Professional Documents
Culture Documents
Received July 14, 2006, and accepted for publication, after revision, September 16, 2006.
From the Plastic Surgery Hospital, Chinese Academy of Medical Sciences
and Peking Union Medical College, Beijing, China.
Reprints: Haiming Zhang, MD, Vice-Director of the Plastic and Cosmetic
Surgery Center of Face and Neck, Plastic Surgery Hospital of CAMS and
PUMC, 33 Ba-Da-Chu Street, Shi-Jing-Shan District, Beijing 100041,
P.R. China. E-mail: aiia523@yahoo.com.cn.
Copyright 2007 by Lippincott Williams & Wilkins
ISSN: 0148-7043/07/5806-0602
DOI: 10.1097/01.sap.0000248110.59452.49
602
Background: Facial contour deformities usually result from congenital abnormalities, trauma, and the aging process. All depressions
in the face, including glabella wrinkles and mild retrogression of
chins, fall in this category. Local injection of autogenous fat parcels
has been introduced for correction of these facial deformities for
almost 20 years.
Method: Using common materials (gauzes and cotton sticks), a
simple technique was used by us to purify syringe-suctioned fat
parcels followed by a multilayered injection of the purified fat tissue
into implantation sites to treat the facial contour deformities in 152
sites of 50 cases with successful outcomes.
Results: Thirty-nine sites in 17 cases were followed up from 13
months to 37 months (average, 22.8 months). The injected fat
parcels deposited successfully and the increasing volume maintained
well. The impact factors on the successful deposit of the injected fat
parcels included the extent of mechanical injuries to the fat cells
during liposuction and lipoinjection, application of the purification
procedure, and postsurgery immobilization as well as the bloodnourishing situation of recipient sites. Postoperative complications
included undercorrection, overcorrection, small fat mass, unevenness, or irregularity.
Conclusion: The introduced purification and injection techniques
provided a comparative simple and reliable method in facial recontouring treatment. The local volume could be increased successfully
by means of controlling the influencing factors of fat parcel deposit.
Key Words: fat parcels, fat parcels injection, purifying technique
of fat parcels, facial contour deformity, facial recontouring
(Ann Plast Surg 2007;58: 602 607)
TABLE 1. Clinical Materials of Facial Contour Deformities Treated by Fat Parcel Injection
Forehead
Temporal depression
Buccal
Zygomatic
Infraorbital
Nasal root
Upper eyelid
Eyebrow
Scar depression
Lips
Nasolabial fold
Wrinkles
Chin
Sites
Causes
Volume of Fat
Parcel
Times of Follow Up
Times of
Reinjection
1
29
32
4
12
1
10
12
7
18
12
11
3
Congenital
Congenital
Congenital aging
Congenital
Congenital fracturing
Operative
Operative traumatic
Congenital
Trauma skin grafting
Congenital or aged
Congenital or aged
Aged
Congenital
18
810 ml
810 ml
78 ml
34 ml
1.5 ml
34 ml
45 ml
37 ml
24 ml
23 ml
0.52 ml
46 ml
0
1637 months
1437 months
0
0
No
1524 months
1318 months
14.523 months
0
1734 months
1634 months
0
2
13
24
01
01
0
12
01
23
12
2
0
0
Complications
Irregularity
Small fat bulk, undercorrection
Undercorrection
Undercorrection
Unevenness
Undercorrection
Undercorrection or overcorrection
Undercorrection
Undercorrection
Existence but milder than before
Overcorrection or unevenness
Operation Procedure
Preoperative Preparation
Preoperative planning involved identifying and marking the contour deformities to be corrected and potential fat
harvest sites. Photographs were taken before and after marking the skin and they were posted for intraoperative reference.
A permanent, color-coded marker was used to designate areas
where aspiration and injection could or could not be safely
603
Hu et al
performed. Common aspiration sites included the periumbilical area, the inner and outer thigh, the buttocks, the inner and
back arm, and the waist. In addition, entry wound sites were
marked, considering cannula length, to allow maximum access to tissue while minimizing skin incisions. A map of all
injection sites was then drawn for intraoperative volume
estimation and tabulation.
Anesthesia
The tumescent fluid created by Klein19 was injected
subcutaneously in the donor sites. The subcutaneous diffusive
anesthesia, in which the limited volume of anesthetics was
used, or the local nerve blocks were taken in the recipient
sites. Although some researchers7,12 thought that epinephrine
might hurt fat parcels, use of epinephrine still held many
advantages, eg, reducing the occurrence of hematomas and
decreasing the dosage of anesthetic drugs. Thus, epinephrine
was regularly used in our liposuction procedure and could be
mostly removed in our purification procedure of dry gauze
absorption.
604
Postoperative Nursing
The skin stab incision at the donor site would heal naturally. Gauze covering was performed over the lipoinjection area
for immobilization purposes and removed 3 days later.
Reinjection Interval
Chajchir20,21 suggested an interval for reinjection of 4 to 6
weeks. However, we considered this interval might be too short
605
Hu et al
FIGURE 5. A, Frontal view before surgery. Her bilateral upper eyelids became depressed (arrows) severely and unnaturally because her majority of the orbital septal fat was removed in a procedure of eyelidplasty in 2001. B, Frontal
view 29 months after autogenous fat parcel injections (3.5
mL, 1 layer, 2 times, and under the muscles).
DISCUSSION
During the past 6 years, the previously described procedures for purification and injection of autogenous free fat
parcels had been applied in correcting various mild or moderate facial depression deformities in 50 cases (152 sites)
(Figs. 1, 2, 4, and 5). From our experience, we summarized
that the following influential factors were associated with the
deposits of the injected fat parcels.
