible and Chin

Fat grafting to this region can address a retruded chin, jowls, or poor jawline definition. Stab incisions are made along the margin of the mandible, submental area, and pre - jowl sulcus, and the fat is placed by fanning the injections laterally and inferiorly, taking care to avoid damage to the facial artery.

6. Complications Associated with Autologous Fat Facial Rejuvenation

6.1 Common Complications

Despite careful techniques, several complications can occur. Bruising, edema, and ecchymosis are the most common sequelae. Overcorrection due to the transfer of excess fat and undercorrection due to insufficient volume transfer or excessive fat resorption can also happen. Other complications include pyogenic granulomas and cellulitis secondary to infection and/or prolonged inflammation, blistering, scarring, tissue bunching or palpable deformities from superficial injections, contour irregularities, nodules or calcifications, pain at the donor site due to inadequate anesthesia, and deformity at the donor site due to excessive or unequal fat harvesting or violation of a zone of adherence.

6.2 Rare but Serious Complications

Blindness due to occlusion of the ophthalmic artery and stroke due to occlusion of the internal carotid artery are rare but extremely serious complications. Fat embolism can also occur, causing symptoms such as headaches, nausea, vomiting, dizziness, numbness, weakness, and vital sign instability. In cases of blindness resulting from fat grafting, urgent intervention is required, including immediate transfer to the hospital and administration of timolol 0.5% drops, aspirin 325 mg, and acetazolamide 500 mg while awaiting transfer.

6.3 Managing Complications

Graft loss and bruising can be minimized by using an atraumatic technique. Cool compresses can be helpful in the first three days after treatment to reduce ecchymosis, but excessive icing should be avoided as it can lead to vasoconstriction and risk of graft loss. Vigorous activity should be avoided for two to three weeks after the procedure. It is important to distinguish expected edema from cellulitis, which presents with fever, warmth, erythema, and tenderness. Prolonged edema can be treated with facial lymphatic massage, therapeutic ultrasound, patient education, and reassurance. In cases of overcorrection with insufficient fat resorption, the excess volume may be addressed with deoxycholic acid injection.

7. Top Five Tertiary - level Private and Public Hospitals for Autologous Fat Facial Rejuvenation in New York City

7.1 Zuckerman Plastic Surgery

Located in the prestigious upper east side of New York City, Zuckerman Plastic Surgery offers expert facial fat grafting injections. Dr. Joshua D. Zuckerman conducts a thorough consultation to assess the patient's facial structure, skin quality, and aesthetic goals. The procedure is performed under local anesthesia, often combined with sedation. Fat is harvested using a gentle liposuction technique, purified, and then meticulously injected into the target areas of the face. The benefits of their facial fat grafting include natural results, improved skin quality, long - lasting effects, and the dual benefit of reducing unwanted fat in donor areas while enhancing facial contours. The recovery process is relatively quick, with most patients experiencing mild swelling and bruising that resolve within a week or two.

7.2 Mount Sinai - New York

Mount Sinai's plastic surgeons offer a comprehensive approach to facial rejuvenation. They not only provide autologous fat grafting but also a range of non - invasive treatments such as injectables, skin resurfacing techniques, and non - invasive tissue lifting. The injectable treatments include relaxing agents like Botox® and fillers like Restylane®. Skin resurfacing techniques involve various forms of chemical peeling, skin abrasion, or laser resurfacing. The non - invasive tissue lifting, such as Ultherapy®, can provide the effects of a face and neck lift without surgery. Their plastic surgeons work closely with patients to recommend an individualized treatment plan based on the patient's goals.

7.3 Cedars - Sinai

Cedars - Sinai has a team of experts specializing in facial plastic surgery. They offer personalized facial procedures for unique needs, including autologous fat facial rejuvenation. The surgeons take the time to get to know the patient and their goals, discussing the benefits and risks of the procedure. Whenever possible, they use a minimally invasive approach, resulting in smaller incisions, less pain, and a shorter recovery time. Their areas of expertise include a wide range of facial cosmetic and reconstructive procedures, making them a reliable choice for patients seeking facial rejuvenation.

7.4 NewYork - Presbyterian Hospital

NewYork - Presbyterian Hospital is a renowned medical institution. Their plastic surgery department has highly skilled surgeons who are experienced in autologous fat facial rejuvenation. They combine advanced techniques with a patient - centered approach. The hospital has state - of - the - art facilities and access to the latest research, ensuring that patients receive the best possible care. They also offer comprehensive pre - and post - operative care to support patients throughout the entire process.

7.5 NYU Langone Health

NYU Langone Health's plastic surgery team is well - known for its excellence in facial rejuvenation procedures. Their surgeons are at the forefront of innovation in autologous fat grafting techniques. They offer a range of services to address different facial concerns, from minor volume loss to more significant reconstructive needs. The hospital emphasizes patient education, ensuring that patients are fully informed about the procedure, its risks, and expected outcomes. Their multidisciplinary approach involves collaboration with other specialists when necessary to provide the most comprehensive care.

8. Importance of Choosing the Right Hospital

Choosing the right hospital for autologous fat facial rejuvenation is crucial for achieving optimal results and minimizing risks. A top - tier hospital will have experienced surgeons who are well - versed in the latest techniques and safety protocols. They will also have access to high - quality equipment and a supportive medical team. Additionally, a good