No-Touch Technique for Autologous Fat Harvesting Ahmet Karacalar, I ˆ . Orak,, S. Kaplan,, and S S .Yıldırım, Samsun, Turkey Abstract. A new technique for autologous fat harvesting is presented. It is termed the ‘‘no-touch’’ technique because the concentrated fat graft is obtained with no handling of fatty tissue. With the no-touch technique, fat aspiration is performed under tourniquet. There is no need for any mechanical manipulations such as centrifugation, washing, whisking, filtering, or straining. The medial aspect of the knee is used as the donor area. Fat is aspirated through a disposable 10-ml syringe and a 14-gauge microcannula, which consists of a curved, semiblunted tip such as that of the Tuohy needle. What remains in the syringe is the con- centrated fat without blood, serum, or lidocaine. The au- thors report their experience with 30 patients. Key words: Fat—Fat graft—Fat transplantation—No- touch Despite the controversy over the results of autologous fat transfer, this procedure has become the standard in the management of contour deformities and irreg- ularities. Although various new strategies for autolo- gous fat transfer have been presented in recent years, each has a major inherent drawback: the injection of mechanically and chemically traumatized fatty tissue. The technique presented in this article completely eliminates the purification step, which is the most traumatic part of fat graft transplantation. With this technique, the medial aspect of the knee is used as the donor area. The extremity is exsanguinated using Esmarch’s elastic bandage or a pneumatic tourniquet. Pure fatty tissue is aspirated through a disposable 10- ml syringe and a 14-gauge microcannula. The author has termed this technique a ‘‘no-touch’’ procedure because the concentrated fat is obtained with no handling of the fat under the tourniquet (Fig. 1). With this technique, the success of fat grafting is greatly increased for several reasons [10]. First, the injected material is relatively pure fatty tissue without blood, serum, adrenaline, or local anesthetic agent [11]. Second, the delicate structure of fatty tissue is preserved because chemical trauma and most mechanical trauma are completely eliminated [6]. Finally, the risk of infection is diminished because the technique is sterile and anaerobic. Our previous study showed the importance of obtaining pure fat by adipoaspiration under tourni- quet [10]. On the basis of that study, we have under- taken a prospective pilot clinical study to determine the role of this technique for autologous fat transfer. The pilot study was first suggested in the Karacalar’s comments on the article by Mladick [11]. After the initial part of the learning curve was overcome with a group of patients in the pilot study, the following technique was used for 30 consecutive patients. Thus, standardization was applied to the procedure. The main purpose of this article is to describe this new technique in detail, and to discuss its rationale with a brief review of the literature. Patients and Methods The study enrolled 27 women and 3 man ages 19 to 58 years. The indication for treatment was facial and body contour deformities and inverted nipple defor- mity. The patients were observed for an average of 12 months (range, 1–24 months). Outcomes were judged by clinical observation and the overall This study was presented at the XVI Congress of ISAPS at Istanbul in 2002. Correspondence to Ahmet Karacalar, Ondokuz Mayıs U ¨ niversitesi, Tıp Faku¨ltesi, Plastik ve Rekonstru¨ktif Cer- rahi A.D., Samsun, 55139, Turkey. Tel.: 362-4576000; Fax: 362-4576041; email: akaraca@omu.edu.tr Aesth. Plast. Surg. 28:158–164, 2004 DOI: 10.1007/s00266-004-3129-z