Micro Fat Grafting

Autologous fat transfer

Fat grafting is a natural, long-lasting way to replace volume & softly enhance the area that in need for tissue volume replacement like, face, hand, leg, breast, buttock or any part that has lost its fatty cushion due to aging process, loss weight, congenital asymmetry or due to traumatic causes.

Lipofilling has become a very important tool in plastic surgery today, with history of more than one hundred years, with good to excellent results in relation to low donor-site morbidity, low complication rate, & fast recovery time. Many technical developments have led to a more delicate procedures to improve the quality of fat grafting, including

  • Mircr0 Fat Grafting
  • Nano Fat Grafting
  • SNIF
  • PRP enriched Fat Grafting
  • Stem Cells Enriched Lipotransfer (CAL).

Each has its uses. The  term microlipofilling is very appropriate because it defines well the technique,  due to its smaller particle size compared to conventional macro fat graft.  Microlipofilling can be performed percutaneously or by injecting the fat directly under the skin flap into the underlying tissues. Care is taken to inject small quantities only in one place with the “fanning out” technique and injecting 2-mm fat rolls to prevent large cystic spaces. In this manner, diffuse abscess formation is avoided by leaving a layer of vascularized tissue on the neighboring surfaces. Before we inject, we are careful to draw back on the syringe to check for blood to prevent the administration of an intra-arterial or intravenous bolus of fat. Care must be used in the accuracy of fat deposition & over-corrections should be avoided. The simplicity of this method permits repetition of the procedure, if desired. However, we recommend waiting at least 6 months if repetition is necessary. Augmentation of certain face and neck areas has great architectural appeal; this is particularly true when contouring can be achieved by microlipofilling technique.

Clinical Applications of Microlipofilling in Plastic Surgery

Since all maneuver is gentle & meticulous, it can be use for excellent option for restoring volume and/or improve contour in area that require absolute delicacy and precision such as the

  1. Nano- & microfat grafting
    With respect to relatively delicate areas of the face such as eyelids
    &  lips, a novel technique of micro and nanofat grafting can
    be used, typically with harvesting cannulas as small as 0.7 mm in
    diameter.36-39 Tonnard et al highlighted the clinical application
    of the micro and nanofat grafts and sought to determine the cellular
    content of nanofat grafts.40 Briefly, microfat particles were
  2. Atrophic aging changes of fat, muscle and bony tissue.
  3. To give more noticeable & attractive facial contouring. The trend in our time for men & women is to have more sculptured fashioned looking & this very helpful for patients having thin or skinny face or long face.- Facial Sculpturing by Fat Transfer.
  4. To restore facial volume after weight loss.
  5. Micro fat injections can be excellent option for restoring volume and/or improve contour in area that require absolute delicacy and precision such as the

Hollow underneath the eyes (Tear trough deformity)

  • Hollow of upper eyelids
  • Temples
  • Earlobes
  • Cheeks
  • Brow
  • Lips
  • Backside of hands

5. To correct facial asymmetry due to congenital defect or after trauma defect or post-surgery defect like excision of facial tumour.

6. To treat deep lines as permanent augmentation in volume and contour. When combined with procedures like face lift to reduce bulky cheeks, it can produce aesthetically pleasing, well-balanced facial contours.

7. To treat facial scars or acne scar.

As an added benefit for many patients, the end volume result of micro fat transfer (when the volumizing effect is our concern) is highly improved compared to the conventional macro fat graft, the decrease of resorption percentage of transferred fat very significant, due to better fat graft vascularization with microparticles than the macro ones. 

The other highly important advantage is the less incidence of fat cyst formation which the reason behind FDA banning the lipofilling of the breast. But, with the new approach of fat injection, the micro-lipofilling, in 2009 FDA has withdrawn their banning for fat transfer to breast in the USA.

Read More- References

  1. Bernardi C. Microlipofilling in periorbital region. In: Proc. XX Int. Congr. on Aesthetic Plastic Surgery – ISAPS, San Francisco, USA, 14-18 August 2010.
  2. Coleman SR. Long-term survival of fat transplants: controlled demonstrations. Aesthet Plast Surg 1995;19:421-5.
  3. Condé-Green A, NF de Amorim, I. Pitanguy Influence of decantation, washing and centrifugation on adipocyte and mesenchymal stem cell content of aspirated adipose tissue: A comparative study. J Plast Reconstr Aes 2010;63:1375-81.
  4. Delay E, S Garson, G Tousson, R. Sinna Fat injection to the breast: technique, results, and indications based on 880 procedures over 10 years. Aesthet Surg J 2009;29:360-76.
  5. Galiè M, M Pignatti, I Scambi. Comparison of different centrifugation protocols for the best yield of adipose-derived stromal cells from lipoaspirates. Plast Reconstr Surg 2008;122:233-4.
  6. Ghazouane, R., Bertrand, B., Philandrianos, C. et al. Aesth Plast Surg (2017) 41: 1217.
  7. Guerrerosantos J, Gonzalez-Mendoza A, Masmela Y. Long-term survival of free fat grafts in muscle: an experimental study in rats. Aesthetic Plast Surg 1996;20:403–408.
  8. Guerrerosantos J. Autologous fat grafts for body contouring. Clin Plast Surg 1996;23:619–631.
  9. Guerrerosantos J. Simultaneous rhytidoplasty and lipoinjection: a comprehensive aesthetic strategy. Plast Reconstr Surg 1998;103:191–199
  10. José Guerrerosantos; Microlipofilling, Aesthetic Surgery Journal, Volume 22, Issue 2, 1 March 2002, Pages 196–198.
  11. José Guerrerosantos, Fadi Haidar, Juan Carlos Paillet; Aesthetic Facial Contour Augmentation with Microlipofilling, Aesthetic Surgery Journal, Volume 23, Issue 4, 1 July 2003, Pages 239–247
  12. Neuber F. Fet transplantation. Chir Kongr Verhandl Dtsch Ges Chir 1893;22:66.
  13. REA Nordstrom. “Spaghetti” fat grafting: a new technique. Plast Reconstr Surg 1999;917:1997.
  14. Rigotti G, A Marchi, M Galiè. Clinical treatment of radioterapy tissue damage by lipoaspirate transplant: a healing process mediated by adipose-derivated adult stem cells. Plast Reconstr Surg 2007;119:1409-22.
  15. Roger K. Khouri; Jan Maerten Smit; Eufemiano Cardoso; Norbert Pallua; Laurent Lantieri; Irene M. J. Mathijssen; Gino Rigotti. Percutaneous Aponeurotomy and Lipofilling: A Regenerative Alternative to Flap Reconstruction? Plastic and Reconstructive Surgery. NOV 2013;132(5):1280–1290.
  16. Shue, S., Kurlander, D.E. & Guyuron, B. Fat Injection: A Systematic Review of Injection Volumes by Facial Subunit; Aesth Plast Surg (2018) 42: 1261. 
  17. SR Coleman. Hand rejuvenation with structural fat grafting. Plast Reconstr Surg 2002;110:1731-44.
  18. Toledo LS, R. Mauad Fat injection: a 20-year revision. Clin Plast Surg 2006;33:47-53.
  19. Lambros Fat injection for the aging mid-face. Oper Tech Plast Reconstr Surg 1998;5:129-37.
  20. YG Illouz. The fat cell graft: a new technique to fill depression. Plast Reconstr Surg 1986;78:122.

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