Lipofilling procedure in the practice of a dermatocosmetologist

When using a “closed system” of autolipofilling, the method is absolutely safe and excludes infection, therefore it can be performed by a dermatocosmetologist in a manipulation room. The system was presented in Ukraine by its developer, Italian plastic surgeon Mario Goisis, at the “Portrait of a Complex Patient” conference.

Carrying out the procedure

The procedure is minimally invasive and is performed under local anesthesia with Klein's solution. The fat used for transplantation can be extracted from any part of the body (belly, sides) where the required amount is available. Aspiration of 15–20 ml of fat is carried out using a special cannula with perforation into the closed Goisis System, where it is filtered and purified before being administered to the patient. The finished autologous filler is slowly injected with 21-22 G cannulas to fully integrate it into the surrounding tissue and increase the likelihood of engraftment. Since 25-30% of transplanted fat cells do not survive, lipofilling usually involves slight overcorrection of problem areas. In general, the procedure lasts about an hour, depending on the number of injection zones. The most common areas for volume replenishment are the face, hands, and external genitalia. The remaining areas (breasts, buttocks, legs) require more autologous filler.

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

The results of the procedure are assessed for the first time after 3 weeks, when postoperative swelling goes away. A re-evaluation is carried out after 4-6 months, when the dead fat cells are re-absorbed by the body, and the remaining transplanted fat tissue has finally taken root, sprouts a capillary network and begins to fully function (photo 1).

Photo 1. Patient before and after autolipofilling procedure

Contraindications and possible complications for the method are the same as for other injection procedures. More serious risks, including complications after the administration of local anesthetic and fat embolism, can arise both due to improper technique of the procedure and due to the body's individual reaction to lipofilling.

The advantage of this technique is aesthetic improvement in both the donor and recipient areas; surviving fat is permanent; the introduced material is completely natural; The method is cost-effective, minimally invasive, does not take much time, and demonstrates a low percentage of complications.

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. In addition, using a special filter that crushes and homogenizes the resulting adipose tissue, you can prepare a biorevitalizing emulsion. The emulsion is administered papularly and linearly retrogradely to improve skin quality (thickening, moisturizing, regeneration).

Disadvantages include that the patient may require repeated procedures, and the stability of the results depends on hormonal and weight changes. Lipofilling is not possible in very thin patients.

To mix or not to mix?

Reported fat cell survival rates in the medical literature vary widely (10–90%) and depend on the method of harvesting, processing, and injecting the fat cells. To even out this indicator, many surgeons suggest adding autologous plasma (PRP), which is known as a natural reservoir of growth factors that stimulate tissue repair and regeneration.

Purified fat obtained by the Coleman method was mixed with varying amounts of PRP for in vitro, in vivo (mice) and clinical experiments: > 50% PRP - for skin rejuvenation, correction of superficial scars, infraorbital area, 20% PRP with 80% purified fat – for deep filling (nasolabial folds, lips or soft tissue defects). In vitro studies have shown that PRP increases fat cell survival and stem cell differentiation.

Animal studies showed that fat graft survival was significantly increased by the addition of PRP. Several clinical cases have confirmed improved wound healing and better tissue regeneration when fat is mixed with PRP.

When using a closed Goisis System, the PRP addition step may not be necessary. The method is gentle and assumes satisfactory survival of fat cells and a large number of stem cells, in contrast to the classical method.

First published: Les Nouvelles Esthetiques Ukraine 1 (107)/2018