Best Practices for Harvesting and Processing Fat for Hand Grafting : A plastic Surgeon's Guide

Fat grafting to the hands, also known as autologous fat transfer, has gained significant popularity in the field of plastic surgery. This technique is used to rejuvenate aging hands by restoring volume, improving skin texture, and camouflaging veins and tendons. This comprehensive guide will cover all aspects of fat grafting to the hands, including indications, preoperative evaluation, contraindications, surgical techniques and steps, postoperative care, possible complications, different techniques, prognosis and outcome, alternative options, average cost, and recent advances.

Indications for Fat Grafting to Hands

Fat grafting to the hands is primarily indicated for patients who experience volume loss in their hands due to aging or other factors. Common indications include:

• Age-related volume loss: As people age, the hands lose subcutaneous fat, making veins and tendons more prominent.
• Wrinkled and thin skin: Thinning of the dermis and loss of elasticity can result in a wrinkled appearance.
• Prominent veins and tendons: Reduced fat volume makes veins and tendons more noticeable.
• Hand trauma or deformities: Fat grafting can be used to improve the appearance of hands affected by trauma or congenital deformities.

Preoperative Evaluation

A thorough preoperative evaluation is essential for the success of fat grafting to the hands. This includes:

• Medical history: Assess the patient’s overall health, medical conditions, and history of previous surgeries.
• Physical examination: Evaluate the hands for skin quality, volume loss, and the prominence of veins and tendons.
• Patient expectations: Discuss the patient’s goals and expectations to ensure they are realistic.
• Donor site assessment: Identify potential donor sites for fat harvest, typically the abdomen, thighs, or flanks.

Contraindications

Certain conditions and factors may contraindicate fat grafting to the hands:

• Poor overall health: Patients with significant comorbidities may not be suitable candidates.
• Smoking: Smoking can impair healing and affect the survival of the grafted fat.
• Poor skin quality: Severely sun-damaged or very thin skin may not respond well to fat grafting.
• Previous hand infections: A history of infections in the hands can complicate the procedure.

Surgical Techniques and Steps

Fat grafting to the hands involves several critical steps:

1. Fat Harvesting

Fat is typically harvested from areas with sufficient subcutaneous fat, such as the abdomen, thighs, or flanks. The process involves:

• Tumescent anesthesia: Injecting a solution containing saline, lidocaine, and epinephrine into the donor site to minimize pain and bleeding.
• Liposuction: Using a cannula to gently suction fat from the donor area.

2. Fat Processing

The harvested fat is then processed to remove impurities and excess fluids. Techniques include:

• Centrifugation: Spinning the fat to separate viable fat cells from blood, oil, and other components.
• Filtration: Using filters to purify the fat.
• Decanting: Allowing the fat to settle and removing the supernatant.

3. Fat Injection

The processed fat is injected into the hands using fine cannulas. Key steps include:

• Anesthesia: Local anesthesia is applied to the hands.
• Small incisions: Tiny incisions are made to insert the cannulas.
• Layered injection: Fat is injected in small amounts at various depths to ensure even distribution and natural appearance.
• Molding: Gentle molding of the hands to shape the injected fat.

Postoperative Care

Proper postoperative care is crucial for optimal results and includes:

• Compression garments: Wearing compression garments on the donor sites to reduce swelling.
• Hand protection: Avoiding strenuous activities and protecting the hands from trauma.
• Follow-up visits: Regular follow-up appointments to monitor healing and fat survival.
• Managing expectations: Educating patients on the gradual improvement and potential need for touch-up procedures.

Possible Complications

While fat grafting to the hands is generally safe, complications can occur:

• Infection: Though rare, infection can occur at the donor or recipient sites.
• Fat necrosis: Small areas of fat may not survive, leading to lumps or cysts.
• Over or under-correction: Achieving the desired volume can be challenging, sometimes requiring additional procedures.
• Asymmetry: Uneven fat distribution can result in asymmetrical hands.
• Fat resorption: Some of the injected fat may be reabsorbed by the body, necessitating repeat treatments.

Different Techniques

Several techniques can be employed to enhance fat grafting outcomes:

• Microfat grafting: Injecting very small parcels of fat for better survival and smoother results.
• Nanofat grafting: Using even smaller fat particles to improve skin quality and texture.
• Combination with PRP: Mixing fat with platelet-rich plasma (PRP) to enhance graft survival and tissue regeneration.

Prognosis and Outcome

The prognosis for fat grafting to the hands is generally positive, with most patients achieving significant improvements in hand appearance. Outcomes include:

• Improved volume: Restoration of lost volume, making hands look fuller and more youthful.
• Enhanced skin quality: Smoother and more elastic skin.
• Natural appearance: Fat grafting provides a natural look and feel compared to synthetic fillers.
• Long-lasting results: With proper technique, the results can be long-lasting, although some fat resorption is expected.

Alternative Options

Alternative treatments to fat grafting include:

• Dermal fillers: Hyaluronic acid-based fillers can be used to add volume to the hands, though they are temporary.
• Laser treatments: Improve skin texture and reduce pigmentation.
• Chemical peels: Enhance skin quality and reduce fine lines.
• Sclerotherapy: Treats prominent veins but does not address volume loss.

Average Cost

The cost of fat grafting to the hands varies depending on several factors, including the surgeon’s experience, geographic location, and the extent of the procedure. On average, the cost ranges from $3,000 to $7,000. It is essential to discuss all associated costs during the consultation.

Recent Advances

Recent advances in fat grafting technology and techniques have improved outcomes and safety:

• Adipose-derived stem cells: Incorporating stem cells from fat to enhance regeneration and graft survival.
• Enhanced processing techniques: Improved methods of fat purification and enrichment.
• Minimally invasive techniques: Developments in minimally invasive fat harvesting and injection methods.