606
purification procedure must be performed before lipoinjection.7,18 From our experience, the gauze absorption could remove those useless or harmful materials effectively and efficiently. With approximately 50% of the volume reduction of the
mixed suction solution, the desired effective fat parcels were
greatly enriched, which was the key for successful treatments.
the recipient sites could become fatty after the injection when
the patients were gaining weight.
Injection Location
The mobility feature of the injection areas was another
influential factor determining whether the injected fat parcels
successfully deposited. The less frequently the injection areas
moved, the more successfully the fat parcels deposited. In our
studies, the deposit of fat parcels at the relatively static locations
such as the forehead and temporal fossa (Figs. 2, 4, and 5) was
better.
Blood Supply
Like other free grafted tissues, the fat parcels would
only deposit well at the recipient sites with a rich blood
supply. In our studies, good recontouring results are usually
achieved for the congenital facial deformities. There was a
less successful deposit of fat parcels for the deformities
causes by operation, infection, or trauma because of the
existence of the scar tissue with poor blood supply.
Indications
The best indications for the free autogenous fat parcel
injection were those facial depression deformities caused by
the congenital underdevelopment (Fig. 4) and traumas or
after surgery (Figs. 1 and 5). The glabella wrinkles and the
nasolabial fold depression (Fig. 4) were also good indications
for a small-volume lipoinjection treatment. Dramatic results
would be achieved for those cases of mild chin retrogression.
Potential Problems
The fat parcels used in the procedures were collected
from the body portion or extremities. These were the places
for humans to deposit their energy. It would be possible that
CONCLUSION
The reported technique for the collection, purification,
and injection of fat parcels was quite simple and can be
completed in a short time period. The volumetric maintenance was enough to improve the facial contours in our
studies by application of this technique. The results achieved
by this procedure were very reliable and reproducible.
REFERENCES
1. Neuber F. Fettransplantation. Bericht uber die Berhandlungen der Dt
Ges f Chir. Zentralbl Chir. 1893;22:66.
2. Ellenbogen R. Free autogenous pearl fat grafts in the facea preliminary
report of a rediscovered technique. Ann Plast Surg. 1986;16:179 194.
3. Brown JB, Fryer MP, Randall P. Silicones in plastic surgery. Plast
Reconstr Surg. 1953;12:374.
4. Illouz YG. The fat cell graft: a new technique to fill depressions. Plast
Reconstr Surg. 1986;78:122123.
5. Fournier PF. Microlipoextraction et microlipoinjection. Rev Chir Esthet
Lang Fr. 1985;10:36 40.
6. Brandow K, Newman J. Facial multilayered micro lipoaugmentation. Int
J Aesth Restor Surg. 1996;4:95110.
7. Coleman SR. Facial recontouring with fat parcels. Facial Cos Surg.
1997;24:347367.
8. Billings E, May JW. Historical review and present status of free fat graft
autotransplantation in plastic and reconstructive surgery. Plast Reconstr
Surg. 1989;83:368 381.
9. Tzikas TL. Lipografting: autologous fat grafting for total facial rejuvenation. Facial Plast Surg. 2000;20:135143.
10. Cook T, Nakra T, Shorr N, et al. Facial recontouring with autogenous
fat. Facial Plast Surg. 2004;20:145147.
11. Carpaneda CA, Ribeiro MT. Percentage of graft viability versus injected
volume in adipose autotransplants. Aesthetic Plast Surg. 1994;18:17.
12. Abergel RP, David LM. Aging hands: a technique of hand rejuvenation
by laser resurfacing and autologous fat transfer. J Dermatol Surg Oncol.
1989;15:725.
13. Eppley BL, Smith PG, Sadove AM, et al. Experimental effects of graft
revascularization and consistency on cervicofacial fat transplant survival. J Oral Maxillofac Surg. 1990;48:54 62.
14. Eppley BL, Sidner RA, Platis JM, et al. Bioactivation of free fat
transfers: a potential new approach to improving graft survival. Plast
Reconstr Surg. 1992;90:102.
15. Ayhen M, Senen D, Adanali G, et al. Use of beta blockers for increasing
survival of free fat grafts. Aesthetic Plast Surg. 2001;25:338 342.
16. Aboudib JHC, Cardoso de Castro C, Gradel J. Hand rejuvenescence by
fat filling. Ann Plast Surg. 1992;28:559 564.
17. Novaes H, Norair dos Reis, Campinas RB. Counting method of live fat cells
used in lipoinjection procedures. Aesthetic Plast Surg. 1998;22:1215.
18. Coleman SR. Hand rejuvenation with structural fat grafting. Plast
Reconstr Surg. 2002;110:17311744.
19. Klein JA. The tumescent technique for liposuction surgery. Am J Conm
Surg. 1987;4:263267.
20. Chajchir A, Benzaquen I. Liposuction fat graft in face wrinkles and
hemifacial atrophy. Aesthetic Plast Surg. 1986;10:115.
21. Chajchir A, Benzaquen I, Wexler E, et al. Fat injection. Aesthetic Plast
Surg. 1990;14:127.
22. Peer LA. Loss of weight and volume in human fat grafts. Plast Reconstr
Surg. 1950;5:217.
23. Chajchir A, Benzaquen I, Moretti E. Comparative experimental study of
autologous adipose tissue processed by different techniques. Aesthetic
Plast Surg. 1993;17:113.
24. Rudolph R, Ballantyne DL. Skin grafts. In: McCarthy JG, ed. Plastic
Surgery. Philadelphia: WB Saunders Co; 1990:252.
607