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Assuming you’ve read part one, this is gonna be part two on the purification/filtering process ANDD injecting the fat. After all this is done I honestly might just combine both parts into one giant guide. This is messy formatting and I apologize
I’m going to first begin with the machine assisted lipo thing that I said I’d get into in this part..
Continuing onwards..
For one thing, you’d begin this process by blocking off the port to the graft bags. You wont be using those until maybe the end. Next, after filling up your harvesting syringe, you must detach it from the system and allow it to sit for around 45 minutes for the decantation process. You’d need to put on a syringe cap to prevent the fluid from leaking out.
The fluids will separate and the blood will flow to the bottom and oils will flow to the top.
You should leave it to sit upright in this manner, so that after it’s done sedimenting you’re able to just squirt out the unwanted fluids.
But sadly it doesn’t end here. Since the unwanted oils end up at the TOP of the syringe, you are gonna connect this to the stopcock again and pass the fluid into another syringe (around 3-5cc). This time, you will only be passing the middle fat layer, leaving the unwanted oils behind in the original syringe.
I feel like this image is a perfect way to capture it. You can see they are connecting two syringes, and they passed down the fat layer into the other syringe, but are leaving the light yellow oily layer behind.
Now after the unwanted fluids are out (finally), it’s time to refine the fat particles and shrink them. This is because we want do to MICROFAT GRAFTING rather than macro, because micro (as listed in part 1/2) is best used for facial volume restoration.
How do we do this? Well during the size refinement process, surgeons often pass the fat through two different syringes in order to break up large globules, and even out the fat. This is a crucial part of the process.
In order to do this, you’ll be reusing the stopcock again, and replacing the tubing/harvesting cannula with a 3mL LUER LOCK SYRINGE. This 3mL syringe is would be your INJECTING syringe to inject the fat into yourself.
Now, you will place the stopcock nob on the collection bag pathway since you won’t be using it. Then you will slowly pass the fat between your harvesting syringe into your injection syringe 10-15 times. I should’ve added this in part one, but make sure the stopcock diameter is around 2.4mm (ideal for microfat). If it isn’t, you should buy a 2.4mm transfer adapter instead to pass the fat.
How do you know when your fat is blended up enough?
This part is sadly unpredictable, you will only be able to rely on your eyes to understand what size fat particles you have. Unless you have some thousand dollar microscopic telescope. You don’t want to accidentally shred your particles into nanofat, as that is only used for small refinements like skin rejuvenation instead of actual structural volume restoration.
How do you tell what size your particles are? Well nanofat is a lighter almost yellow shade, and microfat is still a darker orange.
If you start seeing your syringes turn light yellow, you’ve shredded your particles into nanofat. Congrats, you fucked it up. It apparently takes 30 passes to emulsify it into nanofat, so don’t get up to that point
I haven’t mentioned using the port which leads to the collection bag yet so you may be wondering what that’s for. Well, if you wind up with any extra fat, you can use the stopcock and squeeze the fat from the syringe directly into that bag. Sadly, the remaining time you would have is 12-24 hours to use that extra fat. You’d have to store it in a medical grade 4° fridge. The longer it’s stored, the worse quality it will be.
Tools added:
Syringe cap
Another syringe around 3-5cc for the pure fat
2.4mm transfer adapter if needed
3ml luer lock syringe for injecting
Manual syringe lipo method:
You will basically do the same stuff as I listed for the machine method. Go read up. After you are done harvesting, you need to leave your syringe facing a certain way for 45 mins so you can squirt the blood and unwanted fluids out.
Afterwards, you will be using a syringe connector or also known as a luer lock transfer adaptor(2.4mm). You’ll use this and pass the fluids through it into another syringe and stop 8/10 the way through (just an imaginary estimation) so you leave the unwanted excess oil behind in the og syringe. Now you have a syringe full of just fat.
You will then utilize the transfer adaptor again and remove the syringe with oil out of it. Replace it with another syringe of the same size. This is so you can do size refinement. You will then repeatedly pass the fat between your syringes 10-15 times.
