Autologous Fat Transfer (eBook)

Autologous Fat Transfer 1
History, Principles, Fat Cell Physiologyand Metabolism 17
History of Autologous Fat Transfer1 18
1.1 Introduction 18
1.2 History 18
References 19
History of Autologous Fat Transplant Survival1 20
2.1 Introduction 20
2.2 Historical Review 20
References 24
Principles of Autologous Fat Transplantation 26
3.1 Introduction 26
3.2 Fat Transplant Survival 26
3.3 Indications for Fat Transplantation 27
3.4 Complications of Fat Transplantation 28
3.5 Technique of Autologous Fat Transplantation 28
3.6 Insulin 30
3.7 Centrifugation 30
3.8 Ratchet Gun for Injection 30
3.9 Severing Tethering Bands 31
3.10 Machine Liposuction 31
3.11 Specific Principles 31
References 31
The Adipocyte Anatomy, Physiology, and Metabolism/Nutrition 33
4.1 Introduction 33
4.2 Histology 33
4.3 The Interstitium 34
4.4 Physiology 34
4.5 Gross Anatomy 35
4.5.1 Apical Layer 35
4.5.2 Mantle Layer 35
4.5.3 Deep Layer 35
4.6 Deep Fat of the Neck 36
4.7 Upper Arm Fat 36
4.8 Abdomen 36
4.9 Hips and Flanks 37
4.10 Thighs and Buttocks 37
4.11 Lower Leg 37
4.12 Nutrition and Metabolism 38
4.13 Fat’s Future 40
4.14 Conclusions 40
References 40
Fat Cell Biochemistry and Physiology 42
5.1 Introduction 42
5.2 Fat Cells 42
5.3 Lipolysis 43
5.4 Multilineage Cells in Fat 44
5.5 Obesity 44
5.6 Diabetes 45
5.7 Hypertension 46
5.8 Hematopoiesis 46
5.9 Inflammatory Response 46
5.10 Traumatic Lipomas 46
5.11 Multiple Symmetrical Lipomatosis 46
5.12 Discussion 47
References 47
White Adipose Tissue as an Endocrine Organ 50
6.1 Introduction 50
6.2 Role of White Adipose Tissue in Metabolism 50
6.3 Leptin on Brain 51
6.4 Adiponectin on Liver and Muscle 51
6.5 Location of WAT 51
6.6 Adipokines and Inflammation 52
6.7 Conclusions 53
References 53
Preoperative 54
Preoperative Consultation 55
7.1 Introduction 55
7.2 Initial Conference 55
7.3 Physical Examination 55
7.4 Discussion with the Patient 55
7.5 Laboratory Studies 56
7.6 Radiologic Studies 56
7.7 Written Instructions 56
7.8 Postoperative 56
7.9 Conclusions 56
Techniques for Aesthetic Procedures 57
Guidelines for Autologous Fat Transfer, Evaluation, and Interpretation of Results 58
8.1 Introduction 58
8.2 Conclusions 61
References 62
Face Rejuvenation with Rice Grain-Size Fat Implants1 63
9.1 Introduction 63
9.2 History 63
9.3 Preoperative Evaluation 65
9.4 Harvesting 65
9.5 Fat Processing 66
9.6 Fat Transfer 66
9.7 Postoperative Care 67
9.8 Discussion 67
Fat Transfer in the Asian 68
10.1 Introduction 68
10.2 Cultural Issues 68
10.3 Strategies for the Aging Asian Eyelid 69
10.4 Aging Asian Eyelids with a Natural Supratarsal Crease 69
10.5 Aging Asian Eyelids Without a Supratarsal Crease 71
10.6 Aging Asian Eyelids with a ­Man-Made Crease 71
10.7 Strategies for the Aging Asian Face 72
10.8 Conclusions 72
References 73
Subcison with Fat Transfer 74
11.1 Introduction 74
11.2 Subcision 74
11.3 Autologous Fat Injection 76
11.4 Conclusions 76
References 77
Autologous Fat Transplantation for Acne Scars 78
12.1 Introduction 78
12.2 Volumizers and Fillers 78
12.3 Treating Scar Tissue 78
12.4 Physiology of Acne Scars 79
12.5 Evaluating Acne Scars 79
12.6 Acne Scar Morphology 80
