Dr. Little’s Philosophies
Structural Fat Graft in Facial Rejuvenation
The placement of living fat grafts harvested with blunt needles from the hip and positioned in the face with similar needles is a safe, predictable, long-lasting technique in rejuvenation surgery that has been mastered by an increasing number of plastic surgeons worldwide. When performed with taste and restraint, it brings impressive–yet entirely natural–improvments to the face, but especially the eyes and the mouth, that Dr. Little feels he could not otherwise offer.
The Challenge of Fat Graft
It is not, however, a simple technique that is easily learned, and many inexpert practitioners of fat graft have created undesirable results, including lack of graft take (no improvement) or, much worse, visible irregularities that are then difficult (if not impossible) to correct, especially in the challenging area of the eyelids. Thus has fat graft remained a controversial technique for some plastic surgeons, who have then contributed to an environment of misinformation surrounding it (Dr. Little is happy to discuss any aspect of such “misinformation” during the consultation). Suffice it to say that among those surgeons who have invested the time and commitment to learn this clinical art (Dr. Little didn’t consider himself a true expert in fat graft until ten years into his experience), the benefits of structural fat graft to their patients have proven considerable, bringing enhancements that could not otherwise have been achieved.
A Pioneering Role in “Micro” Fat Graft
To address the special challenges of the lower eyelid in early fat graft, Dr. Little–along with French plastic surgeon Frank Trepsat–became the first to advocate (in the same issue of the same 2001 journal) smaller needle size for fat graft to this delicate area (see: about Dr. Little / abbr. C.V. Part II: publications #112, #131, and #142). Since that time, such “micro” fat graft remains his preferred choice to reverse the volume deficiencies of the eyelids and the lips (where he continues to utilize the identical ultra-fine needle he originally presented). In fact, fat graft throughout the face is now performed by most plastic surgeons through similar “micro” needles. Furthermore, there is increasing evidence that fat graft brings overall improvements to the grafted regions that go beyond mere volume enhancement–especially to the quality of the overlying skin, probably through the addition of fat-based (mesenchymal) stem cells. While this further benefit remains unproven, many (including Dr. Little) believe that skin quality, color, and texture improve in areas that have been properly treated with fat graft. Dr. Little remains as well-recognized for his expertise in fat graft (especially to the challenging region of the eyelids), as for his facelift skills. He regularly delivers lectures and teaching courses on his fat graft technique to plastic surgeons at home and abroad (more than 80 since 2010).
Fat Graft Alone
While Dr. Little has added fat graft to all of his facelift and eyelid cases for many years, he now also performs fat graft alone, without surgery, in an increasing number of patients, especially those who feel they have developed hollow eyes or sunken cheeks before their time.
Illustration: detail from Leonardo da Vinci (?), “Annunciation,” ca. 1475, Galleria degli Uffizi, Florence