Why Nanofat Grafting Is Hotter Than Ever

Keri Stephens:
Hi. Welcome to The MEDQOR Podcast Network. This is Keri Stephens, the co-chief editor of plastic surgery practice. Thank you for joining me for this podcast episode. I’m so excited to have Dr. Alex Zuriarrain with us today, to discuss the rise of nanofat grafting, a topic he recently covered in an article for PSP. Dr. Zuriarrain is the founder of Zuri Plastic Surgery in Miami, where he specializes in aesthetic procedures of the face and body, including face lift, eyelid surgery, rhinoplasty, breast augmentation and reduction, abdominoplasty, liposuction, and the Brazilian butt lift. Dr Zuriarrain, thank you so much for joining us today.

Dr. Alex Zuriarrain:
Thank you. Thank you so much for having me.

Keri Stephens:
Yeah. No, we’re so glad to have you back. You know, you wrote this article on the topic, and I thought it was really good at describing it, but we wanted to get more in depth in the podcast, so to start out, can you just give us a history of nanofat grafting and why it’s growing in popularity?

Dr. Alex Zuriarrain:
Yeah, so all of this started when doctors, and specifically plastic surgeons, were trying to improve their results, especially with breast reconstruction procedures or doing augmentation of different areas of the body using fat. We have really, really done a lot of research in the last 15 to 20 years, regarding not just any type of fat that we want to transfer to these areas, but now more specifically, the use of nanofat. And nanofat is exactly what it’s trying to say, the word nano being very, very, very tiny particles of fat. We have found that the survivability of these nanofat grafting techniques is very, very good, and it creates a lot of improvements, not only in volume, but also in tissue architecture, tissue quality, skin quality, and so all of these are really revolutionizing plastic surgery.

Keri Stephens:
Yeah, and I have personally had an experience recently. I underwent more breast reconstruction post-mastectomy, and they did the fat grafting, and I will say, the results are so much better than before. I mean, it looks and feels more natural, and I guess that’s because it’s my own fat that they’re using. Just how do you think, specifically then, from the reconstruction, how is this changing the game for breast reconstruction patients in particular?

Dr. Alex Zuriarrain:
Yeah, in particular, breast reconstruction patients are getting a much softer breast appearance. It’s very hard to do breast reconstruction with implants and have a very natural result, so for the most part, especially thinner women that have very thin tissue envelopes, the addition of fat grafting is fantastic. It really augments the areas where the implants really can’t help you, which is really the upper pole, the cleavage area, and to get a more smooth, top to bottom shape for the breasts. And of course, the patients that have had radiation specifically, the radiation damages the skin and the soft tissue of the breast, so when we add stem cells with the fat grafting, it actually regenerates that tissue. It softens it, and it really improves the overall results.

Keri Stephens:
Yeah. Can you talk about the stem cells, and how that’s impacting the process?

Dr. Alex Zuriarrain:
Yeah, so the stem cells are really the workhorse of tissue regeneration. From the molecular standpoint, what they’re doing is basically helping to reduce inflammation. They’re increasing growth factors that help to stimulate tissue growth and tissue repair, so they are basically the regenerative medicine aspect of the fat grafting or the nanofat grafting procedures. And they’re really useful when you’re not only in the breast, for example, but also in the face, when we’re talking about facial fat grafting, especially for aging process, and helping even with some fine lines and wrinkles. We use plasma, which is basically the centrifuged blood that has stem cells in it, also, to do a lot of micro-needling procedures nowadays, for facial wrinkles and folds, and improving the skin texture.

Keri Stephens:
No, that’s really interesting. You mentioned the face and the breasts, but what are the other main body regions plastic surgeons are using nanofat grafting for?

Dr. Alex Zuriarrain:
Yeah. So the neck’s a good option as well. You know, if you want to get a more defined jawline, for example, that’s a great area to use it. Some people are using it in the brow. We use a very delicate needle, maybe a 27-gauge or 30-gauge needle, and we directly inject the fat into these furrows, or these brow lines, to soften up the brow. Basically, anywhere in the body that has kind of like a hardened look cosmetically, it will definitely improve in terms of contour and volume, with the nanofat grafting.