12.7 Acne Scar Treatment Options 80
12.8 Lipofilling Acne Scars (Figs. 12.1–12.4) 81
12.9 Longevity 84
12.10 Complications 84
12.11 Conclusions 84
References 84
The Art of Facial Lipoaugmentation 87
13.1 Introduction 87
13.2 Goals of Lipoaugmentation 88
13.3 Instrumentation 90
13.4 Technique 90
13.4.1 Donor Site 90
13.4.2 Recipient Site 91
13.4.3 Final Fat Preparation 91
13.4.4 The Malar Fat Pad 92
13.4.5 Other Facial Enhancements 93
13.5 Repeat Procedures 93
13.6 Conclusions 94
References 94
Use of Platelet-Rich Plasma to Enhance Effectiveness of Autologous Fat Grafting1 95
14.1 Introduction 95
14.2 General Biology of Wound and Graft Healing with PRP 97
14.3 Autologous Fat Graft Healing Model 99
14.4 PRP Technique 99
14.4.1 Isolation of Platelet-Rich Plasma 99
14.5 Harvest of Autologous Fat by Closed Syringe 101
14.6 Autologous Fat Grafting with PRP 103
14.7 Results and Complications Using PRP 108
Discussion 111
Conclusions 114
References 118
Fat Transfer to the Face 121
15.1 Introduction 121
15.2 History of Fat Transfer 121
15.3 Insulin 122
15.4 Centrifugation 122
15.5 Ratchet Gun for Injection 123
15.6 Albumin in Improving Fat Cell Survival 123
15.6.1 Oncotic Pressure 123
15.6.2 Colloid Osmotic Pressure 123
15.7 Starling’s Equation 124
15.8 Avoiding Hypo-Oncotic Trauma in Fat Transfer 124
15.9 Indications for Fat Transfer 124
15.10 Preoperative Consultation 124
15.11 Technique 125
15.12 Complications 125
15.13 Conclusions 128
References 128
Fat Autograft Retention with Albumin 130
16.1 Introduction 130
16.2 Background 130
16.3 History 130
16.4 Microenvironment 131
16.5 Starling’s Equation 132
16.6 Effect of Tumescence 133
16.7 Use of Albumin to Correct pi Deficit Physical Characteristics 134
16.8 Importance of Not Washing 134
16.8.1 The Interstitium 134
16.9 Procedure and Methods 135
16.10 Case Results 136
16.11 Fat’s Future 137
16.12 Conclusions 138
References 139
Aesthetic Face-lift Using Fat Transfer 141
17.1 Introduction 141
17.2 Anatomy and Pathophysiology 142
17.3 Advantages and Disadvantages 143
17.4 Patient Selection 143
17.5 Potential Areas for Facial Fat Transfer 144
17.6 Technique 144
17.7 Fat Harvesting 145
17.8 Fat Injection Technique 146
17.9 Postoperative 147
17.10 Graft Survival 148
17.11 Other Indications 149
17.12 Discussion 149
17.13 Conclusions 149
References 150
Fat Transfer to the Glabella and Forehead1 152
18.1 Introduction 152
18.2 Glabella and Forehead 152
18.3 Equipment 153
18.4 Anesthetic 153
18.5 Injection Technique 153
18.6 Results 153
18.7 Expectations of Fat Survival 153
18.8 Complications 155
18.9 Discussion 155
References 155
Eyebrow Lift with Fat Transfer 157
19.1 Introduction 157
19.2 Technique 157
19.3 Postoperative Care 158
19.4 Discussion 158
Treatment of Sunken Eyelid 159
20.1 Introduction 159
20.2 Refilling 159
20.2.1 Fat Graft 159
20.3 Dermofat Graft (Fig. 20.6) 162
20.4 Others 165
20.5 Repositioning 165
20.6 Conclusions 167
References 168
Fat Graft Postvertical Myectomy for Crow’s Feet Wrinkle Treatment 169
21.1 Introduction 169
21.2 Technique 169
21.3 Conclusions 173
References 174
Optimizing Midfacial Rejuvenation: The Midface Lift and Autologous Fat Transfer 175
22.1 Introduction 175
22.2 Methods 175
