Facial fat injection (Autologous fat transfer)

                Fat grafts have become an important necessary and reliable procedure in plastic surgeons, routine practice. There was a review of the previous 100 years history of fat grafting.
                I describe the efficacy of fat injection today as true soft tissue augmentation. My opinion is fat injection now no longer a temporary patient satisfier if performed correctly.

Patient selection

            
     You benefit most from fat autografting injections if you fall into these criteria.

  1. Young age below 60 yrs with well vascularized face
  2. Thin facial soft tissue
  3. Thinned peribuccal areas (cheek hollowness)
  4. Flatten malar area, forehead
  5. Thin lip
  6. Depressed scar (adjunct with scar recursion)
  7. Abundant doner site fat deposit saddle bags, buttock, abdomen


How the procedure is done ?

Fat harvesting
                I use the wet technic to aspirate the fat mainly from the saddle bags (lateral aspect of the thigh). The Hercules model aspirator (Well Johnson, Tucson, AZ) is used with low pressure vacuum setting, usually no 3.7, 4.0, 4.6 mm. diameter cannula are frequently employed to suck out the fat cell with tender harvesting maneuver to lessen fat cell damage.
                In some occasion I may use vacuum 50 cc. syringe suctioning with the tulip style cannula. This procedure can be performed under the office base
                Then I clean fat cell from contaminants such as local anesthetic, oil, blood with normal saline by my special tea strainer like silver bowl until the fat is ready for injection.
                Ultimately fat cell is transfered into 10 cc. syringe attached to the lipoinjected gun (lipoject ).

Area and amount of fat injection


Injection technic

                Perioperative mapping of the injected site on upright position is identified and outline by marking dye. Regional or local anesthesia is used.
                The injection by Lipoject usually consist of multiple layers and multiple tracks by introducing blunt tip 3.0 mm injected needle through a tiny incision, unsightly placed such as side burn, infralobule, corner of the mouth, etc.
                Theoretically the more vascularized neighboring tissue is the less amount of fat resorption will be so "fanning out technic" is always my most favorite one.
                Then molding and dispersing of fat by digital massaging make the deposition of fat accurate.
                 I like to overcorrect about 20% of the ideal fat volume to compensate the post operative resorption which I have anticipated around 30-40% so far.
                Then tape is applied to give a uniform pressure and control of injected fat displacement for 24-48 hours.

How do you look postoperatively ?

                The operated area will swell up till few days postop. Bruising rarely occur due to technical refinement. However swelling may last 1-2 weeks. You should refrain from vigorous massaging the area operated since it might jeopardize the viability of the transplant fat.
                The retrospective review demonstrated that lipoinjection is a useful adjunct in facial recontouring and can be accomplished with excellent aesthetic results.