Lipofilling or Lipoestructure
There are different ways of referring to the use of the patient’s own fat, obtained through careful liposuction and prepared to fill, remodel or increase other areas where it will be grafted.
It is important to highlight the fact that it is a GRAFT, it is not a filler. The difference is that the graft has to survive, it has to be irrigated and remain viable; if that’s not achieved, it will be reabsorbed and disappear.
Autologous fat can be defined as the best filling material and the least harmful to the organism, since it is the patient’s own fat tissue, provided that the necessary conditions for its collection and subsequent handling are met, and the means are adequate to guarantee the viability of the grafted tissue.
Lipostructure or lipofilling of fat is a technique that achieves stable and long-lasting results, considering that the fat is not reabsorbed in the long term.
Lipostructure is essentially a “fat autotransplant”
Adipose or fatty tissue has been used as a filling material since the early twentieth century, but the results obtained with its use weren’t too good or constant, because as a rule the grafted tissue was reabsorbed to a greater or lesser extent.
Although there were several attempts to improve the results of the technique, it wasn’t until the beginning of this century when Dr. Coleman described the standardization of an atraumatic procedure that allows to obtain good and reproducible results with the use of adipose tissue grafts, a process to which he named LIPOSTRUCTURE.
Since then, applications have grown exponentially. Precisely, it has been in the Plastic Surgery area where there has been more progress. Initially it was used in facial fillers for the treatment of atrophies (by drugs and congenital) but later its use has been extended to reconstructive and aesthetic surgery.
After oleman’s work, the number of articles and experiences by other researchers and surgeons multiplied.
Applications of adipose tissue grafts:
- Facial atrophies (by retroviral, congenital, Romberg)
- Breast reconstruction
- Body contour defects following trauma, congenital malformations or sequelae of surgery.
- Correction of surgical sequels of body contour.
- Breast augmentation.
- Facial rejuvenation alone, or associated with lifting, blepharoplasty, etc.
- Rejuvenation of hands
- Increasing of buttocks
- Increase of legs
- Filling of depressed scars
- Correction of asymmetries
1 to 2 sessions are needed for aesthetic procedures and up to 4-5 sessions for more complex reconstruction procedures.
Lipofilling can be done with local anesthesia (with or without sedation) or with general anesthesia (if liposuction exceeds approximately 4,000 cc). In many cases, hospital admission is not necessary and the intervention is performed as a day hospital.
The extraction of the fat is done with special cannulas and with a very careful technique to avoid breaking the adipocytes, the cells that accumulate fat. The extracted fat undergoes a “cleaning” process to infiltrate only the adipocytes alive and that may remain in the tissue. The best fat to infiltrate will also be the one that also maintains the stem cells from adipose tissue.
The filling is obtained by infiltrating all the obtained fat with micro-cannulas until the desired result is achieved. The lipofilling practically leaves no visible scars.
In the postoperative period, an antibiotic and painkillers are administered orally. It is advisable to wear an elastic band or a bra in case of breast filling for 10 days.
The lipofilling is the intervention that allows to remove the unsightly fat from places where you want to eliminate it (flanks, hips, waist, legs, arms, …) and add it in those areas where we would like to increase the volume (breasts, glutes, face, calves …). The procedure is not invasive, so in the majority of cases it is ambulatory, that is, the patient goes home the same day after the surgery, takes a few hours of rest in the clinic and the postoperative period is practically zero, it can continue a normal life in 24 hours.
MAIN USES OF LIPOFILLING
There are several techniques to increase the volume of the breasts, either through the introduction of cohesive silicone gel prostheses or with the breast lipofilling technique.
This technique may be indicated in those women who have enough donor fat tissue to allow them to achieve the breast volume they desire, while benefiting from the result of a liposuction.
It is interesting in cases of important asymmetries of breast volume, since a better result can be obtained than with the use of a single prosthesis.
It can be practiced with local anesthesia and sedation or with general anesthesia and the patient can sleep at home or spend a night at the Clinic.
The fat implantation technique is very important to ensure that it survives in the implanted area and maintains the volume achieved, ensuring that the fat is not reabsorbed in the long term. In this case, the fundamental thing is following the instructions given by the medical team.
It is important to indicate the following:
- The injection of purified fat into the breast does not change the risk of breast cancer at all according to the currently available data. Benign calcifications can appear at the hands of an expert radiologist and with a quality phonograph, are easily distinguishable from the suspicious calcifications due to their shape and location.
- Oily cysts may appear, which are benign, but are sometimes palpable or may require a puncture to be evaluated.
- To avoid unnecessary surprises, a strict mammography control is recommended in the first years with the intention of clearly documenting the appearance of these images and avoiding confusion in the future:
- First mammography 9-12 months after surgery.
- Follow-up every 6 months the 2 years after the first mammogram.
Facial Lipofilling or Lipostructure
We know that over the course of several years the face loses volume. There is atrophy of some of the adipose packs that are responsible for the contours and others move. This evolution is perfectly seen comparing any of our photos from our childhood until now. Lipofilling aims to restore the original content of these fatty packs, especially in the area of the cheekbones, but we can also use it to improve the contour of the jaw or fill the temporary area.
