Rainy day funds: The fat banking era is here

There are plenty of places to store and protect what's important. You've got financial banks, blood banks, fertility banks and even food banks, but have you heard of "fat banks"? There is an emerging trend of harvesting and storing your own fat cells for later use in plastic surgery procedures.

"Fat banking" is gaining more attention in the United States. However, fat banking is a process that differs from a surgeon harvesting a patient's fat and storing it in a freezer in their office. Fat banking is a specific cryopreservation and storage practice.

ASPS Member Surgeons Darren Smith, MD, and Kristy Hamilton, MD, share their thoughts on fat banking and help answer some of the most crucial questions patients have on the procedure and whether it's right for you.

ASPS: What is "fat banking," and how is the fat harvested and stored?

Dr. Hamilton: Fat banking is the cryopreservation and storage of a patient's live adipose tissue for use at a later date. This allows a patient to receive several rounds of fat grafting from a single harvest, allowing for higher volumes of fat to be transferred over time, with subsequent transfers happening without general anesthesia and the recovery of multiple rounds of liposuction.

The tissue is sent to a specialized lab, processed with minimal manipulation to remove waste and dead cells and cryopreserved using Tissue & Cell Technologies' proprietary process. It is then stored in liquid nitrogen at -190 degrees Celsius. The surgeon then calls back volumes of the patient's fat for subsequent fat grafting, which is ready to load into syringes and inject under local anesthesia in the comfort of the clinic.

ASPS: Who are good candidates for fat banking?

Dr. Smith: To be a good candidate for fat banking, you should be in good overall health and have enough fat available to bank, though smokers are generally not ideal candidates for this procedure.

ASPS: How much fat do you need to bank, and what procedures can this fat be used for?

Dr. Smith: How much fat you need to bank depends on what you want to do with it, and the two major procedures for using banked fat are fat transfer to the breasts and fat transfer to the buttocks.

Dr. Hamilton: Tissue & Cell Technologies can receive 50 cc to 2000 cc of lipoaspirate per kit. A surgeon can harvest more than one kit per patient, but generally, 2000 cc of volume is sufficient for most applications.

The fat can be used for fat grafting to subcutaneous tissue sites of the same patient. This generally consists of fat grafting to the breast, buttocks and face, including breast augmentation (with or without an implant), breast reconstruction (with or without an implant), Brazilian butt lift, facial fat grafting (for volume and/or rejuvenation), treatment of scars and treatment of other volume deformities. Future applications include the use of adipose-derived stem cells for the healing of various orthopedic indications, but will require FDA approval to allow tissue labs to expand cell lines.

ASPS: Can fat banking be done over the course of several sessions?

Dr. Hamilton: Yes, the advantage of fat banking is that it allows several treatments for the patient from a single operative harvest, though a patient may choose to undergo liposuction again to harvest more. Once preserved, the tissue can remain in a bank for several years. Most plastic surgery applications – breast, butt, face, etc. – can be achieved with serial fat grafting within a year. Any leftover on the bank can remain on the bank for future uses – facial filler, orthopedic indications to come, etc.

ASPS: What testing is done to ensure the fat is sterile and viable before storage?

Dr. Smith: Testing is proprietary to the banking facility, but it is thoroughly tested to ensure it is safe for use.

ASPS: What percentage of stored fat typically survives thawing?

Dr. Hamilton: Tissue viability samples at thaw/return generally fall into the 85 to 95 percent viability range, in comparison to the 75 to 85 percent viability range in tissue tested at receipt from the surgeon. Higher viability at return is expected because the lab process of removing waste and dead tissue isolates the live tissue.

ASPS: Does banked fat perform as well as freshly harvested fat?

Dr. Hamilton: The viability of banked fat is generally higher than that of freshly harvested fat. Unfortunately, there are not many large studies that test the viability of freshly harvested fat or the volume retention of regrafted fat. The performance of fat grafting depends both on the purity and viability of the fat and, to a high degree, on the techniques employed in the grafting procedure.

ASPS: How long does stored fat last?

Dr. Smith: Fat can be stored for years without degradation.

Dr. Hamilton: At cryopreservation temperatures, there is no cell activity, so the tissue, in theory, can be preserved as long as it is kept in the freezer. We believe the fat can be preserved and stored for decades. The thawed tissue is thought to be the same cellular age as when harvested, though more studies are warranted to fully characterize cellular activity and "cellular age" post-thaw.

ASPS: What can a patient expect from upfront costs or storage fees associated with fat banking?

Dr. Smith: It can cost $2,000 to $8,000, depending on the volume of fat being banked, and then it is probably $200 to $1,000 a year to keep that fat banked in a safe, compliant way.

Dr. Hamilton: There are several ways for a patient to pay for fat banking storage. The most popular option is to pay for an all-in-one package that includes transport, processing and storage of fat for one year, with up to three withdrawals included.

A Rainy Day Fat Account?

In the age of GLP-1 medications, rapid weight loss and patients seeking to add volume and curves, fat banking may be an excellent option, offering patients the flexibility to store their fat for later use to enhance their aesthetic goals.

"This is a really interesting proposition to surgeons," said Dr. Hamilton. "I love the idea of being able to build volume on a patient without having to take them back to surgery. It's the same value that alloClae offers in some ways, with the ease of the in-office procedure, although, of course, this involves an initial liposuction surgery. The interesting element here is that, with each round of fat transfer, the patient will have more and more native tissue that can receive even more fat. Suddenly, it seems reasonable to fully build a breast out of fat and achieve a much larger cup size, if desired, by doing multiple rounds of fat grafting without having to do multiple rounds of liposuction."

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.