Dr. Alex Zuriarrain:
Now, nanofat grafting is very different than the Brazilian butt lift type of fat grafting. I want to make sure that our audience really understands the difference. When we talk about nanofat grafting, we’re talking about centrifuging the fat, meaning spinning it down, getting it to the micro-level, whereas when we do Brazilian butt lift surgeries, we’re not spinning that fat down for the most part. We’re keeping it totally intact, and we’re just going for volume in that case. And that’s a very different operation. It’s a very different body part, and the goals are very different when you’re doing nanofat grafting versus large-volume fat grafting.

Keri Stephens:
No, I think that’s a really good and important distinction. So what are the key advantages of nanofat grafting? And on the flip side, are there any disadvantages?

Dr. Alex Zuriarrain:
Yeah, so main advantages is that it’s very safe. This is not like using filler material, I’ll give you an example, hyaluronic acid or that type of material, that although yes, it can be degraded by hyaluronidase or one of these enzymatic breakdown medications, this is your own body tissue. This is yours. It’s autologous, meaning it comes from you. There’s not going to be any rejection of it. It’s not going to form nodules. It’s not going to somehow create an allergic reaction or cause some sort of systemic response. It’s very well accepted by your body, and the great thing about nano is that nano is very fine particles, so your body’s not having to try to get large chunks of fat to survive. Instead, it assimilates very easily into the existing space, the existing tissue architecture, and it does really well in terms of survival.

Dr. Alex Zuriarrain:
Now, the drawbacks of fat grafting, and it doesn’t matter where it is in the body, but if we’re talking about facial fat grafting with nanofat, you have to be careful that you don’t over-correct the problem, because unlike hyaluronidase or some of these other products that are off the shelf, that you can degrade with another enzymatic medication, these fat grafting procedures are not reversible, okay? So you have to be very judicious in your approach as a surgeon. You cannot try to over-correct. You can’t overfill with nanofat, because since the survival is so good, if you over-correct, you’re going to get a deformity that you’re not really going to be able to fix. So when it comes to the lower eyelids for example, where a lot of people don’t like the dark circles, and they want to improve the lower lids, if you over-correct there, they can end up with some extra fat in those areas, and that is not cosmetically appealing.

Keri Stephens:
No, that’s good. So, you said it is safe. Are there any side effects from this procedure?

Dr. Alex Zuriarrain:
You know, the initial reaction to any work is the injection procedures, whether it’s fillers, or fat, or even Botox. There’s going to be an initial inflammatory reaction by the patient, swelling, some types of bruising, minimal discomfort. But the great thing about fat on the long term is that unlike these synthetic substances, they don’t pump up or form nodules or calcifications that really need future surgery to remove. So for the most part, the long-term safety is far superior.

Keri Stephens:
And how much of the fat lasts, usually?

Dr. Alex Zuriarrain:
Yeah, so most of the literature for fat grafting has really been found to be about 30% of the fat is going to disappear in about six months, and you’re left with about 70% of the fat grafting. In my experience, the nanofat grafting has a higher survival rate, so almost around 80% of my injections are good to go, and they survive.

Keri Stephens:
That’s awesome, and in your practice, how often are you performing this procedure?

Dr. Alex Zuriarrain:
I’m doing this at least five days a week. I operate every single day, so it’s typically at least five patients a week that are interested in either lip fat grafting, under-eye fat grafting, nasolabial fold, underneath the eyelid of the lower lid or the tear trough area, a lot of breast fat grafting, and of course, then, the BBL’s a whole nother procedure. But the nanofat for the face, very, very popular. A lot of people are realizing that the off-the-shelf fillers are not the best when it comes to nodule formation later on down the line, and I think also, if you know by looking in the media, all the celebrities that are filling their faces with these products are looking kind of weird as they age.

Keri Stephens:
Yeah, it doesn’t always age well, no.

Dr. Alex Zuriarrain:
No.