After this step your fat is complete, and ready to inject.
You’re not gonna wanna inject with a 10cc syringe, so you can use the adaptor to squirt your fat into a smaller syringe (3ml) for injecting.
Tools added:
Syringe cap
Luer lock transfer adaptor 2.4mm
Two 10cc or 60cc syringes for the pure fat
3ml luer lock syringe for injecting
Injecting:
If you’ve had prior experience injecting yourself with diy fillers and stuff like that, this wont be much of a foreign concept for you to grasp.
Unfortunately, microfat is usually injected with pretty low gauge cannulas.
I asked this one plastic surgery forum about what size cannula they use with microfat, and one of the surgeons replied with this.
.7mm-1mm in diameter= 20-24 gauge cannulas. These are pretty damn thick
but you’ll have to use them in order to be safe and preserve the fat particle size.
As for the length, 5-9cm long cannulas are usually used on more sensitive areas like the tear troughs, and can go up to 15cm for bigger facial areas like the jawline and cheeks.
Numbing:
Since you’re gonna be going through the subcutaneous layer, it’ll be helpful for you to inject a few more mL of lidocaine into the recipient area. I made sure to recommend
45mg/kg of lidocaine for the tumescent solution even tho the max is 50mg/kg, so that way you still have some leeway to use more for this part.
Epinephrine is also sometimes used along with lido for your injection site to control bleeding. For areas on the face 1-5ml of 0.5-1% lidocaine is usually used. With epinephrine you would want to use an incredibly dilute amount (1:1,000,000), (it’s supposed to be mild). So for example if u wanna use 5ml of lido for an area, you would only use .005mg of epinephrine. But then again that’s a lot of more complicated math, and if you wanna take a risk and do it without epinephrine go ahead.
Also in my opinion you should be staying around 1-3ml of lidocaine no matter how much you think it’ll hurt, just to be safe with your dosages since you already would’ve injected god knows how much into your harvesting area.
Injecting regular filler and injecting fat are very comparable pain wise.
Overcorrection:
Because there’s only a certain percentage of injected fat cells that will wind up surviving, overcorrection aka intentional overfilling is typically done during this procedure. This step is a reason why some patients leave unsatisfied, because they either A. End up losing only a small percentage of fat cells, so now they are stuck with an overfilled appearance, or B. They end up losing a lot of the cells and didn’t inject enough in the first place.
How can you tell you’ve filled enough? You can’t really. But you can make an educated guess.
The quality of the cells harvested, the technique in which you injected, and of course the amount of mL injected are all key factors.
People typically aim for 10-20% overcorrection in the face.
Technique:
Like for most fillers, a canulla will be used to inject the fat into the face. The fanning technique or threading technique are the most common methods used depending on the area of the face.
This is such a helpful chart that provides imagery on each filler technique.
Microdroplets:
The SIZE of the blobs of fat you will be injecting under the skin are very important. You want to be using MICRODROPLETS instead of fat blobs since smaller droplets have higher survival (because their center can get oxygen/nutrients easier). Microdroplets are gonna be like 0.1ml each. Which means this process is gonna be LONG and precise, you’ll be doing tons of passes.
Aside from the fact that the spot looks fucking painful to be injecting in, in this video u can see how they use little amounts at a time
There are guides EVERYWHERE about how to inject into certain parts of the face. Standard filler guides usually include that stuff. Follow those for specifics. It’s generally the same deal, BUT with fat grafting you want to overcorrect by 20% don’t forget that. With fillers they are always gonna tell you that less is more, but less is not more when it comes to fat grafting. They may want you to use “2 ml” in the chin (FOR EXAMPLE), but go for 3ml instead. But just because I’m mentioning overcorrection, that’s not me saying you should be injecting big globs into your face. I’ll say this again, you must layer microdroplets only.
Tools added:
Low gauge cannula ~25g, yikes
Marker to mark injection sites
Sterile gauze wipes incase of bleeding
Aftercare:
You can expect bruising and swelling just like with regular filler, certain areas are more prone to it than others. You need to avoid compression on the area/s you injected with fat, don’t touch them and let them breathe. Don’t sleep on your side or stomach. Don’t use strong skincare products, or do vigorous face washing. Avoid strenuous activity/exercise, as well as hot environments like the sauna. The fat will slowly stabilize itself over the course of ~2 months.
