Anyone who has had rhinoplasty surgery knows that the risk of needing a revision surgery is quite real. National revision runs are felt to be as high as 30-50%. In my practice, the overall 15 year revision rate is less than 9%. Additionally this rate reflects only the need for minor touch-up or optimization procedures. My patients can tell you that I’m never satisfied with my results, so I always strive to make them better.

In patients who have already had multiple revision surgeries or traumatic injuries to the nose, they often present with a particular set of difficulties. They have reduced blood supply, subcutaneous scarring, and skin quality problems that make revision surgery quite difficult. Often the damaged skin is thin and of poor quality for trying to make a natural, soft, pliable nose. The risk for wound healing problems and poor outcomes is high.

In the last couple of years, there has been interest shown in the use of nanofat injections to the nose to rehabilitate the tissue conditions to make revision surgery a more successful process for patients already devastated by poor outcomes. When discussing fat transfer, it is important to understand the types of fat transfer and what they are used for. For my patients, I break down fat transfer into 3 basic types:

1. Macrofat
2. Microfat
3. Nanofat

Macrofat transfer is performed by using traditional liposuction techniques to harvest large molecules of fat for fat transfer to the breast, buttocks, and body. The large molecules provide the best lift and fill. Microfat transfer is performed by using liposuction with smaller cannula diameters to get smaller molecules of fat that can be used for facial and hand augmentation. The smaller molecules provide for more natural, less lumpy results that match the needs of the smaller compartments of the face and hands. The lift and fill capabilities are also less to avoid bulging outcomes.

Nanofat transfer is the newest type of fat transfer. Using special tiny cannulas, small molecule fat is harvested. This fat is then first passed through a series of smaller and smaller separators, followed by one pass through a nanofat mesh. The result is that you obtain 400 micrometer (0.4mm) size fat molecules along with Adipose Derived Stem Cells (ADSC). Nanofat cells are so tiny, they can be injected using a tiny Botox needle. The magic, however, lies in the power of the ADSC.

Stem cells are a particular type of cell that aid in tissue regeneration. ADSC are what are known as pluripotent stem cells. This means that they can behave differently based on the type of tissue they are exposed to. When injected into skin, they control local processes that can improve both the vascularity and characteristics of skin. I started using nanofat in my practice in December of 2018 and have seen good results so far with no complications. As a busy rhinoplasty and facial plastic surgeon, I have had a handful of patients who’ve had minor scarring issues after surgery. Using nanofat, these scars have definitely gotten softer and blended better into the surround normal skin.

From this experience, I decided to try nanofat injections to treat tear-trough deformities of the lower eyelids. We normally used hyaluronic acid fillers like Restylane and Belotero in the past, but patients often complained of swelling and dark circles. With nanofat, we’ve seen none of these problems. Check out the results below on a woman in her 40’s who had both microfat and nanofat injections to the lower eyelid hollows:

It is clear that the science of nanofat and tissue regeneration continues to advance. As this advancement moves along, patients will continue to benefit from better and greater numbers of options for cosmetic self-improvement.