Doctors 'recycle fat' to reconstruct body
Liposuction is not usually something you can get on the NHS, but in special circumstances you now can.
'Fat grafts' use fat extracted from a patient though liposuction to correct body asymmetries arising from birth, trauma or cancer surgery.
Because the fat comes from the patient, there is no chance of rejection, and surgeons are achieving increasingly sophisticated results in re-sculpturing the body.
The grafts are now being used in lieu of more complex surgery or in place of implants.
Consultant plastic and reconstructive surgeon Fazel Fatah performs plenty of liposuction in his private work at Birmingham's Westbourne clinic.
The technique has been refined somewhat since the early days - he now uses a laser to melt fat beneath the skin before sucking it out.
Traditional liposuction requires more elbow grease, with surgeons having to literally vacuum up the solid fat beneath the skin.
The applications of liposuction have also moved on. Fat grafts using fat harvested from liposuction are now being used in the cosmetic sector to refine the results of face lifts and pump up cheeks.
But Mr Fatah is also using the techniques at Birmingham City Hospital for reconstructive NHS surgery.
"The technique for fat grafts is called lipo modelling. We use small syringes and very fine cannula to take the fat," he says, pointing to the long metal tubes he uses to suck the fat out.
Getting the fat out is the easy bit. Putting it back in again is more complex. Once the fat has been centrifuged to remove liquid and oil, it has to be painstakingly applied to the area to be augmented as fine lines.
"The technique is absolutely vital because without using the correct technique, fat graft doesn't work and can cause a lot of problems," Mr Fatah says.
"You cannot leave big blobs of fat in the tissues because that doesn't take as a graft.
"Instead you have to use tiny particles like little beads along separate lines, and also you do that in multiple planes so you have a three-dimensional lattice of tiny particles of fat."
The procedure can also be conducted as day surgery and will not result in the scarring that may come with more intrusive surgery.
"We use it a great deal in breast abnormalities and also in conjunction with breast reconstruction," says Mr Fatah, who is also the president of the British Association of Aesthetic Plastic Surgeons.
"Sometimes we use it instead of implants, which is a very good thing for the patient not to have an implant and have the worries of needing more surgery in the future."
"If, after tissue transfer forming a new breast, you still look at the patient and you haven't got it quite right - there's an element of asymmetries or contour irregularities - you can use fat grafts to iron these things out.
"[The grafts] enhance the quality of the reconstruction and makes the patient feel better about themselves and the result of the surgery."
On his computer are images of another case where fat has been used to repair a defect from birth - a man who was born with part of his chest muscle missing close to his armpit.
"This is a deformity that normally patients are born with whereby they don't have a part of the pectoralis major muscle.
"We've taken fat from the patient's abdomen and the hips, and in two stages we've been able to reconstruct all of that missing part of the muscle."
Fat grafts, he says, are one example of where procedures developed and refined in the cosmetic industry are finding a non-cosmetic application.
"If we do breast reconstruction, we're no longer satisfied just by producing mounds on the chest for the patient to wear a bra over.
"We want that patient to feel comfortable taking that bra off and looking at her body and seeing two symmetrical looking breasts - and all these techniques, many of them, come from developments in cosmetic surgery."