VOLUME LIPOSTRUCTURING AND LIPOFILLING, FAT GRAFTING

Reinjection of autologous fat has been developed and codified in the 90’s by Dr. S. Coleman, an American plastic surgeon. This surgical technique is also called lipofilling, lipostructuring or fat graft.

The principle is to achieve a graft of the fat tissue by subcutaneous injection, a fat that has been retrieved from the patient’s own body. This follows the same principle of a skin graft or a bone graft: fat cells will be revascularized around the reinjection zone.

Lipofilling can be achieved on any skin depressions (hollows) which can be natural, post-traumatic or iatrogenic.

It is important to note that lipostructure also improves the trophic quality of the skin, because the injected fat contains growth factors and stem cells.

This revolutionary method is applicable both in cosmetic surgery and in reconstructive surgery:
– In Cosmetic surgery:
– Filling and mitigation of facial wrinkles;
– Restoration of the facial volume after a weight loss and / or the result of facial aging. This restoration can be done individually or combined with face and neck lift or an eyelid surgery.
– Breast augmentation in case of a breast hypotrophy;
– Penoplasty increase of the penis length and diameter, also called penile augmentation or lipopenosculpturing in Switzerland.

-In Plastic and reconstructive surgery:
– Filling of a subcutaneous depression following a trauma or a surgical procedure.
– Fixing the irregularities due to a liposuction;
– Fixing the side effects of tritherapy (HAART) in HIV patients. These patients have a significant widening of the cheeks and temples due to the melting of facial fat.

Two consultations are necessary before the surgery because clinical examination is essential before a facial lipostructuring. Doctor Jean-Charles BAYOL welcomes you at Laclinic-Montreux, or at the Beauty Suite in Lausanne, (near Geneva by car).

It will be necessary to bring photographs picturing you at a younger. These photographs will allow to study and understand the evolution related to the aging of your face and plan the procedure more accurately.

The fat tissue sampling areas will be chosen during the general clinical examination.

As with any surgical procedure, it is best to stop (or at least reduce) smoking the weeks before surgery. Similarly, any medication containing aspirin which promotes bleeding and bruising should be prohibited within 10 days prior the surgery.

Lipofilling is a real surgical act and should be done in a licensed plastic surgery clinic. When this procedure is performed, hospitalization lasts only one day (ambulatory surgery) at Laclinic in Montreux. When paired with another surgical procedure such as a face lift, it may be appropriate to remain hospitalized overnight following the procedure.

Facial lipostructuring can be performed under local anesthesia. If it is associated with a more important surgical procedure, a neuroleptic (conscious anesthesia or local anesthesia) or a general anesthesia will be more suitable.

Each cosmetic surgeon has his own technique that fits each case scenario in order to get the best result. The main steps of the surgery are:
– The first surgical step involves removing fat tissue. The collection area will have been determined in advance with the patient, taking into account any localized excess fat on the body. Most often this collection is done on the thighs and especially around the knees. It can also be made on the abdomen. To do so, the surgeon uses a small cannula, it is not traumatic and usually leaves no mark
– The collected fat is prepared by centrifuging in order to separate the oily supernatant, blood products and debris (figure 1).

Figure 1: centrifuging and cleaning of the fat

-The reinjection (or more precisely the graft) of the fat tissue is made through micro-incisions using small cannulas that respects the skin, the vessels and the nerves (Figure 2).

Figure 2: reinjection of the fat tissue with micro-cannulas

This graft is made following a fan-shaped pattern using a retro-tracing method in all the layers of the subcutaneous tissue. This technique increases the contact surface between the transplanted cells and the recipient tissue, which improves the survival of the implanted adipocytes (Figure 3).

Figure 3: Graft areas and average injected quantity

Insofar as this is true engraftment of living cells, the implanted fat tissue remains alive in the body and will not disappear (like a skin graft or a bone graft) .

The procedure can last from 30 minutes to 2 hours depending on the number of areas that need to be grafted.

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The procedure is not painful. However, there are almost systematically edemas (swelling of the tissue) and bruising which fade away within 24 to 48 hours. Edema may sometimes be important but will disappear after 10 to 20 days.

To reduce the extent and the duration of swelling and bruising, you will be systematically accompanied by the physiotherapy department for post-operative care. This care will be carried out on the same day in case of an outpatient hospitalization, or the next day if you stay in hospital overnight. Gentle massage of the face and LED-care treatments will ensure the lymphatic drainage and promote healing. Several weeks after surgery, a LPG treatment may be undertaken.

Even if in most cases physical recovery may be fast due to the superficial nature of the procedure, the importance of the social embarrassment caused by the bruises and the swelling of the face have to be considered carefully in order to organize one’s business and social life.

Exposure to the sun must be prohibited for a month after surgery because of the risk of permanent skin pigmentation.

The final result will start to appear 2 to 3 weeks after surgery, when the scars have finally disappeared.

It takes 3 to 6 months after a lipostructuring to evaluate the final result.

When the surgery has been correctly assessed, the result is very satisfactory: volumes have returned, hollows and depressions have been filled.

There is a resorption rate of 20 to 30%, Doctor Jean-Charles BAYOL will consider during the procedure if a very slight over-correction will have to be made.

The fat that has been grafted on the face behaves like the fat present in the rest of the organism in case of a change of weight. If the face is slimming the hollow part will grow larger, in case of a gain of weight there will be an over-correction. Hence the importance of maintaining a stable weight after the lipofilling procedure.

The fat that has been grafted is final and will not disappear. Overcorrection will not disappear and will cause a puffy and swollen aspect like we sometimes unfortunately see on TV or in newspapers. It is then better to under-correct than over-correct. The result can be improved by a second session of autologous fat reinjection.

What is true for the face is also true for the penoplasty (also called penile size enlargement). The result may be increased by a second session of lipofilling.

When there is a small localized imperfection (insufficient correction or small asymmetry), it can easily be adjusted under local anesthesia.

Facial lipostructuring is a cosmetic surgical procedure that remains a real surgery. It must be done in a licensed plastic surgery clinic. Most often it is performed under local anesthesia and complications are exceptional.

An adipocyte grafting should be performed by a qualified and serious cosmetic surgeon, specifically trained for this type of technique and working in a surgical context to minimize the risk of surgical complications. Even if these complications rarely occur it is important to know them:

–Infection: Rare, it is prevented by the prescription of antibiotics during or after surgery.

–Overcorrection: If the fat has been too largely reinjected the excess volume that will result will be unaesthetic and final. The treatment is complex because it cannot be corrected by an isolated liposuction. Only a reoperation with a surgical removal of the excess fat will ensure the correction of the overcorrection.

The best treatment of this complication is therefore preventive. Doctor Jean-Charles BAYOL carries out only very slight overcorrections that reflect the fat absorption rate (approximately 20-30%). before a lipofilling procedure his patients are always warned of the possibility of a second meeting to perfect the result.

Reinjection of autologous fat on the face is a simple surgical procedure performed under local anesthesia. It allows a cosmetic correction of a facial disgrace, alone or combined with another surgical procedure. The final result always creates a true psychological well-being.

Lipofilling is a sustainable alternative to repeated injections of resorbable filling products. Fat injected in the face also improves the quality of the skin.