Naples, Fla. — Dermatologists can treat a range of anatomic areas with autologous fat injections—both to address aesthetic concerns and to optimize outcomes after reconstructive plastic surgery, Dr. Katharina Russe-Wilflingseder said.
Lipofilling is an appropriate technique to augment nasolabial folds, cheeks, and hands, as well as for aesthetic improvement after reconstruction breast surgery, for example. The advantages to this approach outweigh the drawbacks, although both should be considered, she said at the Annual Meeting of the Florida Society of Dermatology & Dermatologic Surgeons
Dr. Russe-Wilflingseder recommended standard wet suction aspiration of a patient’s fat with a 2.5-mm to 3-mm cannula. She also is an advocate of minimal processing, or immediate reinjection of unwashed fat, using a 1.4-mm cannula.
“It is an excellent technique—I rarely use any fillers any more,” said Dr. Russe-Wilflingseder, an aesthetic plastic surgeon in private practice in Innsbruck, Austria.
She turned to the literature to answer some basic questions about autologous fat transplantation technique. For example, the “donor site does not seem to be important for cell survival,” she said. “It should be based on your own decision, the adiposity of donor site, and on the patient’s nomination.”
Some physicians ask whether liposuction or excision is best for fat harvesting. “If we look at the literature, this does not make a difference,” she commented. Excision or gentle aspiration is the generally recommended harvesting technique.
Most reports suggest a short and gentle centrifuge is the optimal processing technique. However, Dr. Russe-Wilflingseder keeps it even simpler. She uses a 10-cc filter syringe to immediately re-inject unwashed fat. “We believe it is very important to leave everything inside.”
Her strategy is to re-inject tiny amounts, using multiple passes and applying the autologous fat to different layers using a fine cannula.
In addition, more fat is preferred to less, she said. “We believe it is better to overcorrect than to undercorrect” in part because a sufficient amount of fat is necessary for revascularization, which takes up to 7-21 days.
Redness of the skin the day after the operation is a common adverse event, Dr. Russe-Wilflingseder said. As with any invasive procedure, there is a risk of infection as well. Otherwise, “there are nearly no side effects.”
An inability to predict the stability and longevity of the fat grafts is another potential drawback to autologous lipofilling, she said. “Our experience is that about 50% [of injected fat] stays alive” in the long term. Another concern is the availability of donor site adiposity. For example, more fat is required to correct after reconstructive breast surgery. One patient, for example, required two treatments with a total 100 cc of fat.
On the plus side, fat injections can improve not only volume but the appearance of scarring after breast tumor resection. Other advantages relate to the “ideal properties” of autologous fat: It is easily available, adaptable, and takes little time to harvest and re-inject, Dr. Russe-Wilflingseder said.
She reported success with many different applications to fill soft tissue and contour defects, some done in combination with submental tissue tightening or carbon dioxide laser resurfacing. For example, 10 to 20 cc of autologous fat injected in the upper nasolabial folds yields great long-term results, she said. For another patient, 10 cc of fat rejuvenated the appearance of their hands. “The quality of the skin improves a lot after the lipofilling.”
Disclosures: Dr. Russe-Wilflingseder said she had no relevant financial disclosures.