A few points about how Dr. Rohrich harvests and emulsifies the fat, which, according to the study, differs from ways in which most providers harvest, prepare and use fractionated fat:

• Dr. Rohrich manually harvested the fat with low-pressure lipo-aspiration of the inner thigh, using a blunt 3-mm multiport cannula with 1-mm holes. 
• His preference is to transfer autologous fat at the start of the procedure to maximize fat cell survival.
• He then prepares fractionated fat with mechanical emulsification during which he pushes the fat for 50 passes between two connected 10-cc syringes.
• This fracto-fat is viable adipose cells similar to regular adipose cells from each harvest, so it must be injected deep into the dermis to prevent lumps or fat nodules.

Patients results from fractionated fat lid-cheek junction blending were aesthetically pleasing at the time of follow-up, which ranged from 0 to 21 months. No nodules were found with the use fractionated fat cell injections placed below the orbicularis muscle at the eyelid-cheek junction. There was slightly more bruising and swelling in the fractionated fat group compared to those receiving regular fat injections. Skin quality improvements were subjectively visible at four to six weeks, according to the authors.

While the researchers write that fractionate fat is an option for adding volume to cheeks and other areas as it can potentially improve skin quality due to stem cell activity within viable fat cells.

“Fractionated fat is easy to use with smaller cannulas and delivers a large number of condensed adipose-derived stem cells using a very small volume of product,” they write. “Also, it can be used without any restrictions or regulations because it is an autologous product from the patient that has not been altered in any manner.” 

References: Rohrich RJ, Mahedia M, Shah N, Afrooz P, Vishvanath L, Gupta RK. Role of Fractionated Fat in Blending the Lid-Cheek Junction. Plast Reconstr Surg. 2018;142(1):56-65