Lipofilling: filling with autologous adipose tissue

Vladlena Averina, dermatovenerologist, scientific director of the conference “Portrait of a complex patient”, president of the Association of Aesthetic Gynecology and Andrology, member of the Scientific Committee of AMWC Monaco, AMEC Paris, ICAD (Bangkok)

Denis Yurchenko, surgeon of the highest category, plastic surgeon, founder of the Club of Plastic Surgeons of Ukraine, member of the Ukrainian Society of Aesthetic Medicine

Plastic surgeons, and now dermatocosmetologists, can offer a proven minimally invasive method of filling wrinkles, replenishing volume and truly revitalizing the skin through lipofilling.

Lipofilling is the filling of missing volumes on the face and body with autologous adipose tissue. The result of the procedure is not only the alignment of folds and volume restoration, but also a noticeable improvement in the quality of the skin.

For dermatocosmetologists, in the near future the lipofilling technique will become a new trend. Taking fat from subcutaneous fat within 15-20 ml, followed by preparing a filler from autologous fat and introducing it into selected areas of the face and body is a procedure that is understandable and well accepted by patients. Unlike other fillers, autofat is not rejected by the body, does not cause allergic reactions and has a long-lasting rejuvenating effect.

Working with PDO threads, Aptos or others, as well as with lipolytic cocktails, we work in subcutaneous fat and superficial fat packets, which is also the “point of application” for adipose tissue sampling. When using a “closed system”, the method is absolutely safe and completely eliminates infection, therefore it can be performed by a dermatocosmetologist in a manipulation room.

For the first time in Ukraine, such a system was presented by its developer, Italian plastic surgeon Mario Goisis, as part of the conference “Portrait of a complex patient.”

One of the main advantages of the method is the production of 15-20 ml of autologous filler, which in terms of volumizing abilities corresponds to 10-12 ml of hyaluronic filler. It has also been proven that, in addition to replenishing tissue volumes, as a result of lipofilling, their rejuvenation occurs due to mesenchymal stem cells contained in adipose tissue. Stem cells stimulate the growth of blood vessels in the transplanted fat and regenerative processes, which has a positive effect on the quality of the skin.

Carrying out the procedure

The procedure is minimally invasive and is performed under local anesthesia. The fat used for transplantation can be extracted from any part of the body (belly, sides) where the required amount is contained.

After injection anesthesia with Klein's solution, fat is aspirated with a special cannula with perforation into a closed system. In this case, we are not talking about classical liposuction, the purpose of which is to remodel the body by removing large amounts of fat. For lipofilling, only 15-20 ml of adipose tissue is needed. In the system, the aspirated fat is filtered and purified before injection. Then the finished autologous filler is injected with 21-22G cannulas.

The fat is injected slowly, completely integrating into the surrounding tissue, which will allow it to quickly grow into blood vessels and increase the likelihood of its engraftment.
Fat loss due to reabsorption by the body is inevitable and amounts to up to 30% of the injected volume.

The duration of the lipofilling effect is determined by many factors: location, sampling method, quantity and area of administration, individual characteristics. The fat that remains 6 months after lipofilling is retained forever (about 70%). After 4-6 months, if necessary, a repeat fat transfer can be performed to achieve the desired result. Repeat procedures are required in approximately 30% of patients.

Since 25-30% of transplanted fat cells do not survive, lipofilling usually involves slight overcorrection of problem areas.

Contraindications and undesirable consequences

Contraindications for the method are the same as for other injection procedures:

• diabetes;
• blood clotting disorder;
• oncological diseases;
• infectious diseases;
• cardiovascular pathologies;
• connective tissue diseases in acute and chronic form;
• mental disorders;
• period of menstruation - during breast lipofilling.

Undesirable consequences of lipofilling are listed in order of frequency of occurrence:

• long-term swelling (up to 3-4 months) under or above the correction area;
• partial reabsorption of injected fat due to failed engraftment;
• uneven skin surface;
• skin pigmentation in the treated area.

Complications of this method include:

• asymmetry;
• bumpiness, unevenness of relief;
• pain in treated areas;
• tissue granulation;
• the occurrence of hematomas and swelling at the site of collection;
• change in skin sensitivity in the collection and injection area

More serious risks include complications from local anesthetic injection and fat embolism, which is caused by fat being injected into a blood vessel.

Such complications can arise both due to incorrect technique of the procedure, and due to the individual reaction of the body to lipofilling.

As a significant drawback of the procedure, it is necessary to mention the risk of complete resorption of the transplanted fatty tissue over time.

In general, the procedure lasts 1-1.5 hours, depending on the number of injection zones.

The preliminary result of the operation can be assessed after 10-14 days.

Complete rehabilitation occurs after a few months, when the transplanted adipose tissue finally takes root - it grows into a capillary network and begins to fully function.

Postoperative rehabilitation requires the patient to comply with certain restrictions: avoid physical activity, heat and water procedures for a week.

Long-term results may vary depending on the physiological state of the body: menopause, pregnancy, weight gain and loss.

The most common areas for volume replenishment are the face, hands, and external genitalia. The remaining areas (breasts, buttocks, legs) require more autologous filler.

Another advantage of this method is the preparation of a biorevitalizing emulsion from an autologous filler. For this purpose, a special filter is used that grinds and homogenizes the resulting adipose tissue. The emulsion is administered papularly and linearly retrogradely to improve skin quality (thickening, moisturizing, regenerating).

On the picture.

Before and after lipofilling. Photos courtesy of Dr. Mario Goisis

First published by “Cosmetologist” No. 6 2017