The first 48 hours are the most important. Follow protocol.
Fat grafting RISKS:
Thank you to @Ghoultune and @Histy for asking about risks on part 1/2, here we go
Well to start off, I will mention the most dangerous risk of the procedure
-Fat embolism is a risk where fat globules enter your bloodstream. Causing blockage and inflammation. This is very serious and is actually the reason why fat grafting has been fatal. Yes people have died from it. Due to the fat entered their veins have travelled to their heart/lungs. This is a reason why BBLs are literally one of the most dangerous surgeries ever. This fatal risk can be easily minimized if you just STAY IN THE SUBQ LAYER. Do NOT inject fat any deeper than that (water), and ALWAYS aspirate especially when it comes to a procedure like this. If fat enters a blood vessel it’s wraps. The risk is much lower in the subq layer, but that doesn’t mean it’s completely rid of blood vessels.
-Infection is also a risk, which is to be expected since this involves injecting. You just need to keep your environment sterile, and make sure to wipe your injection site beforehand with chlorhexidine wipes (antiseptic final boss). Gauze will be used to cover up the wounds too. I also mentioned GLOVES will be used during this whole thing.
-Fat necrosis (every filler user knows about this) will happen from fat cells being injected and not receiving proper nutrients/oxygen so they die. injecting too superficially and/or injecting droplets that are too large, compression, and bad distribution increases this risk. Just remember what I said about injecting microdroplets only. Necrosis is not the end of the world, the body will end up breaking down the dead fat and it’ll be metabolized. But in turn, you can be left with scar tissue, bruising, and…
-Oil cysts. The dead fat can liquify into a cyst. These usually just go away on their own overtime.
Those are pretty much all the risks. Which goes to tell you this is all 100% achievable.
Should I just put all this framework (this part and first part) into one big thread?
@ecoli @Chainsandwhips2 @sparkle @foidslayer @LaWi
I’m going to first begin with the machine assisted lipo thing that I said I’d get into in this part..
Continuing onwards..
For one thing, you’d begin this process by blocking off the port to the graft bags. You wont be using those until maybe the end. Next, after filling up your harvesting syringe, you must detach it from the system and allow it to sit for around 45 minutes for the decantation process. You’d need to put on a syringe cap to prevent the fluid from leaking out.
The fluids will separate and the blood will flow to the bottom and oils will flow to the top.
You should leave it to sit upright in this manner, so that after it’s done sedimenting you’re able to just squirt out the unwanted fluids.
But sadly it doesn’t end here. Since the unwanted oils end up at the TOP of the syringe, you are gonna connect this to the stopcock again and pass the fluid into another syringe (around 3-5cc). This time, you will only be passing the middle fat layer, leaving the unwanted oils behind in the original syringe.
I feel like this image is a perfect way to capture it. You can see they are connecting two syringes, and they passed down the fat layer into the other syringe, but are leaving the light yellow oily layer behind.
Now after the unwanted fluids are out (finally), it’s time to refine the fat particles and shrink them. This is because we want do to MICROFAT GRAFTING rather than macro, because micro (as listed in part 1/2) is best used for facial volume restoration.
How do we do this? Well during the size refinement process, surgeons often pass the fat through two different syringes in order to break up large globules, and even out the fat. This is a crucial part of the process.
In order to do this, you’ll be reusing the stopcock again, and replacing the tubing/harvesting cannula with a 3mL LUER LOCK SYRINGE. This 3mL syringe is would be your INJECTING syringe to inject the fat into yourself.
Now, you will place the stopcock nob on the collection bag pathway since you won’t be using it. Then you will slowly pass the fat between your harvesting syringe into your injection syringe 10-15 times. I should’ve added this in part one, but make sure the stopcock diameter is around 2.4mm (ideal for microfat). If it isn’t, you should buy a 2.4mm transfer adapter instead to pass the fat.
