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Botox Procedure for Wrinkle Correction

Botox is a brand name, and its ingredient is a type of neurotoxin produced by the anaerobic bacterium Clostridium botulinum, which is found when canned food spoils.

When this neurotoxin acts on the human body, it blocks acetylcholine, a secretory substance at nerve endings, and has the effect of paralyzing muscles.

It is used to reduce expression wrinkles on the face.

It can be applied to the glabella, eye area, and forehead where expression wrinkles are strong.

History of Botox Use

It began being used in ophthalmology in the 1970s to treat strabismus, and from the late 1980s it was also used for wrinkle correction, including blepharospasm. More recently, it has also been used for localized hyperhidrosis (a condition involving excessive sweating).

It has been used for nearly 30 years, and there are no special side effects associated with the medication.

This muscle-paralyzing effect is applied to suppress expression wrinkles.

Botulinum toxin type A (brand names: Botox, Dysport, BTX, etc.) is commercialized and in use.

Application of Botox for Facial Wrinkle Correction

Among facial wrinkles, the ones that can benefit from Botox are expression wrinkles that appear when making facial expressions.

These include horizontal forehead lines, the vertical glabella wrinkle between the eyebrows, eye wrinkles that appear when smiling, and horizontal wrinkles on the bridge of the nose.

It should not be used under the eyes or around the mouth.

Under the eyes, the skin may sag or eyelid eversion may occur as a side effect, and around the mouth, the expression may become stiff and awkward, so as a rule Botox should not be used below the under-eye area.

Areas Where Botox Is Applied

| * Forehead wrinkles* Eye wrinkles* Glabella wrinkles* Nose bridge wrinkles |

Botox Procedure

Commercialized botulinum toxin is diluted and injected into the areas where wrinkle correction is desired, and the procedure causes only a slight amount of pain.

The effect appears on average after 2 to 3 days and does not interfere with daily life.

The duration of the effect is about 3 to 6 months, and as the effect wears off, muscle strength begins to return; after about 6 months the effect is almost completely gone.

At that point, the treatment can be repeated.

Anesthesia Method and Procedure Time for Botox

No separate anesthesia is used.

A topical anesthetic cream (EMLA) may be applied, but it is of almost no effect.

Topical anesthetic cream only numbs the epidermal layer of the skin, so it has almost no anesthetic effect for Botox procedures, which require the drug to be injected deeply under the skin.

Local injection anesthesia can also be used, but since there is pain when the needle pierces the skin, it is of little practical value.

Rather, it can be said that receiving the Botox injection directly without anesthesia is less painful.

Because Botox procedures use the finest 30-gauge needle, there is no pain other than a slight sting, so there is no need to worry.

The procedure takes about 2 to 3 minutes per area.

Facial Wrinkle Botox Procedure

1. The facial area is disinfected, and the areas for wrinkle correction are marked with a design pen.

2. Botox is drawn into a syringe.

3. Botulinum toxin is injected along the marked areas.

Usually, 0.5 cc is injected into each marked area.

4. Immediately after the procedure, you can apply makeup and go home to resume daily life.

Facial Wrinkle Botox Procedure

Types of Botox Currently Sold in Korea and Their Differences

The first product introduced and sold in Korea was American Botox.

After that, the product imported from France is Dysport, and more recently there is BTX, which is made in China through OEM and imported as a domestic product.

They are all the same botulinum toxin, so the ingredients are identical, but there are some differences.

The high-priced product is Dysport, followed by Botox, and the less expensive product is Chinese BTX.

Different clinics use different types of botulinum toxin, so the procedure cost varies.

If the price is too low or the effect seems weak, you should check whether Chinese-made product is being used.

Duration of Botox Effect and Recurrence

The duration of Botox varies depending on the area and differs from person to person.

In some cases, the effect may wear off in as little as 3 months, and in others it may last more than 9 months.

On average, the effect wears off within 3 to 6 months, after which facial expressions return to normal and expression wrinkles recur.

If you want to suppress expression wrinkles again, you can undergo another treatment.

Tolerance to Botox

When Botox enters the body as a foreign substance, tolerance can develop just like with other medicines.

In some cases, the body itself produces Botox antibodies, and if the amount of antibody production is high, there are cases where Botox has almost no effect.

As the number of procedures increases, the likelihood of the body producing antibodies against Botox rises, so it should be kept in mind that repeated injections may reduce the effect due to antibodies.

Wrinkles for Which Botox Is Not Effective

Botox works by paralyzing the facial muscles so that the face cannot crease into wrinkles, so it is only effective on wrinkles that appear when making expressions.

