AUTOLOGOUS FAT INJECTION
or
LIPOFILLING (LIPOSTRUCTURE)
Aesthetic surgery:
This document has been conceived under the authority of the French Society of plastic Reconstructive and Aesthetic Surgery (SOFCPRE).
DEFINITION, AIMS AND PRINCIPLES
As soon as the first liposuction techniques were invented Plastic Surgeons realised that the fat extracted could be re-injected elsewhere in the body, thus acting as filler.
This technique, autologous fat injection, known as lipo-filling, remained disappointing for many years: the re-injected fat tended to be reabsorbed to a great extent, leaving a result, which was neither predictable nor lasting.
Nevertheless Plastic Surgeons were not discouraged and tried to understand the reason for these unsatisfactory results. Little by little progress was made and it was from 1995 onward that the injection of autologous fat became a reliable technique. (S. COLEMAN).
The principle is an autograft of fat cells from fat harvested from the patient.
Lipostructure can be used for many depressions (troughs), which can be natural or post-traumatic.
The aims and indications of this procedure can be summed up as follows:
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1.Aesthetic indications
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The filling and smoothing of certain wrinkles, especially of the face.
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Restoration of the ‘fullness’ of a gaunt face or one showing the first signs of aging.
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Restoration of volume and shape to the face: especially in the case of a face emaciated by aging.
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In complement to certain neck- and face-lifts to give a more balanced result.
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As an additional procedure after a previous face-lift, to improve the shape of the mid-section of the face without resorting to another face-lift.
The treatment of these aesthetic misfortunes does not justify an assumption by health insurance.
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2.Indications concerning restorative or reconstructive surgery
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Filling of a depressed zone resulting from injury
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Correction of irregularities following an unsatisfactory liposuction.
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Correction of wasting after triple therapy for HIV + patients.
In these indications of reconstructive surgery, lipostructure can be reimbursed by health insurance under certain conditions.
It is important to keep in mind that lipostructure is a truly surgical technique which must be carried out by a competent, qualified Plastic Surgeon, who is experienced in this technique and who operates in a surgical environment.
BEFORE THE OPERATION
Prior to the operation a thorough clinical and photographic examination will have been carried out in order to determine the corrections required.
If lipostructure is being used to reduce age-related effects photographs of the patient when young will have been studied in order to analyse the aging process.
A preoperative check up will be carried out as prescribed.
An anaesthesiologist will see you in consultation at the latest 48 hours before the operation.
Tobacco is not a formal contra-indication but his arrest a month before the intervention is recommended in view of its adverse effect on wound healing.
No aspirin-based medication should be taken during the 10 days preceding the operation.
HOSPITAL STAY AND TYPES OF ANAESTHESIA
Type of anaesthesia:
Local anaesthesia with sedation given by intravenous drip (‘twilight’ anaesthesia) is the usual choice for lipostructure. One can also use local anaesthesia alone, or general anaesthesia.
The type of anaesthesia will be chosen after discussion between yourself, the surgeon and the anaesthesiologist.
Hospital stay:
The procedure may be carried out on an outpatient basis, in an ambulatory facility, the patient arrives and leaves on the same day.
It can be said to remain hospitalized overnight following the operation.
THE PROCEDURE
Each surgeon has adopted his or her own specific technique, which he or she adapts in order to obtain the best results in each case. We can however give you some basic points.
We start by carefully defining the areas from which the fat will be harvested, and the re-injection sites.
The harvesting of fat is carried out atraumatically through a tiny incision hidden in the natural skin creases, using a small cannula.
An area with reserves, or even an excess, of fat will be chosen for harvesting, at a site not normally visible.
After harvesting, centrifugation will be carried out for a few minutes, in order to separate the intact fat cells, which will form the graft, from elements that cannot be used.
Re-injection is carried out through 1mm incisions using micro-cannulas.
Tiny particles of fat are re-injected at different levels and in multiple divergent directions. This increases the surface area in contact with the implanted cells and receptor tissue and ensures the survival of the grafted fat cells.
Dans la mesure où il s’agit d’une véritable prise de greffes de cellules vivantes, et sous réserve que la technique soit bonne et la prise de greffe effective, les cellules ainsi greffées resteront vivantes au sein de l’organisme, ce qui fait de la technique de lipostructure une technique définitive puisque les cellules adipeuses ainsi greffées vivront aussi longtemps que les tissus qui se trouvent autour d’elles.
La durée de l’intervention est fonction de la quantité de graisse à réinjecter et du nombre de localisations à traiter. Elle peut varier de 30 minutes à 2 heures en cas de lipostructure isolée.
APRES L’INTERVENTION : LES SUITES OPERATOIRES
Dans les suites opératoires, les douleurs sont en règle générale peu importantes.
Un gonflement des tissus (œdème) apparaît pendant les 48 heures suivant l’intervention et mettra en général 5 à 15 jours à être totalement résorbé.
Des ecchymoses (bleus) apparaissent dans les premières heures au niveau des zones de réinjection graisseuses : elles se résorbent dans un délai de 10 à 20 jours après l’intervention.
Since there is true bonding of living cells, when the technique is correct and the graft takes, these grafted cells will become a living part of the body. This means that lipostructure is a permanent technique since the grafted fat cells will live for as long as the surrounding tissues.
The length of the procedure varies according to the amount of fat to be re-injected and the number of treated sites. It can vary from 30 minutes to 2 hours for lipostructure alone.
