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What does lipofilling mean?
Lipofilling is a surgical technique using patient's own fat, harvested in one area in order to restore a volume deficiency in another area. The fat is grafted, which means that the fat cells are harvested and transferred without restoration of their blood supply. Consequently, the surrounding tissues of the grafted fat are responsible for the new blood supply, the nutrition, and the final survival of these grafted fat cells. Insufficient blood supply will inevitably lead to resorption of the grafted fat.
Volume deficits in the face may be congenital (for example in the Barraquer Simons syndrome or Romberg disease) or they may be the result of a disease. Natural aging is also accompanied by a certain facial volume loss.
Initial attempts to graft larger amounts of fat have been unpredictable and unstable over time. This was mainly due to the used surgical technique. In the early 1990s however, an American doctor called Sidney Coleman, developed a method to transfer fat taken from the patient's body by means of injection. Using this technique, results became predictable and lasting.
Which problems can be solved by a lipofilling procedure?
Sunken cheeks, the disappearance of fat at the cheekbones, deep grooves running from the nose to the corners of the mouth, and in some instances of lines between the lower eyelids and the cheek can be improved by means of this procedure. Lipofilling can also be used for lip enhancement. Finally, fat injection may smooth out all types of superficial irregularities, such as those rarely seen after liposuction or injuries.
The fat harvest site(s) as well as the recipient site(s) will be marked prior to the surgery. The intervention may be performed under local or general anesthesia depending on the extent of the procedure.
Local anaesthesia will be applied to both sites by means of a subcutaneous injection using a very fine needle. You will feel a sting and a slight burning sensation during the injection, which however will disappear almost immediately. The anaesthesia keeps working for up to two hours, protecting you from pain during treatment. Thus anaesthetized areas will be disinfected and special sterile drapes will be arranged.
The fat is harvested using basically the same technique as performed during a normal liposuction: fat is removed by means of vacuum suction system through small incisions using a hollow cannula.
The abdomen, the inner thighs, or the inner knee areas are the most suitable harvest sites. In case of lipofilling, specially designed thin cannulas connected to vacuum tubes are used to harvest the fat. This method is used to minimize the damage to the fat cells during the harvesting procedure. The obtained fat is then centrifuged in order to remove excess of fluids; hereafter the purified fat is drawn up into separate small syringes.
The recipient areas have been marked prior to the surgery. The purified fat is then injected into dozens of tiny channels, about 1/20 of a ml per channel, through one or more injection sites. This ensures that the grafted fat cells remain in maximal contact with the surrounding tissue, which supplies each fat cell with oxygen and nutrients in order to survive at the new site. The complete intervention will take up to two hours, depending upon the extent of the areas to be treated.
After the intervention
The areas which have been treated will be swollen immediately after the operation, especially if the lips have been treated. In order to minimize this swelling, it is important to administer a wet cold pack (which is a freezer bag filled with ice cubes and water surrounded by a compress) to the treated areas immediate after the intervention. The cooling may be stopped after a few hours.
The swelling will increase until the third day after the intervention, where after it will gradually subside. After seven to ten days you will feel confident about going out and resuming your normal social life. If any bruises have been developed, they might remain visible for a little longer. In most cases they can be hidden reasonably well with make-up.
After three weeks most of the swelling will be gone, but the correction may still look exaggerated. This is caused by the fact that, in order to obtain de desired result, some initial over-correction is needed. This implies that more fat will be injected during the intervention than actually is needed.
Namely, 30- 50% of the injected fat cells will not survive. This survival percentage is variable, and dependant on the blood supply and the mobility of the recipient site. Well vascularized and immobile facial areas do show the highest survival of injected fat.
The final result can be assessed after three months. A second session may be scheduled in order to correct any shortfall in volume due to fat resorption.
After the disappearance of the swelling some slight indurations may be temporarily palpated. Exceptionally they may be permanent. In areas with extreme thin skin, such as the lower eyelids, some irregularities may be visible for a while in rare cases. Sometimes bleeding may occur in sensitive persons, this will slow down recovery.
The most important risk however is the chance of an infection. Antibiotics must therefore be taken after the intervention. Don't forget to tell your surgeon if you are allergic to any antibiotics. Finally, there is also a small chance of asymmetry if the fat does not survive at an even rate in all locations. However, this can always be corrected later.
What else should you know?
Once the injected fat cells have become established they function in the same way as all other fat cells in your body. This means that they will grow and shrink in line with any fluctuations in your general weight. If you put on a lot of weight, the transplanted fat will swell somewhat; and if you loose a lot of weight, the amount of fat in the treated area reduces too.