22.3 Surgical Technique 176
22.3.1 Fat Retrieval 176
22.4 Fat Processing 176
22.5 Fat Transfer Procedure 177
22.6 Complications 177
22.7 Results 178
22.8 Discussion 178
References 181
Autologous Fat Transfer to the Cheeks and Chin 183
23.1 Introduction 183
23.2 Anatomy 185
23.3 Technique 185
23.4 Complications 186
23.4.1 Bruising 186
23.4.2 Infection 187
23.4.3 Asymmetry 187
23.4.4 Loss of Volume 187
23.4.5 Neuralgia 187
23.4.6 Fat Cysts or Fibrosis 187
23.5 Discussion 187
23.6 Conclusions 187
References 188
Nasal Augmentation with Autologous Fat Transfer 189
24.1 Introduction 189
24.2 Surgical Technique 189
24.3 Postoperative Problems 190
24.4 Conclusions 190
References 192
Lipotransfer to the Nasolabial Folds and Marionette Lines 193
25.1 Introduction 193
25.2 Technique 193
25.2.1 Preparation of Donor Site 193
25.2.2 Preparation of Recipient Site 194
25.3 Harvest 195
25.4 Processing of Fat 196
25.5 Injection of Fat 196
25.6 Complications 196
25.7 Discussion 197
25.8 Conclusions 198
References 199
Autologous Fat Transplantation to the Lips 200
26.1 Introduction 200
26.2 Preoperative Evaluation 200
26.3 Technique 201
26.4 Harvesting of Fat 201
26.5 Injection Technique 203
26.6 Fat Storage 203
26.7 Complications 204
26.8 Discussion 204
References 205
Three Dimensional Facelift 206
27.1 Introduction 206
27.2 Rejuvenation 206
27.3 Muscle Laxity 206
27.4 Volume Depletion 206
27.5 Patient Consultation 207
27.6 Procedure 207
27.7 Postoperative Care 208
27.7.1 First Postoperative Day 208
27.7.2 Second Postoperative Day 208
27.7.3 Third Postoperative Day 208
27.7.4 Fourth Postoperative Day 208
27.7.5 Fifth and Sixth Postoperative Days 209
27.7.6 Seventh Postoperative Day 209
27.7.7 Tenth Postoperative Day 209
27.8 Discussion 209
27.9 Complications 210
27.10 Conclusions 210
Complementary Fat Grafting of the Face 211
28.1 Introduction 211
28.2 Technique 212
28.3 Marking the Recipient Sites 212
28.4 Selecting Donor Site 212
28.5 Donor-Site Harvesting 212
28.6 Processing the Fat 213
28.7 Injection Techniques 214
28.7.1 General Principles 214
28.7.2 Systematic Site-Specific Infiltration 215
28.7.2.1 Inferior Orbital Rim (from Port A) 215
28.7.2.2 Nasojugal Groove (from Port A) 215
28.7.2.3 Lateral Canthus (from Port B) 215
28.7.2.4 Lateral Brow (from Port B) 215
28.7.2.5 Anterior Cheek/Malar Septum (from Port B) 215
28.7.2.6 Lateral Cheek (from Port A) 216
28.7.2.7 Buccal Recess (from Port A) 216
28.7.2.8 Prejowl Sulcus (from Port C) 216
28.8 Immediate Postoperative Care 216
28.9 Complications 216
28.9.1 Lumps 217
28.9.2 Bulges 217
28.9.3 Overcorrection 217
28.9.4 Undercorrection 217
28.10 Discussion 217
28.11 Conclusions 218
Fat Transplants in Male and Female Genitals1 219
29.1 Introduction 219
29.2 Preoperative Preparation 219
29.3 Technique 220
29.4 Penile Enhancement 221
29.5 Vulvar Enhancement 221
29.6 Postoperative Care 222
29.7 Complications 222
29.8 Discussion 223
29.9 Conclusions 223
References 223
History of Breast Augmentation with Autologous Fat 225
30.1 Introduction 225
30.2 Historical Contributions 225
30.3 Recent History with Liposuctioned Fat 225
30.4 Discussion 227
References 228
Breast Augmentation with Autologous Fat 230