How do you know when your fat is blended up enough?
This part is sadly unpredictable, you will only be able to rely on your eyes to understand what size fat particles you have. Unless you have some thousand dollar microscopic telescope. You don’t want to accidentally shred your particles into nanofat, as that is only used for small refinements like skin rejuvenation instead of actual structural volume restoration.
How do you tell what size your particles are? Well nanofat is a lighter almost yellow shade, and microfat is still a darker orange.
If you start seeing your syringes turn light yellow, you’ve shredded your particles into nanofat. Congrats, you fucked it up. It apparently takes 30 passes to emulsify it into nanofat, so don’t get up to that point
I haven’t mentioned using the port which leads to the collection bag yet so you may be wondering what that’s for. Well, if you wind up with any extra fat, you can use the stopcock and squeeze the fat from the syringe directly into that bag. Sadly, the remaining time you would have is 12-24 hours to use that extra fat. You’d have to store it in a medical grade 4° fridge. The longer it’s stored, the worse quality it will be.
Tools added:
Syringe cap
Another syringe around 3-5cc for the pure fat
2.4mm transfer adapter if needed
3ml luer lock syringe for injecting
Manual syringe lipo method:
You will basically do the same stuff as I listed for the machine method. Go read up. After you are done harvesting, you need to leave your syringe facing a certain way for 45 mins so you can squirt the blood and unwanted fluids out.
Afterwards, you will be using a syringe connector or also known as a luer lock transfer adaptor(2.4mm). You’ll use this and pass the fluids through it into another syringe and stop 8/10 the way through (just an imaginary estimation) so you leave the unwanted excess oil behind in the og syringe. Now you have a syringe full of just fat.
You will then utilize the transfer adaptor again and remove the syringe with oil out of it. Replace it with another syringe of the same size. This is so you can do size refinement. You will then repeatedly pass the fat between your syringes 10-15 times.
After this step your fat is complete, and ready to inject.
You’re not gonna wanna inject with a 10cc syringe, so you can use the adaptor to squirt your fat into a smaller syringe (3ml) for injecting.
Tools added:
Syringe cap
Luer lock transfer adaptor 2.4mm
Two 10cc or 60cc syringes for the pure fat
3ml luer lock syringe for injecting
Injecting:
If you’ve had prior experience injecting yourself with diy fillers and stuff like that, this wont be much of a foreign concept for you to grasp.
Unfortunately, microfat is usually injected with pretty low gauge cannulas.
I asked this one plastic surgery forum about what size cannula they use with microfat, and one of the surgeons replied with this.
.7mm-1mm in diameter= 20-24 gauge cannulas. These are pretty damn thick
but you’ll have to use them in order to be safe and preserve the fat particle size.As for the length, 5-9cm long cannulas are usually used on more sensitive areas like the tear troughs, and can go up to 15cm for bigger facial areas like the jawline and cheeks.
Numbing:
Since you’re gonna be going through the subcutaneous layer, it’ll be helpful for you to inject a few more mL of lidocaine into the recipient area. I made sure to recommend
45mg/kg of lidocaine for the tumescent solution even tho the max is 50mg/kg, so that way you still have some leeway to use more for this part.
Epinephrine is also sometimes used along with lido for your injection site to control bleeding. For areas on the face 1-5ml of 0.5-1% lidocaine is usually used. With epinephrine you would want to use an incredibly dilute amount (1:1,000,000), (it’s supposed to be mild). So for example if u wanna use 5ml of lido for an area, you would only use .005mg of epinephrine. But then again that’s a lot of more complicated math, and if you wanna take a risk and do it without epinephrine go ahead.
Also in my opinion you should be staying around 1-3ml of lidocaine no matter how much you think it’ll hurt, just to be safe with your dosages since you already would’ve injected god knows how much into your harvesting area.
Injecting regular filler and injecting fat are very comparable pain wise.
