Facial Contouring and Rejuvenation With The Use of Fat Injection

Facial Contouring and Rejuvenation
with the Use of Fat Injection
아름다운나라 성형외과
김진영
Plastics for Soft Tissue Augmentation
Gold BioPlastique
Silver Collagen
Rubber Goretex
Paraffin Alloderm
Silk Polymethylmethacrylate
Silicone Polyacrylamide
Injectable silicone Hyaluronic acid
History of Free Fat graft
1893 Neuber : depression of scarred area
 tiny fat parcels transplantation
 successful take rate depend on the size of the fragments
1910 Lexer : depression after zygomatic arch fracture
 fat tissue block transplantation
 importance of atraumatic technique
1950 Peer : 50% survival rates in the free fat transplants
 neovascularization occurs after 4 days
Development of Fat Injection
1977 Illouz : Advent of liposuction
1981 Fournier : Syringe liposculpture
1986 Coleman : Lipostructure
Survival of Transplanted Fat Cell
Host Replacement theory

Cell Survival theory
Experimental study of Fat cell survival
1993 Carpaneda : adipose graft viability study
Transplanted fatty tissue should be within 1.5mm

of living, vascularized tissue for optimal survival.
Analysis of Lipocyte viability after liposuction
(1)
- Matthew J. Concannon, M.D., University of Missouri
- Case : 16 women, 4 men ( age 27-49 yrs )
- Centrifugation 10, 30, 50, 100g
2, 4, 6, 8 min interval
- Number of viable cells in top, middle,
and bottom layers of the fat segment
(2)
(3)
Applications of Fat Injection
▶ Face
▶ Hand dorsum
▶ Breast
▶ Hip
▶ Liposuction Complication
Effects of Fat injection in the face
Facial recontouring :
tired, sad  healthy, attractive, softening
strengthen, straighten the nose
voluminous lip, chin, forehead
Facial rejuvenation
restore fullness of youth
Fat Harvesting sites
▶ Abdomen
▶ Medial thigh
▶ Lateral thigh
▶ Medial knee
▶ Buttock
▶ Upper arm
Fat Injection solution
Ringer’s lactate solution 300 cc
Lidocaine 2% 10-20 cc
Sodium bicarbonate 8.4% 3 cc
Epinephrine 1:1000 0.3 cc
Recipient sites preparation
Block anesthesia : Supraorbital nerve

Trochlear nerve
Infraorbital nerve
Mental nerve
Local anesthesia
Techniques of Fat Harvesting
- Gentle manipulation
- Avoid high negative pressure
- Syringe liposuction
- Blunt tipped cannula 3mm diameter
- 10cc Luer-lock syringe
Techniques of Fat Transfer and Purification
- Minimal air exposure

- Removal of nonliving components
(anesthetic solution, blood, oil, ..)
- Avoid washing, filtering, or straining
- Sedimentation and Centrifugation 3000RPM, 2 min
Techniques of Fat Injection
- Maximize contact with recipient vascularized tissues

- Minimal positive pressure
- Blunt tipped cannula 2mm diameter
- 1cc Luer-lock syringe
- Linear deposition of fat with each withdrawal of infiltrating cannula
- 20-30 passes injection per 1ml
- Layered injection of fat parcels
- Slight overcorrection
Reinjection and Frozen storage of fat
- Better results in 2nd and 3rd injection

 increase of neovascularization in 1st injection
- Frozen storage at –20oC
 inhibit enzymatic activity, free radical,
oxidation, bacterial growth
 block fat cell degradation
Complications of Fat Injection
Prolonged edema Necrosis
Under-correction Irregularity
Over-correction Hyperpigmentation
Infection Fat embolism
Fat Embolism in Fat Injection
- MCA occlusion  Cerebral Infarct

- Retinal or ophthalmic artery occlusion  Blindness

- Cause : Acute increase in local pressure
Well vascularized tissue
Pretraumatized tissue
Periorbital area
Damaged facial vessels
Cases
Results of Fat Injection
A frequent question asked about fat grafting is, "How much of t

he grafted fat will survive?" I do not know. I know that 10 cc of
fat has one result in the dorsum of the hand, 20 cc has another, a
nd 30 cc has still another. My concern is to have the grafted fat s
urvive evenly and predictably.
- Sydney R. Coleman
Conclusion
Fat Injection
is natural long-lasting method of soft tissue augmentation,

especially in the facial contouring and rejuvenation.
But attention must be paid to the nature of fatty tissue.

Facial Contouring and Rejuvenation With The Use of Fat Injection

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Facial Contouring and Rejuvenation With The Use of Fat Injection

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Facial Contouring and Rejuvenation

with the Use of Fat Injection

Injectable silicone Hyaluronic acid

1893 Neuber : depression of scarred area

 tiny fat parcels transplantation

 successful take rate depend on the size of the fragments

1910 Lexer : depression after zygomatic arch fracture

 fat tissue block transplantation

 importance of atraumatic technique

1950 Peer : 50% survival rates in the free fat transplants

 neovascularization occurs after 4 days

1977 Illouz : Advent of liposuction

1981 Fournier : Syringe liposculpture

1986 Coleman : Lipostructure

Host Replacement theory

1993 Carpaneda : adipose graft viability study

Transplanted fatty tissue should be within 1.5mm

- Matthew J. Concannon, M.D., University of Missouri

- Case : 16 women, 4 men ( age 27-49 yrs )

- Centrifugation 10, 30, 50, 100g

- Number of viable cells in top, middle,

and bottom layers of the fat segment

tired, sad  healthy, attractive, softening

strengthen, straighten the nose

voluminous lip, chin, forehead

restore fullness of youth

Ringer’s lactate solution 300 cc

Sodium bicarbonate 8.4% 3 cc

Epinephrine 1:1000 0.3 cc

Block anesthesia : Supraorbital nerve

- Avoid high negative pressure

- Blunt tipped cannula 3mm diameter

- 10cc Luer-lock syringe

- Minimal air exposure

- Maximize contact with recipient vascularized tissues

- Better results in 2nd and 3rd injection

Prolonged edema Necrosis

Infection Fat embolism

- MCA occlusion  Cerebral Infarct

A frequent question asked about fat grafting is, "How much of t

is natural long-lasting method of soft tissue augmentation,

But attention must be paid to the nature of fatty tissue.

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