31.1 Introduction 230
31.2 Technique 230
31.3 Case Reports 230
31.4 Discussion 230
References 236
Fat Transfer and Implant Breast Augmentation 237
32.1 Introduction 237
32.2 Technique 237
32.3 Clinical Case 237
32.4 Discussion 239
References 241
Fat Transfer with Platelet-Rich Plasma for Breast Augmentation1 242
33.1 Introduction 242
33.2 General Biology of Wound and Graft Healing with PRP 244
33.3 Autologous Fat Graft Healing Model 245
33.4 Technique 247
33.4.1 Isolation of Platelet-Rich Plasma 247
33.4.2 Harvest of Autologous Fat by Closed Syringe 247
33.4.3 Autologous Fat Graft Breast Augmentation with PRP 248
33.5 Results and Complications 251
33.6 Discussion 254
33.7 Conclusions 256
References 256
Cell-Assisted Lipotransfer for Breast Augmentation: Grafting of Progenitor-Enriched Fat Tissue 259
34.1 Introduction 259
34.2 Adipose Tissue-Specific Progenitors with Multipotency 259
34.3 Biological and Therapeutic Concepts of Cell-Assisted Lipotransfer 260
34.4 Concept of Cell-Assisted Lipotransfer 262
34.5 Possible Roles of Adipose-Derived Stem/Stromal Cells in Cell-Assisted Lipotransfer 262
34.6 Technique 263
34.7 Cell Processing (Stromal Vascular Fraction Isolation Procedure) 264
34.8 Results of Clinical Trials (2003–2009) 264
34.9 Preoperative and Postoperative Evaluations 265
34.10 Outcomes 265
34.11 Discussion 266
34.11.1 Refinement of Autologous Fat Graft Techniques 266
34.12 Indications 267
34.13 Complications 268
34.14 Conclusions 268
References 268
Fat Transfer to the Hand for Rejuvenation 270
35.1 Introduction 270
35.2 Hand Rejuvenation 270
35.2.1 Hand Lift 270
35.2.2 Dermabrasion 270
35.2.3 Skin Peel 271
35.2.4 Vein Stripping 271
35.2.5 Autologous Fat 271
35.2.6 Silicone 272
35.3 Technique for Fat Transfer 272
35.3.1 Harvesting Zone Markings 272
35.3.2 Operative Zone Disinfection 272
35.3.3 Operative Zone Anesthesia 272
35.3.4 Anesthesia of the Harvesting Zone 273
35.4 Pure Hand Lipofilling Technique 273
35.5 “Prepared” Fat Grafting: Delayed Harvesting 275
35.6 Implant Conservation 275
35.7 Complications 276
35.8 Durability of Results 277
35.9 Conclusions 277
References 277
Correction of Deep Gluteal and Trochanteric Depressions Using a Combination of Liposculpturing with Lipo-Augmentation 278
36.1 Introduction 278
36.2 Surgical Concepts 278
36.3 Technique 279
36.4 Results 284
36.5 Discussion 284
36.6 Conclusions 285
References 287
Buttocks and Legs Fat Transfer: Beautification, Enlargement, and Correction of Deformities 288
37.1 History 288
37.2 Technique 288
37.3 Materials 288
37.4 Fat as a Tissue Filler 289
37.5 Placement of the Fat Graft 289
37.6 Synopsis of Technique 289
37.7 Qualities of Fat Transplant 290
37.8 Complications 290
37.9 Discussion 290
Autologous Fat Transfer for Gluteal Augmentation 293
38.1 Introduction 293
38.2 Indications 293
38.3 Technique 293
38.4 Liposuction 294
38.5 Fat Injection 294
38.6 Further Liposuction and Injection 296
38.7 Postoperative Care 296
38.8 Complications 296
38.9 Results 296
References 296
Autologous Fat for Liposuction Defects 297
39.1 Introduction 297
39.2 Defects Occurring During Liposuction 297
39.3 Defects Following Liposuction 298
39.4 Conclusions 298