AFTER THE OPERATION: POSTOPERATIVE CARE
After the operation pain is usually mild.
Swelling appears during the 48 hours following the procedure; this usually takes 5 to 15 days to disappear completely.
Bruising appears after a few hours on the injection sites: it disappears 10 to 20 days after the procedure.
Although recovery is in general rapid because of the nature of the procedure, you will have to take into account the swelling and bruising, and organize your social and professional life in consequence.
Exposure to sunlight or UV rays must be avoided for the areas concerned for at least 4 weeks otherwise permanent pigmentation can occur.
Once the swelling and bruising have settled the final result will begin to be visible 2 to 3 weeks after the procedure.
RESULTS
The final aspect will not be visible before 3 to 6 months.
This is usually satisfactory, whenever the indication and the technique have been correct: the depressions have been filled and volume restored.
There is a variable difference, 20 to 40% between the amount of fat re-injected and the amount of engraftment. The practitioner will consider this in the evaluation of re-injecting fat.
If the graft has taken correctly, we have already seen that the cells remain alive for as long as the surrounding tissues.
You should know that fat re-injected who took as fat grafting is sensitive in the future to changes in weight, so in case of weight loss or weight gain, the regions that received the benefit of lipostructure will widen or increase in volume.
Nevertheless the result will deteriorate little by little as these tissues age.
The goal of this surgery is to make an improvement and not to achieve perfection. If your wishes are realistic, the result should give you great satisfaction.
LES IMPERFECTIONS DE RESULTAT
Nous avons vu que, le plus souvent une lipostructure correctement indiquée et réalisée rendait un réel service aux patient(e)s, avec l’obtention d’un résultat satisfaisant et conforme à ce qui était attendu.
Dans quelques cas, des imperfections localisées peuvent être observées (sans qu’elles ne constituent de réelles complications) : hypo-correction localisée, asymétrie légère, irrégularités.
Elles sont, en règle générale, accessibles à un traitement complémentaire : petite "retouche" de lipostructure sous simple anesthésie locale à partir du 6 ème mois post-opératoire, dont la patiente aura été prévenue de la possible opportunité pour parfaire le résultat.
DISAPPOINTING RESULTS
We have seen already that lipostructure, when correctly indicated and carried out, can be beneficial to patients, giving a satisfactory result corresponding to what was expected.
In some cases localized imperfections can be observed (without being true complications): hypo-correction of some areas, slight asymmetry, irregularities.
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They can usually be corrected by ‘touch up’ lipostructure under local anaesthesia 6 months after the initial procedure. You will have been informed about this possibility.
POSSIBLE COMPLICATIONS
Lipostructure, although essentially an aesthetic procedure, is nevertheless an operation, and this implies that the risks inherent to any surgery apply here.
We must distinguish here between risks related to the anaesthesia and those related to the surgery.
For the anaesthesia, the anaesthesiologist will explain the risks during the preoperative consultation. You must be aware that anaesthesia can cause unpredictable reactions, which can be difficult to control: the presence of an experienced anaesthesiologist, in a surgical context, means that the risks are statistically practically negligible.
In fact techniques, products and monitoring methods have progressed considerably over the last twenty years, giving optimal safety, especially when the operation is not an emergency and the patient is in good general health.
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Concerning surgery: by choosing a competent, qualified Plastic Surgeon, used to performing this procedure, you limit the risks, without however eliminating them completely.
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Fortunately, real complications are rare following lipostructure that has been carried out correctly. Rounded cannulas do not harm the skin, the blood vessels and the nerves In fact practically all the operations go well and patients are completely satisfied with the result.
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The infection is normally prevented by prescription of antibiotics before and after the procedure.
The most frequent complication of lipostructure is hyper-correction, this is caused by re-injection of an excessive quantity of fat giving an unsightly result.
This hypercorrection rapidly becomes permanent and cannot be treated by simple liposuction: it can only be remedied by a true surgical operation to remove the excess fat.
All things considered, the risks must not be overestimated, but you must be conscious that an operation, even a minor one, always has some degree of unforeseeable unknown factors.
You can be assured that if you are operated on by a qualified Plastic Surgeon, he will have the experience and skill required to avoid these complications, or to treat them successfully if necessary.
These are the facts that we wish to bring to your attention, to complement what you were told during the consultation.
Our advice is for you to keep this document and to read it and think it over carefully after your consultation.
Once you have done this you will perhaps have further queries, or require additional information.
We are at your disposal should you wish to ask questions during your next consultation, or by telephone, or even on the day of the operation, when we will meet in any case, before the anaesthesia.
"Copyright", © "All Rights Reserved" SOFCPRE, any reproduction, even partial, of these texts is prohibited without permission from the French Society of Plastic Reconstructive and Aesthetic Surgery. A copy or reproduction by any means whatsoever, including photocopying, photography, screen capture, copy, paste, recording or otherwise, constitutes an infringement punishable under the Act of March 11, 1957 on the protection of copyright.
Authorization for reproduction of March 10, 2009, for: MCEI (www.chirurgiens-plasticiens.info).
This factsheet has been designed under the auspices of the French Society of Plastic Reconstructive and Aesthetic Surgery (SOF.CPRE) as a complement to your first consultation; to try to answer any questions you can ask yourself if you intend to use a surgical lipo-filling.
The purpose of this paper is to bring you all the information necessary and essential for you to make your decision with full knowledge of the facts. So is it advisable to read with the greatest attention.