Lipografting: Autologous Fat Grafting for Total Facial Rejuvenation

ABSTRACT

Surgeons who perform facial rejuvenation procedures have long recognized the importance of volume enhancement. The primary manifestation of aging is loss of subcutaneous tissue, especially the atrophy of fat, which directly contributes to laxity of skin. Autologous fat transplantation has been attempted for over a century with varying degrees of success but more recent techniques have provided more predictable, reproducible, and even permanent results. Fat is an ideal tissue filler substance because it is living tissue and because it is from the patient's own body it is nonallergenic. My technique has evolved over an 11-year period in more than 1800 patients. The procedure can be performed alone as a total facial rejuvenation or in combination with facelift or other facial surgery. The technique requires minimally traumatic fat harvesting, fat preparation, and multilevel facial infiltration. Excess fat not used in the initial procedure is frozen and stored at -16°C and can be used successfully for minor touch-up procedures. Preoperative evaluation of the patient and their understanding of the benefits and limitations of volume restoration surgery is imperative. Structural improvement to the main support areas of the face in the appropriate aesthetic proportions is of prime importance.

KEYWORDS

Fat grafting - fat transfer - facial rejuvenation

REFERENCES

• 1 Neuber F. Fettransplantation. Bericht uber die Verhandlungen der Dt Ges f Chir.  Zentralbl Chir. 1893;  22 66
• 2 Lexer E. Freie Fettransplantation.  Deutsch Med Wochenschr. 1910;  36 640
• 3 Bruning P. Contribution e l’etude des greffes adipueses.  Bull Acad R Med Belg. 1914;  28 440
• 4 Gurney C E. Experimental study of the behavior of free fat transplants.  Surg. 1938;  3 680
• 5 Peer L A. Loss of weight and volume in human fat grafts.  Plast Reconstr Surg. 1950;  5 217-230
• 6 Peer L A. The neglected free fat graft.  Plast Reconstr Surg. 1956;  18 233
• 7 Saunders M C, Keller J T, Dunsker S B, Mayfield F H. Survival of autologous fat grafts in humans and mice.  Connect Tissue Res. 1981;  8 85-91
• 8 Ellenbogen R. Free autogenous pearl fat grafts in the face: a preliminary report of a rediscovered technique.  Ann Plast Surg. 1986;  16 179-194
• 9 Fournier P F. Microlipoextraction et microlipoinjection.  Rev Chir Esthet Lang Fr. 1985;  10 36-40
• 10 Ilouz Y G. The fat cell “graft”: a new technique to fill depressions.  Plast Reconstr Surg. 1986;  78 122-123
• 11 Coleman S R. Facial recontouring with lipostructure.  Clin Plast Surg. 1997;  24 347-367
• 12 Brandow K, Newman J. Facial multilayered micro lipoaugmentation.  International Journal of Aesthetic and Restorative Surgery. 1996;  4 95-110
• 13 Amar R E. Microinfiltration adipocytaire (MIA) au niveau de la face, ou reconstruction tissulaire par greffe de tissue adipeux.  Ann Chir Plast Esthet. 1999;  44 593-608
• 14 Bertossi D, Kharouf S, D’Agostino A et al.. Facial localized cosmetic filling by multiple injections of fat stored at -30°C: techniques, clinical follow-up of 99 patients and histologic examination of 10 patients.  Ann Chir Plast Esthet. 2000;  45 548-556
• 15 Shoshani O, Ullmann Y, Shupak A et al.. The role of frozen storage in preserving adipose tissue obtained by suction-assisted lipectomy for repeated fat injection procedures.  Dermatol Surg. 2001;  27 645-647