Periorbital Fat Transfer with Platelet Growth Factor 299
40.1 Introduction 299
40.2 Technique 299
40.3 Periorbital Fat Graft 299
40.4 Technique 299
Cryopreserved Fat 301
41.1 Introduction 301
41.2 Review of the Literature 301
41.3 Conclusions 306
References 306
Techniques for Non-Aesthetic Procedures 308
Fat Transfer for Non-Aesthetic Procedures 309
42.1 Introduction 309
42.2 Nonaesthetic Procedures Using Fat Transfer 309
42.2.1 Breast Reconstruction 309
42.2.2 Clival Cordomas 309
42.2.3 Congenital Short Palate 309
42.2.4 Eye Socket Reconstruction 309
42.2.5 Frontal Sinus Fracture 309
42.2.6 Growth Plate, Partial Closure 309
42.2.7 Hemifacial Atrophy(Parry-Romberg Syndrome, Romberg Syndrome,Progressive FacialHemiatrophy, Progressive Hemifacial At 310
42.2.8 Intrinsic Web Space Paralysis 310
42.2.9 Lumbar Disk Herniation 310
42.2.10 Lupus Erythematosis 310
42.2.11 Malar Fracture 310
42.2.12 Migraine Headaches 311
42.2.13 Morphea Zoniform 312
42.2.14 Myringoplasty 312
42.2.15 Orbicularis Oculi Resection for Crow’s Feet 312
42.2.16 Ozena Treatment 312
42.2.17 Pectus Excavatum 312
42.2.18 Postradiation Defect 312
42.2.19 Sulcus Vocalis 312
42.2.20 Temporomandibular Joint 313
42.2.21 Thin Toes 313
42.2.22 Transsphenoidal Surgery 313
42.2.23 Vocal Cord Paralysis 313
42.2.24 Vocal Fold Scar 313
42.3 Use of Autologous Adipose Stem Cells for Nonaesthetic Transfer 313
42.4 Conclusions 314
References 314
Fat Transplantation for Mild Pectus Excavatum 316
43.1 Introduction 316
43.2 Surgical Technique 317
43.3 Patient Selection 318
43.4 Sample Cases 319
43.5 Discussion 320
43.6 Conclusions 321
References 321
Correction of Hemifacial Atrophy with Fat Transfer 323
44.1 Introduction 323
44.2 Technique 324
44.2.1 Timing of Operation 324
44.2.2 Preoperative Preparation 324
44.2.3 Fat Graft Harvesting 324
44.2.4 Fat Graft Injection 324
44.2.5 Postoperative Care and Follow-Up 325
44.3 Complications 325
44.4 Discussion 325
44.5 Conclusions 330
References 331
Recontouring Postradiation Thigh Defect with Autologous Fat Grafting 332
45.1 Introduction 332
45.2 Case Report 333
45.3 Technique 334
45.3.1 Harvest 334
45.3.2 Injection 334
45.4 Discussion 334
References 336
Management of Migraine Headaches with Botulinum Toxin and Fat Transfer 338
46.1 Introduction 338
46.2 Glabellar Region 342
46.2.1 History 342
46.2.2 Anatomy 342
46.2.3 Botulinum Toxin 343
46.2.4 Role of Fat Graft 343
46.3 Techniques 343
46.3.1 Surgical Technique: Fat Graft Harvest in Endoscopic Approach 344
46.3.2 Surgical Technique: Fat Graft Harvest in Transpalpebral Approach 345
46.4 Complications 345
46.5 Occipital Area 345
46.5.1 Anatomy 345
46.5.2 Role of Fat Transposition Flap 346
46.5.3 Surgical Technique 346
46.6 Conclusions 346
References 346
Retropharyngeal Fat Transfer for Congenital Short Palate 348
47.1 Introduction 348
47.2 Symptoms of Velopharyngeal Insufficiency 348
47.3 Preoperative Assessment 349
47.4 Criteria and Indications for Retropharyngeal Fat Injection 349
47.5 Surgical Procedure 350
47.6 Results 350
47.7 Conclusions 351
References 351
Autologous Fat Grafts Placed Around Temporomandibular Joint (TMJ) Total Joint Prostheses to Prevent Heterotopic Bone 352
48.1 Introduction 352
