Plastic surgery is famously innovative. It takes theoretical techniques and refines them until they work. It is the specialty that stands at the very forefront of surgical knowledge and provides the skills, tools, and science behind every great advance in surgery. This started in 6000BC with the engineering of pedicled tissue flaps for nasal reconstruction, through to modern day microsurgery that benefits every aspect of transplant surgery to and understanding of autologous fat transfer (AFG).

Rozina describes fat as ‘liquid gold’ or the ‘elixir of youth’ since it is the richest adult tissue source of stem cells. It is the ultimate example of surgical ‘upcycling’. The technologies and expertise in fat transfer continue to develop rapidly and in the right hands, it is a very useful aesthetic tool. It has a vital role in breast reconstruction, breast aesthetics and many facial and body rejuvenation procedures, AFG is useful for both cosmetic and reconstructive indications because there is no scarring at the injection site, no foreign material implanted, a low rate of serious complications, and a typically desirable donor site. Fat transfer is a deceptively simple technique with myriad benefits in soft-tissue augmentation and regenerative effects on local tissue such as reversal of hyperpigmentation, softening of hypertrophic scars and improvement of irradiated tissue. Diverse applications of fat grafting include facial rejuvenation, hand rejuvenation, breast reconstruction and volume enhancement, treatment of skin photo aging and correction of contour deformities (tear trough, scars, divots).

Unfortunately, fat transfer is often misunderstood as a procedure with no limitations, no scars and no downside. This is not the case and outcome is dependent on the limited fat sources available and fat survival rates. The most troublesome and persistent issue in fat grafting is the unpredictable volume retention of fat grafts after fat transfer.

Rozina is currently supervising PhD research into fat transfer and how to accurately determine the volumes that survive. The original theory of fat cell survival is comparable to that of skin graft survival:-The fat cells (adipocytes) are thought to rely on picking up an oxygenated blood supply and a lack of sufficient oxygen (cellular hypoxia) is the major obstacle to successful engraftment process and long-term volume retention. Studies demonstrate that mature adipocytes can cannote low oxygen tensions (hypoxia )foronly24 hours at normal core body temperature due to the high metabolic demand of the fat cells.