Fat Injections (Lipoaugmentation)
To use autologous fat to fill out defects and augment different parts (of the face) has become increasingly popular. The great advantage is that fat, being autologous, remains to 60-70 % and then becomes permanent. Fat can be injected several times and give the patient a good opportunity to participate in decisions about the final result with regard to volume and shape, e.g. for the lips and cheeks.
It is now more than 10 years since we started to use fat to change and reshape deformed and fallen-in faces / cheeks. In the beginning we used fat in congenital and acquired defects, mainly in the face. Eventually this developed more into the reshaping of faces, e.g. the flat mid-face. It was possible to create a harmonious curve over the malar bones. See examples in the Photo Gallery. We now fill out lips and nearby areas lateral to the mouth, including the cheeks. Even temporal areas are now sometimes filled out with fat.
We now use autologous fat for the following areas and problems:
The breast can be augmented to a moderate degree using autologous fat. We need fairly large volumes to get an obvious result (200 + 200 ml at least). We therefore require good access to subcutaneous fat in that individual. The augmentation is moderate, corresponding to implants of 100 or rarely 200 ml, and often requires several sessions. However, augmentation of the upper breast pole and correction of irregularities after previous surgery or in asymmetries can be achieved by this method. This is true also after radiation and cancer treatment. The damaged skin becomes softer and looks more natural after fat infiltration.
Treatment with breast implants is more rapid and effective than infiltration with fat, which can only correspond to a 100-150cc implant. We normally use implants between 260 and 350cc so the difference is considerable. The advantage in using autologous fat is that you hardly have any problems after the surgery, which must generally be performed under full general anaesthesia. Afterwards we use special bras and always prescribe antibiotics for 7-10 days. Several investigations have now shown that fat injection does not disturb later mammography. In a flat breast, fat injections can help. Fat is infiltrated into several different areas of the breast simultaneously to get a harmonious result.
Hypoplasia of the Mid-Face (Flat Mid-Faces)
In a hypoplastic mid-face you can use implants or fat. Implants have a hard suface and this can give a more pleasant contour. When the elegant convex contour (the ogee curve) is missing over the malar bones, fat or implants are good alternatives. We call this procedure malar augmentation.
Augmentation of Cheeks with Autologous Fat
This can be done if the cheeks have fallen in, for example after serious illnesses, such as cancer or HIV. Following acne and scars, fat is a good alternative. The volume is normalized and the face becomes more natural in appearance and pigmentation.
Lip Augmentation with Autologous Fat
Both the upper and the lower lips can be augmented with autologous fat. The pre-requisite is that something is visible of the lip mucosa from the front. If not, you have to mobilize the mucosa (the red part) from the inside of the lip. The lips become enlarged and you can further augment the lips using autologous material later. See examples in the Photo Gallery.
There are a small group of individuals who resorb almost all autologous fat. We then use either autologous fascia (the cover of the muscles) or a dermagraft (from the deeper parts of the skin). These two materials are more stable than fat and, from the very beginning the area becomes less swollen. Like fat, fascia and dermis can be used 1-2-3 times (or more). The back of the dermis can be covered with a layer of fat, which increases the volume further. The pre-requisite is that the epidermis (the superficial layer of the skin) can first be removed.
Lip augmentation with autologous materials is an important technique and the lips can be shaped in different ways. The upper lip can, for example, be made larger in the central area and less voluminous in the lateral parts. The lateral parts of the lower lip are usually made larger than the central part. This is nature´s most common construction. These autologous techniques of adding volume to thin lips have become an important part of the final re-construction of cleft lip deformities.
Fat is now used in young people with thin lips and also in the elderly to increase volume and to minimize nearby wrinkles and folds. The corners of the mouth and nearby tissues are nowadays often filled out with fat. See examples in the Photo Gallery.
For many years the nasolabial folds have been filled with fat. This is a good alternative to non- permanent fillers.
Jaw and Chin Contours
Many people have a concave contour of the chin. This can be filled out with autologous fat, which will make the chin look smaller.
The Temporal Areas
Some people find that the temporal areas should be rounder to give the face and scull a more attractive appearance. Fat can be used for this purpose.
The Back (Dorsum) of Hands
Older people are usually satisfied after our facial surgery, such as a mid-face lift or a full face-lift. However, we often hear the complaint that “my face looks good, but my hands show my age.”
We now have the possibility to augment the dorsum of the hands with autologous fat. This procedure gives excellent results and virtually no postoperative problems.
Elderly women often experience that the genital area has become too flabby. We can augment the labia with autologous fat and also rejuvenate their function.
We harvest autologous fat from the hips or the stomach, or sometimes from the upper parts of the legs, which usually only causes minimal bleeding. The fat is sucked out and centrifugalized in order to separate it from any remaining fluid or blood, and then injected where needed through small cannulas. Since this fat also contains stem cells, recovery and rejuvenation of the tissues are also improved by these procedures. We only use millimetre-sized openings in the skin both when we harvest and when we infiltrate the fat. This technique is performed in a careful way so that cells are not damaged. The recovery rate using our technique is 60-70%. We always prescribe antibiotics after the operation in order to prevent infections.
Lipoharvesting and -infiltration i.e. lipoaugmentation, is performed at the Institute of Plastic Surgery, Western Harbour, Malmö, Sweden.