(Autologous Fat Injections)
As soon as the first liposuction techniques were invented Plastic Surgeons realized that the fat extracted could be re-injected elsewhere in the body, thus acting as a filler. Autologous fat injection, known as lipofilling or liposculpture, took quite long to improve, as the re-injected fat tended to be reabsorbed to a great extent, leaving a result, which was neither predictable nor lasting. From 1995 onwards, the injection of autologous fat became a highly reliable technique used under the following indications. The principle is an autograft of fat cells from fat harvested from the patient.
Liposculpture: consists of removing excess fat from certain areas (outer thighs for example) and grafting the fat cells into areas where there is a lack of volume, such as:
- The filling and smoothing of certain wrinkles.
- Restoration of the ‘fullness’ of a gaunt face or one showing the first signs of aging.
- Restoration of volume and shape of the face: especially in the case of a face emaciated by aging.
- In complement to certain neck- and face-lifts to give a more balanced result.
- As an additional procedure after a previous face-lift, to improve the shape of the mid-section of the face without resorting to another face-lift.
- To correct corrugations in the appearance of the skin following lipo-aspiration.
- Filling of holes or hollowed out areas following injury.
Before the operation
Prior to the operation a thorough clinical and photographic examination will have been carried out in order to determine the corrections required. Especially when liposculpture is being used to reduce age related effects, photographs of the patient when young may be studied in order to compare the differences between the younger face and the face at the time.
A preoperative check-up will be carried out as prescribed. A consultation with an anesthesiologist will be arranged at the latest 48 hours before the operation.
Smoking is not an absolute contraindication to this procedure, however it is preferable to stop smoking for a month before surgery as its negative effect on healing is well known.
No aspirin-based medication should be taken during the 10 days preceding the operation. For certain types of anesthesia you may be required to fast (neither eat nor drink) for six hours before the operation.
Hospital stay and type of anesthesia
Type of anesthesia: Local anesthesia with sedation given by intravenous drip (‘twilight’ anesthesia) or general anesthesia is the usual choice for liposculpture. The type of anesthesia will be decided after discussion with the surgeon and the anesthesiologist
Hospital stay: The procedure is usually carried out on an outpatient basis; the patient arrives and leaves on the same day. The patient is discharged three to five hours after the procedure. An over-night stay following surgery may be necessary.
Techniques are adapted in order to obtain the best results in each case. However, some basic points can be provided.
We start by carefully defining the areas from which the fat will be harvested, and the re-injection sites. The harvesting of fat is carried out atraumatically through a tiny incision hidden in the natural skin creases, using a small cannula. An area with reserves, or even an excess, of fat will be chosen for harvesting, at a site not normally visible.
After harvesting, centrifugation will be carried out for a few minutes, in order to separate the intact fat cells, which will form the graft, from elements which cannot be used. Re-injection is carried out through 1mm incisions using micro-cannulas. Tiny particles of fat are re-injected at different levels and in multiple divergent directions. This increases the surface area in contact with the implanted cells and receptor tissue and improves the survival of the grafted fat cells.
Since there is true grafting of living cells, when the technique is correct and the graft takes, these grafted cells will become a living part of the body. This means that liposculpture is a permanent technique since the grafted fat cells will live for as long as the surrounding tissues.
The length of the procedure varies according to the amount of fat to be re-injected and the number of treated sites. It can vary from 30 minutes to 2 hours for liposculpture alone.
After the operation
After the operation pain is usually mild. Swelling appears during the 48 hours following the procedure; this usually takes 5 to 15 days to disappear completely. Bruising appears after a few hours on the injection sites: it disappears 10 to 20 days after the procedure.
Although recovery is in general rapid because of the nature of the procedure, you will have to take into account the swelling and bruising, and organize your family social and professional life in consequence.
Exposure to sunlight or UV rays must be avoided for the areas concerned for at least 4 weeks otherwise permanent pigmentation can occur.
Once the swelling and bruising have settled the final result will begin to be visible 2 to 3 weeks after the procedure.
The final aspect will not be visible before 3 to 6 months. This is usually satisfactory, whenever the indication and the technique have been correct: the depressions have been filled and volume restored. Nevertheless the result will deteriorate little by little as these tissues age. A difference of between 20 and 40% exists between the quantity of fat cells grafted and the quantity that will survive. The surgeon will allow for this in his initial evaluation of the amount to be injected. Grafted fat is subject to the same variations in volume as normal body fat; therefore it will fluctuate with weight loss or gain.
The objective of this procedure is to provide improvement but not to attain perfection, when under taken with realistic expectations the results will be extremely satisfying.
Liposculpture, when correctly indicated and carried out, can be beneficial to patients, giving a satisfactory result corresponding to what was expected. Occasionally localized imperfections can be observed (without being true complications): hypo-correction of some areas, slight asymmetry, irregularities.
They can usually be corrected by ‘touch up’ liposculpture under local anesthetic 6 months after the initial procedure.
Liposculpture, although essentially an aesthetic procedure, is nevertheless an operation, and this implies that the risks inherent to any surgery apply here, too. We must distinguish between risks related to the anesthesia and those related to the surgery. For the anesthesia, the anesthesiologist will explain the risks during the preoperative consultation. You must be aware that anesthesia can cause unpredictable reactions, which can be difficult to control: the presence of an experienced anesthesiologist, in a surgical context, means that the risks are statistically practically negligible.
In fact techniques, products and monitoring methods have progressed considerably over the last decade, giving optimal safety, especially when the operation is not an emergency and the patient is in good general health.
However, complications exist, although rare following liposculpture which has been carried out correctly. Following careful selection of the patient & technique, and by using rounded cannulas which do not damage skin, blood vessels or the nerves, we may avoid as far as possible the risk of complications. Practically, all the operations go well and patients are completely satisfied with the result.
Infection is normally avoided by prescription of antibiotics before and after the procedure. The most frequent complication of liposculpture is hypercorrection; this is caused by re-injection of an excessive quantity of fat giving an unsightly result, difficult to be corrected.
My Way …. “Metron Ariston”
Restoring lost facial volume by fat grafting is a powerful technique in treating an aging face. If performed properly, the injection of fat to areas of the face that have atrophied due to age can provide a ravishing and sustainable result, not obtained by other means.
I perform facial liposculpture using the latest technology of micro fat-graft.
Submental fullness (Double chin)
Accumulation of submental fat can be a major concern for most women and men, often having nothing to do with maintaining a healthy body weight. A double chin can result from a variety of causes, including genetics, aging, diet and weight.
I combine Waterjet Assisted Liposuction to remove the fat under the chin, which I reinject in strategic spots in the jawline and jowl areas. It provides remarkable improvement to face contour, giving a gentle “face lift” effect with minimal downtime (less than two days).
This webpage aims to provide some information about the subject. Individual patient circumstances may differ, which might alter both the advice and course of therapy given to you by your doctor.
American Society of Plastic Surgeons, British Association of Plastic, Reconstructive and Aesthetic Surgeons, French Society of Plastic, Reconstructive and Aesthetic Surgery