ARTE FACIAL
by Abraham Gómez, M.D.
Necessary equipment for facial fat transfer
This procedure requires special equipment for the harvesting and processing of fat and its subsequent injection into the face. A portable adipose tissue centrifuge system that delivers high-quality fat grafts is key for adequately processing the harvested fat cells. The usual cannulas employed for most liposuction procedures are too bulky for the delicate fat particles required for facial lipotransfer. Therefore, specially designed fat-harvesting cannulas must be available to extract tiny fat fragments from donor sites. Special cannulas with blunt tips and small diameters are required to inject the fat safely and effectively into the face.
Play Video about Facial Fat Grafting
Selecting the donor site for facial lipotransfer
Choosing the best donor site for harvesting fat depends mostly on surgeon preference and patient convenience. The best quality fat is generally harvested from the abdomen, thighs, or flanks. However, previous surgical interventions in these sites, such as a tummy tuck or liposuction, will preclude harvesting the fat from these areas. In such cases, harvesting can be accomplished from the flanks, knees, or buttocks, although the fat is of lesser quality. The surgeon may also choose the fat-harvesting site based on the patient’s figure, selecting areas that would improve with the sculpting effect of the harvesting (meaning improvement in contour). It is important to note, though, that in most cases, the amount of harvested fat is too little to make a significant difference in the patient’s figure. The ideal location is preferably in areas resistant to exercise and diet modifications, such as women’s outer thigh and abdomen and men’s flanks. Individuals with minimal subcutaneous fat require harvesting from multiple sites.
Marking the patient for facial fat transfer
The patient is marked in the preoperative area while in the upright position. The key landmarks where fat is to be injected are marked carefully. This step is crucial for guaranteeing the best outcome and must be done in a precise and artistic manner. Areas of harvest and injection are marked as discussed in the preoperative consultation and as indicated in the informed consent.
Anesthesia for facial fat transfer procedure
Facial fat transfer should be performed in a sterile surgical environment and, generally, under deep intravenous sedation. Patients undergoing more invasive facial plastic surgery operations simultaneously with fat transfer may benefit from general anesthesia. Local anesthesia is applied to the donor sites before the harvesting of fat, eliminating the pain stimuli and allowing for smoother and more efficient fat harvesting. Recipient sites are also infiltrated with local anesthesia solution before the fat injections.
Adipose tissue processing for facial fat transfer
Once the fat has been harvested, it must be processed to obtain a homogenous graft before injection into the face. The harvested fat is a mixture of oil, concentrated fat particles, and blood. The local anesthetic solution used for the liposuction process is also mixed with the fat. A portable adipose centrifuge system is ideal for processing the harvested fat because it separates the stem cell-rich fat from the blood and local anesthetic solution in a predictable and reproducible manner without damage to the delicate fat particles.
Injecting the fat into the face
As soon as the harvested fat has appropriately been processed in the centrifuge to separate the fat cells from the oil and blood, it is transferred into small 1cc sterile syringes. Carefully selected entry sites for fat injection are infiltrated with local anesthesia in little aliquots to prevent distortion of the injection sites. The fat is injected in tiny amounts with special cannulas employed for facial lipotransfer.
Fat infiltration is performed meticulously and artistically using multiple passes of the cannula to inject tiny aliquots of fat cells in all tissue planes, from subcutaneous tissue to bone.
Facial fat transfer postoperative care
Patients are instructed to avoid exercise for two weeks. Bruising after this procedure is mild, but swelling may last up to one month or more, depending on fat volume and the number of areas treated. Oral non-steroidal anti-inflammatory drugs are enough to control discomfort. The patient is seen for a follow-up one week after the procedure.
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