However, it is not very effective for deep wrinkles that remain even when the face is at rest.

To correct these wrinkles at rest, hyaluronic acid products such as fillers (Juvéderm, Restylane) are used.

Botox Side Effects

Botox does not have special side effects, but it does cause paralysis of the expression muscles.

The following side effects may occur.

If injected below the eyes, the muscles may relax and the eyelids may appear sagging.
If Botox is injected under the eyes in cases of age-related lower eyelid droop, ectropion may occur.
If injected into wrinkles around the mouth, mouth movement may feel unnatural and expressions may become awkward.
When injected into the forehead or between the eyebrows, brow ptosis or eyelid ptosis may occur, causing the eyebrows or eyelids to droop.
Because there are many blood vessels around the eyes, bruising may occur after injection.

Prevention and Measures for Botox Side Effects

You should receive the procedure from an experienced board-certified plastic surgeon.

Even if an undesired result occurs from Botox, it is temporary.

Because the condition returns to what it was before the Botox procedure once the effect wears off, there are no permanent side effects.

After 3 to 6 months, it returns to its original appearance.

Filler Injections for Wrinkle Correction (Juvéderm)

Types of Fillers by Ingredient

Hyaluronic acid (Juvéderm, Restylane, Teosyal, Perlane)

Hyaluronic acid is an intercellular substance that exists between the dermis and epidermis of the skin, and it is a biological material that binds cells together and acts as a lubricant between cells.

The ingredient of Hyaluronic acid - Juvéderm is non-animal hyaluronic acid.

It is the most widely used filler, and because it is a biological material, it is a safe filler with a very low chance of causing side effects or inflammation.

Depending on its use, there are three types: low concentration, injected just under the epidermis; medium concentration, injected into the dermis; and high concentration, used in areas below the dermis.

It should be used according to its intended purpose, and if a high-concentration product is used in the epidermal layer, side effects such as skin protrusion may occur, so a filler with the appropriate concentration for the treatment area must be used.

Uses: Mainly used for fine wrinkles around the eyes, between the eyebrows, and around the mouth, as well as for correcting depressed scars from acne or chickenpox.

Polymethyl methacrylate (Artecoll)

Artecoll consists of PMMA (polymethyl methacrylate) microparticles suspended in a 3.5% collagen solution at a ratio of 1:3.

PMMA (polymethyl methacrylate), also called methacrylic resin, is a type of thermoplastic.

Inflammation and other side effects are not common, but when applied superficially in the skin layer, irregularities may occur in the skin, causing it to harden or develop uneven contours.

It is not a filler that can be used in delicate areas.

It also has weak viscosity in deeper areas, so it is difficult to expect a strong contour-correcting effect for depressed areas.

Uses: Correction of small depressed areas; not suitable for fine wrinkles or delicate procedures

Polyacrylamide (Aquamid, Interpol, Royamid, Bio-Alcamid)

The ingredient consists of 2.5% polyacrylamide mixed with 97.5% apyrogenic water.

It is considered to have excellent longevity, but since many cases of side effects such as inflammation have been reported after it was imported and used in Korea, caution is required.

Because side effects are frequent, some products are banned from import by the Ministry of Food and Drug Safety.

Uses: Use with caution because it often causes inflammation

Collagen (Evolence)

Collagen is one of the components found in the human body, so it is relatively safe as a biological material, but side effects such as allergies can sometimes occur.

In addition, because collagen is absorbed in the body by an enzyme called collagenase, it has the drawback of being less long-lasting than other fillers.

Uses: Used for small depressed areas and correction of fine wrinkles

Radiesse (calcium preparation)

It consists of particles of calcium hydroxylapatite, a bone component, in a water gel; it is a bone-derived material.

Because the particles are firm, it is not suitable for correcting fine wrinkles in the skin, but it can be injected under the skin and applied to small depressed scars or for contour correction of small areas.

Submucosal procedures in soft tissues such as the lips should be used with caution because the product may form a firm lump as a side effect.

Uses: Small depressed areas, chickenpox or acne scars

Features of Filler Injections (Juvéderm)

It is safe because it is a biological material.
The procedure is easy, and precise treatment is possible.
Because it has excellent biocompatibility, no allergy test is needed before the procedure.
Since it is made by cross-linking hyaluronic acid, it helps maintain the effect for a long time.
The effect can be confirmed immediately after the procedure.

Areas That Can Be Corrected with Filler Injections (Juvéderm)

• Forehead wrinkles

• Glabella wrinkles

• Eye wrinkles

• Nose bridge wrinkles

• Nasolabial folds

• Lip wrinkles

• Other fine facial wrinkles

• Depressed scars (chickenpox, acne scars)

Hyaluronic Acid (Juvéderm)

Juvéderm is injected into the dermis beneath the wrinkle through a thin 27-gauge syringe.