Keri Stephens:
Yeah, that’s a… So do you ever foresee the kind of nanofat grafting of the face overtaking the fillers? Do you see that happening?

Dr. Alex Zuriarrain:
I do. I do see that happening, yeah, especially as plastic surgery continues to be very popular and a very common thing to do. A lot of people, I think [inaudible 00:10:29] the benefits of having the fat grafting while they’re asleep, is that they don’t have any pain, no discomfort during the injection.

Keri Stephens:
Yeah, and I think they seem more natural too, because it’s really your own body that’s providing this. I know for me, I felt that way. I was like it was kind of nice, and again, this is a reconstruction, totally different with the face, but just knowing that what you’re putting in is really your own body. So you’re not putting the fillers into your face. You’re putting parts that are really your own, so-

Dr. Alex Zuriarrain:
Yeah, and I think it really ties into the concept of breast implant removal. This is a very hot topic right now in plastic surgery nationwide. A lot of women are seeking to remove their implants that they’ve had for 10 years or 15 years, and a lot of patients are getting symptom relief from removal of their breast implants. So I think we’re all trying to go more organic, more natural, getting away from synthetic products. You know, as plastic surgeons, we’ve really been the pioneers of the synthetic substances that we’ve been using, with very good success, but if we can avoid using synthetic substances and using more of our own body tissue, then I think we’re going to have a much better outcome in the long run.

Keri Stephens:
And are you seeing any people that are removing their breast implants, and because then they probably feel like a pancake look, that then they’re just injecting their own fat, they’re doing the fat grafting to kind of-

Dr. Alex Zuriarrain:
Yes, so that is very common, and that’s almost kind of in the reconstruction category, almost, so I’d put those two together. But yes, the sequence of that is first take out the implants, let everything settle down for about six months. Once you get your final breast position and shape, then you can go ahead and fat graft safely and with better survivability.

Keri Stephens:
And then you also get the benefits of liposuction too, like tighten up a little place you don’t like.

Dr. Alex Zuriarrain:
Exactly.

Keri Stephens:
It’s probably a win-win, I mean, for a lot of people. Okay, so in your article, you mentioned the positive psychological effects of nanofat grafting. Can you elaborate on that for a bit?

Dr. Alex Zuriarrain:
Yeah, so I mean [inaudible 00:12:37] procedures in plastic surgery, when you are doing these types of facial rejuvenation, for example, with nanofat, it really changes people’s perspective about themselves, the way they look, the way that they feel. That’s a really critical component of this fat grafting technique, is that we can avoid making major incisions like face lift incisions, and we can do a lot just with the fat. So psychologically, people feel better about themselves, their self-esteem improves, and that correlates to the way they interact with other people in their daily lives, in their work life, their family life, their relationships. So that, I think, is very positive when it comes to the fat grafting.

Keri Stephens:
Yeah. Okay, and for a final question, is there anything else you think PSP readers and listeners of The MEDQOR Podcast Network should know about nanofat grafting, and that you want to tell them?

Dr. Alex Zuriarrain:
Yes. I don’t have any proprietary interest in this company, but they’re called Tulip Medical. I don’t have any stock or anything. Wish I did, actually. But they’re one of the leaders and the front runners in nanofat, so if you’re looking to have this procedure done and you’re maybe getting some consultations where you live, ask the doctor, be straightforward and say, “What kind of equipment do you use to do nanofat? Have you heard of Tulip Medical? I’d be interested to know what’s the technique we use to centrifuge your fat or prepare your fat.” Those are all fair questions any board-certified plastic surgeon would be more than happy to discuss his or her technique on nanofat grafting. All of us are a little bit different, but the whole point is, is that we are getting the fat to its microscopic level. It’s important that everybody out there understand that this is very different from the large-volume structural fat grafting.

Keri Stephens:
No, that’s so helpful, and thank you so much, Dr. Zuriarrain. We really appreciate what you’ve shared with us today, and hope it’s really informative to our listeners. To check out the latest in plastic surgery news, please visit plasticsurgerypractice.com. And until next time, take care.

Dr. Alex Zuriarrain:
Thank you.