In one study of 38 HIV patients who were treated with fat transfer, researchers graded the results at 1 year on a scale from 1 to 4, with 4 being excellent. The mean score reported by the patients was 3.7 and the mean score reported by the surgeon who performed the procedure was 3.2 (Plast. Reconstr. Surg. 2004;114:551-5). No serious adverse effects were observed.
In a separate study of 33 HIV patients who were treated with fat transfer and surveyed 1 year later, 93% of patients reported being satisfied (14 reported being very satisfied and 17 reported being partly satisfied). Furthermore, 81% (27 patients) reported an improved quality of life.
Three independent evaluators reported a 52% improvement in the area treated at 1 year (Arch. Dermatol. 2005;141:1220-4). No significant complications were observed.
In Dr. Reyter's clinical experience, some patients might need another fat transfer at 1 year, "but even so, a year is a significant improvement, especially for a procedure that didn't entail a lot of risk, didn’t have a lot of cost of consumables, and resulted in a benefit for a person."
In another study, researchers used computed tomography analysis and volume calculating software to evaluate the effects of fat transfer in 26 patients (18 men and 8 women aged 34-59 years) with HIV (Aesthetic Surg. J. 2008;28:380-6). The investigators observed increasing volumes of fat after 1 year, leading some to speculate that fat transfer may involve the transfer of stem cells.
"Are stem cells somehow influencing this result?" Dr. Reyter asked, adding that the data on stem cells in fat transfer are inconclusive. "Stem cells have been shown to be present in fat, and they have been shown to be transferred."
According to Dr. Reyter, his pretreatment protocol is the same as for tumescent liposuction: a CBC test; CD4 measurement; a viral load test; confirmation serum transaminases levels are not elevated; and clearance from the primary care physician.
"An important step is marking," he added. "I like to view the sites of deficit as triangles on the face. I make a topographical overlay. After we numb up the area, a lot of that numbing will distort the facial architecture. So if youdidn’t do a good marking job beforehand, your landmarks will be distorted."
For the fat transfer procedure Dr. Reyter uses small, blunt microcannulas. To harvest donor fat, he uses a straight Coleman harvesting cannula connected to a 10-cc syringe.
"I harvest on manual pressure, and then I let the fat sit to allow it to separate" he said. "There's a lot of debate as to whether or not you should spin the fat. I prefer to do nothing that would introduce trauma to the fat or to expose the fat to contamination."
He uses a 1-cc syringe attached to a blunt-tipped 18-gauge cannula to re-inject the fat, injecting 0.1-0.2 cc per pass on withdrawal.
The donor harvesting of fat takes about 20-30 minutes, allowing the fat to sit takes about 10-12 minutes, and reinjecting the fat takes about 30 minutes. "The whole procedure can take an hour to an hour and 15 minutes to do 20-30 ccs of fat per side, which I think is pretty efficient," he remarked.
Typical filling volumes are 10-20 cc for each cheek, 5-8 ccs for the temple, and 5-10 ccs for nasolabial folds. "Edema during and after fat transfer is common," said Dr. Reyter. "Because of this you have to overfill by 25%-50%. That’s where the skill comes in."
The procedures appear to change the overlying skin texture, "producing a global rejuvenation effect," he said. "It brings people back to speculating what the role of stem cells is."
To date there have been no serious complications since the lipodystrophy clinic opened its doors, said Dr. Reyter, who estimated that 25%-50% of his current clinical work involves fat transfer.
"There is a high degree of patient satisfaction at 6-12 months, and very few touch-ups are necessary," he said.
The responses from patients who have gone through the fat transfer procedure "have been overwhelmingly positive," he added. "So many patients tell us that their lives have been transformed."
For example, one patient with severe facial atrophy and longstanding unemployment was able to finally find employment after the fat transfer – "because he no longer looked so ill," Dr. Reyter said. "Another patient just wrote 'thank you for my new face. ... I look so healthy!' The doctors in the clinic regularly receive thank you notes and tokens of appreciation from the patients – in my experience, much more than we typically get in the course of providing any other medical care."