Facial fat injection (Autologous fat transfer)
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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.
- Young age below 60 yrs with well vascularized face
- Thin facial soft tissue
- Thinned peribuccal areas (cheek hollowness)
- Flatten malar area, forehead
- Thin lip
- Depressed scar (adjunct with scar recursion)
- 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. |
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