After Juvéderm is injected, the increased volume pushes the wrinkle upward.

Through physical support, Juvéderm props up the wrinkle from below, improving it and helping suppress recurrence by remaining in place.

Filler Injection (Juvéderm) Procedure

1. Apply topical anesthetic cream (EMLA) to the area where wrinkle correction is desired.

2. Apply it evenly over the area with wrinkles.

3. Seal it with plastic wrap so the anesthetic does not dry out.

4. After sealing with plastic wrap, wait about 30 to 40 minutes for the anesthetic to absorb.

5. After 30 to 40 minutes, wipe off the topical anesthetic cream (EMLA).

6. Inject Juvéderm along the wrinkle line.

For eye wrinkles, the procedure takes about 10 minutes, and because anesthesia is used, there is almost no pain.

7. After the procedure, you can apply makeup and go home right away.

8. Return one week later to check whether the wrinkles have clearly disappeared.

Examples of Filler Injections (Juvéderm)

Water Glow Injection (Hydration Lifting Whitening) - Aqualifting

Anti-aging Program

A woman’s eternal task is to create skin that is white and clean.

There is Water Glow Injection (Aqualifting) HA-lifting / Aqualifting.

For those worried about dark, wrinkled skin
For those worried about melasma and blemishes
For those who want clear and smooth skin
For those stressed by fine neck wrinkles
For those stressed by fine neck wrinkles

You can solve your concerns with the new concept of Aqualifting - Water Glow Injection!

♥ What Is Water Glow Injection (HA-Lifting)

Water Glow Injection is an anti-aging program that contains the clinic’s know-how, using multi-injection with negative pressure to inject hyaluronic acid into the dermis of the skin, helping maintain clear, firm, translucent skin.

When hyaluronic acid is injected into skin tissue, it helps keep the skin more moist and elastic, and makes the skin tone brighter and more radiant.

It infuses elasticity, vitality, and moisture into the skin at a depth of 1 mm.

♥ Indications and Effects of Water Glow Injection (HA-Lifting)

* HA Dermis (Hyiayu)- face, neck wrinkles, chest, back of hands, lips - melasma/dark circles, acne, pore reduction, improvement of atopic dermatitis - improvement of eye wrinkles, dark circles, nasolabial folds - whitening, moisture, elasticity
* Dermal Toxin (Hyiu + BX)- improvement of eye wrinkles, sagging cheeks/neck wrinkles/chest up - whitening, elasticity
* Extrafluid injection- vitamin C injection- filler injection

♥ Advantages of Water Glow Injection (HA-Lifting)

Non-surgical method
Short procedure time (10 to 15 minutes for the whole face) - use of multi-needles and automated device
Immediate return to daily life after the procedure
Drug injection into a specific skin layer - lifting using a negative pressure device
Accurate drug injection - simple control on OLED screen
Less pain - use of 31G multi-needle

Range of Application for Filler Injections (Juvéderm)

As with most fillers, Juvéderm is not very effective for deep wrinkles.

It is mainly used to correct fine wrinkles.

It is mainly applied to fine forehead lines, fine glabella lines, eye wrinkles, and nasolabial folds around the mouth.

It is also effective for acne, chickenpox, and scars.

Fillers should not be used to correct deep expression wrinkles or for facial contouring.

Caution is needed because the effect is minimal or there is a risk of side effects.

Cases Where Filler Injections (Juvéderm) Are Not Effective

It has weak or almost no effect on very thick and deep wrinkles.

In the case of the forehead, the glabella vertical wrinkle, and deeply sunken nasolabial folds around the mouth, the treatment effect is insufficient.

Filler injections are for fine wrinkles.

Duration of Filler Injections (Juvéderm) and Number of Treatments

Juvéderm is injected into the dermis of the skin and works by pushing wrinkles upward.

Juvéderm is an advanced hyaluronic acid product in which hyaluronic acid is cross-linked so that the effect lasts for a long time.

Usually, the effect lasts about one year, and even if it recurs, the original treatment area recurs only mildly, so the more times it is performed, the more the effect accumulates.

The duration of the effect varies depending on the degree of wrinkles, facial expression habits, and the location of the wrinkles.

In some cases, it lasts for several years or more.

The number of treatments is determined by the pattern in which wrinkles appear, and there is no fixed schedule for treatment.