48.2 Surgical Technique 355
48.3 Complications 362
48.4 Prevention of Fibrosis and Heterotopic Bone 368
References 372
Autologous Fat Grafts for Skull Base Repair After Craniotomies1 374
49.1 Introduction 374
49.2 Characteristics of Fat Tissue 374
49.3 Technique 375
49.4 Advantages, Disadvantages, and Complications 377
49.5 Conclusions 377
References 378
Fat Processing and Survival 379
Fat Processing Techniques in Autologous Fat Transfer 380
50.1 Introduction 380
50.2 Fat Processing Techniques 381
50.3 Future Issues for Fat Processing 383
References 384
Injection Gun Used as a Precision Device for Fat Transfer 386
51.1 Introduction 386
51.2 Technique 386
51.3 Precision Injection with Gun Injection Device 388
51.4 Conclusions 390
References 390
Tissue Processing Considerations for Autologous Fat Grafting 391
52.1 Introduction 391
References 393
Fat Grafting Review and Fate of the Subperiostal Fat Graft 394
53.1 Introduction 394
53.2 Materials and Methods 394
53.3 Results 395
53.4 Histopathologic Examination Findings 396
53.5 Discussion 397
References 399
Complications 401
Complications of Fat Transfer 402
54.1 Introduction 402
54.2 Complications 402
54.2.1 Viral Infection/Warty Over-Growth 403
54.3 Conclusions 409
References 409
Facial Fat Hypertrophy in Patients Who Receive Autologous Fat Tissue Transfer 411
55.1 Introduction 411
55.2 Patients and Methods 411
55.3 Results 412
55.4 Discussion 413
55.5 Conclusions 414
References 414
Lid Deformity Secondary to Fat Transfer 416
56.1 Introduction 416
56.2 Contour Deformity 416
56.3 Fat Embolization 418
56.4 Miscellaneous 418
56.5 Conclusions 418
References 419
Miscellaneous 420
The Viability of Human Adipocytes After Liposuction Harvest 421
57.1 Introduction 421
57.2 Historical Perspective 421
57.3 Liposuction and Free Adipose Transfer 422
57.4 Viability of Human Adipocytes After Aspiration Harvest 423
57.5 Aspiration Techniques 424
57.6 Effect of Local Anesthesia and Epinephrine 424
57.7 Tissue Handling 424
57.8 Tissue Storage 425
57.9 Conclusions 425
References 425
Autologous Fat Grafting: A Study of Residual Intracellular Adipocyte Lidocaine1 427
58.1 Introduction 427
58.2 Materials and Methods 428
58.3 Processing of Samples 429
58.4 Results of Samples 429
58.5 Discussion 430
58.6 Conclusions 430
References 431
Autologous Fat Transfer National Consensus Survey: Trends in Techniques and Results for Harvest, Preparation, and Application 433
59.1 Introduction 433
59.2 Methods 433
59.3 Results 436
59.4 Experience 436
59.5 Technique 436
59.6 Outcomes 437
59.7 Discussion 438
59.8 Conclusions 439
References 439
Medical Legal Aspects of Autologous Fat Transplantation1 441
60.1 Introduction 441
60.2 Requirements for Medical Negligence 441
60.2.1 Duty 441
60.2.2 Breach of Duty 441
60.2.3 Injury 441
60.2.4 Causation 441
60.2.5 Standard of Care 441
60.3 Informed Consent 442
60.3.1 Definition 442
60.3.2 Legal Definition 442
60.4 Medical Record 442
60.5 Legal Aspects 442
60.6 Dangers in Glabellar Injection 443
60.7 Blindness and Central Nervous System Injury 443
60.8 Fat Transfer to the Breast 443
60.9 Fat Hypertrophy 443
References 444
Editor’s Commentary 445
61.1 Introduction 445
Index 448