Lipofilling

The lipofilling procedure is a well-known procedure in aesthetic and reconstructive surgery and its revival is due to recent technical innovation and ongoing scientific research.I is an elegant procedure because the patient’s own fat tissue is used to address or treat other areas in the human body. This eliminates the risk of a foreign body reaction. Moreover, the fat is easily and readily available (under the skin) and for the clients, there is minimal discomfort or morbidity and the lipofilling procedure can easily be repeated if necessary. Lipofilling is a targeted delivery of fat cells in specific anatomical areas.Fat can be harvested from the abdominal region, the inner part of the knees, the upper legs or buttocks and other areas.

Aspirated adipose tissue transplantation is commonly performed in three consecutive stages: harvesting (Body-jet) of adipose tissue from a suitable donor site, 2/ purification of the aspirated fat tissue (lipoaspirate) to eliminate the acellular oily supernatant and excess solution by lipocollector, and 3/ reinjection of the purified fat through a three-dimensional reimplantation technique.The fat is injected in different layers and fine, long threads. The lipofilling can be performed  under local anesthesia. The lipofilling can also be repeated if necessary and this is usually performed three to six months after the first lipofilling procedure. 

The characteristics of the area that needs lipofilling and the availability of sufficient subcutaneous fat tissue are the main determinants whether a lipofilling procedure could be efficient. Other variables are your lifestyle (smoking habits etc.) and general condition or coexistent diseases.The possibility of a second or even third lipofilling procedure should be discussed. This will again depend on the characteristics of the area that need to be lipofilled.

Every defect or anatomical zone is different with specific characteristics. The location is in the face or on the trunk, on the arms or on the hands, etc. The skin can be soft, scarred, indurated, irradiated and the subcutaneous (under the skin) layers can be moldable, indurated or scarred. The contours of the defects can be smooth, irregular, concave or convex, steep or minimal. Because of this variety in clinical presentation, the surgeon will also need a variety of tools to address every single defect. These tools are called cannulas. We have aspiration cannulas (to perform the liposuction) and injection cannulas (to do the actual lipofilling procedure).

The injected cell population ("the lipo-aspirate material") finds itself in a hostile environment. They've been disrupted from their native environment (liposuction) and need oxygen and nutrients to survive. They can survive without being in direct contact with blood vessels through the process called "diffusion" but only for the first 48 hours. Diffusion means that they absorb nutrients and oxygen from their direct environment. Within the next 48 hours after injection they need "re-vascularization" (a new blood vessel needs to reach them to supply the necessary nutrients and oxygen). Re-vascularization is established through a process, called angiogenesis (outgrowth of young new blood vessels from existing vessels). This process is strongly inhibited in smokers as smoking has a negative effect on the small blood vessels. Lipofilling in smokers will result in a bad outcome and necessitates several sessions (if authorized).

Lipofilling procedures used to have one common goal: to restore the body contour or adding volume (augmentation) to a soft tissue deficit. Since the discovery of other intrinsic properties of fat tissue (stem cells, humoral factors,...) and based on data from clinical experience lipofilling treatments could also be used to improve the quality of the scarred tissues. Lipofilling can augment the resultant defect of a scar or even improve the quality of the scar (soften it).

Aestheticindications : wrinkles, breast, face, lips, back of the hand, scar correction, contour improvement, buttocks, genital.

Length: about two hours, depending on the size of the areas to be treated.

Possible side effects. Donor area: bruising, swelling, tenderness, up to 24 hours drainage of anaesthetic liquid. Treated area: bruising, swelling (especially the lips if treated), tenderness.

The areas that have been treated will be rather swollen immediately after the operation, especially the lips if they have been treated. It is therefore important to use a cold pack and a compress in the first few hours to minimize the swelling. The swelling will increase until about the third day, but will then gradually subside. After about a week to ten days patients feel confident about going out and resuming a normal social life. If any bruises have developed, they might remain visible for a little longer but can be hidden reasonably well with makeup.

Surgeons usually over-correct, which means injecting more fat than is actually needed because 25 to 30% of the transplanted fat cells do not survive. The final result is assessed after three months. The surgeon will then take photographs to be compared with those taken before the procedure. After initial resorption of a percentage of the fat (between 20 and 50%) the correction can be considered permanent (usually after 6 weeks)

Risks: asymmetry, irregularities, overcorrection, infection.

Recovery: swelling usually diminishes from the third day on, and social activities can be restarted after about one week, sometimes with the help of some make-up.

After initial resorption of a percentage of the fat (between 20 and 50%) the correction can be considered permanent.

See information about Body-jet, Water-jet assisted lipoplasty (WAL), Jet-assisted fat transfer (J-AFT) and LipoCollector (Human Med)

 
Lipofilling
 
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