On the other hand, the adipose tissue injected improves the quality of the skin, possibly due to its content in stem cells (which in conditions of lack of oxygen such as that produced in the tissue that receives the adipose tissue become capillaries, arteries and veins).
The loss of the volume of the facial fat compartments is one of the main causes of the sagging produced by age.
The increase in volume tightens the skin. On the other hand, adipocytes contain many growth factors that induce a rejuvenation of the appearance.
This minimally invasive technique can be performed under local anesthesia for small locations: dark circles, nasolabial folds, puppet lines. For larger volumes, local anesthesia + sedation or general anesthesia is needed.
If the flaccidity of the skin is important, the lipostructure can be associated with a cervico-facial lift.
Periorbital lipofilling can be performed under local anesthesia. Hospital admission is not necessary, and the patient can return to his home on the same day of the intervention, and practically leaves no visible scars.
The facial fat implant can be performed alone or in combination with other interventions, such as a face lift or cervical lift.
Buttock and calf augmentation
The gluteal augmentation, is a surgery to reshape the shape and volume of this area, either by liposculpture or lipofilling The advantages of the use of fat is that rejection is not possible, it is a graft of the individual. It also contains pluripotent stem cells that, depending on which zone they are grafted on, regenerate tissue.
It is recommended when the patient, in addition to increasing their buttocks, wants to eliminate unsightly accumulations of fat in other parts of the body, thereby improving the figure even more. A liposuction of the areas that the patient wants to improve, once the fat is extracted, is processed and through injections of deposit inside the buttocks to be able to increase them. This surgery can be performed under general anesthesia or under local anesthesia plus sedation. One night of admission to the clinic is recommended.
Rejuvenation of the hands
With age, hands suffer an aging process, especially on the back, where the skin becomes thinner and lax, spots appear, the venous network and bones become more evident. Nowadays, there are different types of treatments to improve the appearance of the hands, and the plastic surgeon will be able to advise which of them will be more effective in each case. The most innovative and effective way to rejuvenate the hands is through the filler treatments, which allows us to add volume to offer a more youthful appearance. The results are immediate. The most frequent fillers are the fat itself, infiltrated with a procedure called lipofilling, or hyaluronic acid.
PROCESS OF EXTRACTION AND INFILTRATION OF FAT
The procedure can be performed under local anesthesia, with intravenous sedation and local anesthesia or with general anesthesia, depending on the case.
Extraction: First, the fat is extracted from the donor area. Depending on the amount of fat we need, in some patients a single area (abdomen or flanks) may be enough, while in patients with less fat it may be necessary to remove multiple areas at the same time.
Usually access to these donor areas is made with a small 2-3mm incision.
Fat processing: by decantation and centrifugation (eliminates unwanted components, such as water, fluids, blood, …). This process is done in different ways, in order to get a fat to transfer of different densities. This density difference will cause us to obtain fat of different qualities, for different purposes (such as rehydrating an area, filling a crease, filling a furrow, restoring volume, …). This is one of the keys to the procedure.
The washing and decanting technique can also be used, which seems to increase the percentage of survival of the fat cells.
The fat contains stem cells that are preserved in the transfer.
Grafting or transfer: finally, fat is grafted. It is a very meticulous process, which allows us to “sculpt” the area to be treated. From small incisions, tiny rows of adipocytes are placed in the areas to be treated. The superposition and cross-linking of said “rows” in three-dimensional form, allows us to achieve the desired volume, with a maximum survival of the transplanted adipocytes (60-80%), is considered a great result.
It involves depositing thousands of micrografts that are less than 2 mm in diameter, creating a scaffolding that increases the volume of the area.
Optionally, PRGF (Platelet Rich Growing Factors) extracted from the patient’s own blood is added to increase the survival and subsequent effect of said fat (enriched lipofilling)
It is extremely important: DON’T SMOKE, in fact, if the patient smokes, the percentage of necrosis or graft failure is close to 100%.
It is also very important that you do not apply pressure on the areas where the graft has been performed, and that you take the medication indicated.
This placement in multiple pathways of fat, conditions an edema (swelling) of tissues important in the first days after the procedure. However, being a non-aggressive procedure that develops on a very superficial level, the patient recovers quickly, returning to a normal activity in a short time.
According to recent studies, it is accepted that the best donor areas are the abdomen and the inner side of the thighs, and that the fat must be obtained with a pressure of less than one atmosphere. Also, that the centrifuge at 3,000 rpm for no more than 3 minutes and place it in multiple planes and small amounts in each pass of the cannula, ensures its better integration and survival.
In our clinic, since 1987, we have used fat grafts in multiple interventions and treatments, and our experience confirms these studies; also that grafted fat behaves like the rest of the fat that patients have; decreases its volume if they lose weight, and increases if they gain weight, remaining stable in their location over the years.
We have integrated it in all cases of surgical facial rejuvenation, in cases of breast asymmetry, in breast augmentation when the use of silicone prosthesis is ruled out, in gluteal augmentation, especially associated with liposuction, and as a filler or filler when there is a loss of fatty tissue, in any location.