Overcorrection:
Because there’s only a certain percentage of injected fat cells that will wind up surviving, overcorrection aka intentional overfilling is typically done during this procedure. This step is a reason why some patients leave unsatisfied, because they either A. End up losing only a small percentage of fat cells, so now they are stuck with an overfilled appearance, or B. They end up losing a lot of the cells and didn’t inject enough in the first place.
How can you tell you’ve filled enough? You can’t really. But you can make an educated guess.
The quality of the cells harvested, the technique in which you injected, and of course the amount of mL injected are all key factors.
People typically aim for 10-20% overcorrection in the face.
Technique:
Like for most fillers, a canulla will be used to inject the fat into the face. The fanning technique or threading technique are the most common methods used depending on the area of the face.
This is such a helpful chart that provides imagery on each filler technique.
Microdroplets:
The SIZE of the blobs of fat you will be injecting under the skin are very important. You want to be using MICRODROPLETS instead of fat blobs since smaller droplets have higher survival (because their center can get oxygen/nutrients easier). Microdroplets are gonna be like 0.1ml each. Which means this process is gonna be LONG and precise, you’ll be doing tons of passes.
Aside from the fact that the spot looks fucking painful to be injecting in, in this video u can see how they use little amounts at a time
There are guides EVERYWHERE about how to inject into certain parts of the face. Standard filler guides usually include that stuff. Follow those for specifics. It’s generally the same deal, BUT with fat grafting you want to overcorrect by 20% don’t forget that. With fillers they are always gonna tell you that less is more, but less is not more when it comes to fat grafting. They may want you to use “2 ml” in the chin (FOR EXAMPLE), but go for 3ml instead. But just because I’m mentioning overcorrection, that’s not me saying you should be injecting big globs into your face. I’ll say this again, you must layer microdroplets only.
Tools added:
Low gauge cannula ~25g, yikes
Marker to mark injection sites
Sterile gauze wipes incase of bleeding
Aftercare:
You can expect bruising and swelling just like with regular filler, certain areas are more prone to it than others. You need to avoid compression on the area/s you injected with fat, don’t touch them and let them breathe. Don’t sleep on your side or stomach. Don’t use strong skincare products, or do vigorous face washing. Avoid strenuous activity/exercise, as well as hot environments like the sauna. The fat will slowly stabilize itself over the course of ~2 months.
The first 48 hours are the most important. Follow protocol.
Fat grafting RISKS:
Thank you to @Ghoultune and @Histy for asking about risks on part 1/2, here we go
Well to start off, I will mention the most dangerous risk of the procedure
-Fat embolism is a risk where fat globules enter your bloodstream. Causing blockage and inflammation. This is very serious and is actually the reason why fat grafting has been fatal. Yes people have died from it. Due to the fat entered their veins have travelled to their heart/lungs. This is a reason why BBLs are literally one of the most dangerous surgeries ever. This fatal risk can be easily minimized if you just STAY IN THE SUBQ LAYER. Do NOT inject fat any deeper than that (water), and ALWAYS aspirate especially when it comes to a procedure like this. If fat enters a blood vessel it’s wraps. The risk is much lower in the subq layer, but that doesn’t mean it’s completely rid of blood vessels.
-Infection is also a risk, which is to be expected since this involves injecting. You just need to keep your environment sterile, and make sure to wipe your injection site beforehand with chlorhexidine wipes (antiseptic final boss). Gauze will be used to cover up the wounds too. I also mentioned GLOVES will be used during this whole thing.
-Fat necrosis (every filler user knows about this) will happen from fat cells being injected and not receiving proper nutrients/oxygen so they die. injecting too superficially and/or injecting droplets that are too large, compression, and bad distribution increases this risk. Just remember what I said about injecting microdroplets only. Necrosis is not the end of the world, the body will end up breaking down the dead fat and it’ll be metabolized. But in turn, you can be left with scar tissue, bruising, and…
-Oil cysts. The dead fat can liquify into a cyst. These usually just go away on their own overtime.
Those are pretty much all the risks. Which goes to tell you this is all 100% achievable.
Should I just put all this framework (this part and first part) into one big thread?
@ecoli @Chainsandwhips2 @sparkle @foidslayer @LaWi
