Structural Fat Grafting

The site selected to harvest the fat does not seem to affect the outcome; therefore I let the patients choose, or I use whatever site is most convenient. A 2-mm diameter (15 or 23 cm length) blunt cobra cannula is used so the fat is harvested in small parcels, as globules—with the idea that it will fit through the aperture of a 10-mL Luer-Lok® syringe (Becton/Dickerson [B-D®], Franklin, NJ). Fat harvested with a large cannula (eg, 9 mm) may not survive the mechanical trauma of being forced through the lumen of a small cannula during placement. Some surgeons use a syringe that results in a very high harvest pressure. I just pull back the 1-mL marker on the 10-mL syringe and maintain gentle suction as fat accumulates. I almost always use epidural or local anesthesia for harvesting. The local area is infiltrated with Ringer's lactate, 1:400,000 epinephrine. When using local anesthetic alone, I use 0.5% lidocaine with 1:200,000 epinephrine, infiltrated at a ratio of 1 to 1 for the planned harvest. …