Side Effects of Filler Injections (Juvéderm)

It is made by refining the intercellular substance that exists between the dermis and outer layer of the skin, and because it is highly biocompatible, it is safe enough that no allergy test is needed before the procedure.

For example, in the case of collagen injections, an allergy test is performed to determine biocompatibility, and only if no allergy is found is the procedure carried out, but with Juvéderm such testing is not necessary.

Another side effect is that if too much Juvéderm is injected into one area due to the practitioner’s inexperience, there is a risk that the injected area may become raised above normal skin.

If over-injected, it can be removed again or dissolved with the antagonist hyaluronidase.

Correct Knowledge You Should Know About Fillers

Safe fillers should be used.

Fillers containing polyacrylamide ingredients (Aquamid, Interpol, Royamid, Bio-Alcamid, etc.) should be used with caution because cases of side effects such as inflammation have frequently been reported after they were imported and used in Korea.

Some products are currently banned from import by the Ministry of Food and Drug Safety.

They are promoted as having strong durability, but on the other hand, because it is difficult to completely remove injected fillers, serious aftereffects may occur after inflammation develops, so this must be kept in mind.

They must be used according to their intended purpose.

There are many different types of fillers, and people often focus on how long they last, but a long-lasting filler is both an advantage and a disadvantage.

If a problem occurs, most fillers are difficult to remove.

Therefore, if the filler spreads between tissues and causes problems, you may suffer serious side effects and aftereffects.

The use of fillers should be limited to the correction of fine wrinkles and small depressed scars.

For example, they should strongly not be used to raise the nose, for under-eye procedures, or on the cheeks, forehead, or lips.

This is not only because the effect is weak, but also because the risk of side effects is very high.

Just as even a good medicine can become harmful if used for the wrong purpose, even a good filler will inevitably have a higher rate of side effects if used for purposes other than its intended use.

Side Effects of Embolism

Even safe fillers can block arteries in the subcutaneous layer when injected, causing embolism.

Because of embolism, tissues or skin supplied by the artery may undergo necrosis.

Necrosis caused by embolism is considered a fatal side effect.

Once necrosis occurs in the skin tissue, it recovers over a long period of time while leaving severe scars, so it is not a trivial problem.

It should be used only for small depressed scars in the dermis or fine wrinkles, and you should keep in mind that if it is injected into deeper areas below the dermis for deep wrinkles or contour correction, there is a risk of embolism traveling through the artery.

Problems with Long-Lasting Fillers

Fillers with high viscosity and long-lasting effects can easily cause serious problems.

A long-lasting filler means the material hardens firmly, which can cause surface irregularities or contours at the treatment area, as well as a foreign-body sensation and a firm feel rather than a soft texture like one’s own tissue.

Therefore, fillers with long-lasting effects must be used very carefully to avoid side effects.

Proper Understanding of Filler Longevity

Using Juvéderm as an example, there are three types of Juvéderm.

They are marked with the numbers 18, 24, and 30, and their viscosities differ.

The ingredients are the same, but the higher the number, the higher the viscosity, the better the effect for correcting depressed areas, and the greater the durability.

One might think that only 30, which has the best durability, should be used, but they are released in three types because each has a different purpose.

The least durable 18 is used as a filler injected just below the epidermis and is used for the finest and shallowest wrinkles.

If 30, which has high durability, is used for shallow wrinkles just below the epidermis, the treatment area may protrude and create surface irregularities, leading to poor results.

Therefore, a lower-viscosity product such as 18 should be used for shallow wrinkles to ensure safety and effectiveness.

The purpose of 30 is to be injected just below the dermis and is suitable for correcting deep wrinkles or depressed scars.

In this way, only by using the right filler for the wrinkle or depressed area can an effective procedure be performed without side effects.

If it is judged only by durability and used in a way that does not match the intended purpose, there is a high risk of side effects, so this must be kept in mind.

Precautions When Using Fillers for Under-Eye Procedures or Aegyo-sal Treatment

Fillers should not be indiscriminately injected under the eyes.

Fillers are not made for contouring procedures.

They are simply for correcting fine wrinkles and small depressed scars.

Injecting them into the under-eye aegyo-sal area or depressed areas under the eyes can make the eyes look awkward or cause side effects.

Because fillers are transparent, when injected under the eyes, the color often looks pale and awkward.

There are also cases where a raised shape is created or the filler spreads and causes an unintended area to protrude.

Many people complain that their under-eye appearance feels awkward or that they experience side effects after filler treatment under the eyes, and to avoid following in their footsteps, fillers should absolutely not be injected under the eyes.

They should also not be injected into the nose, lips, or cheeks.

They should only be applied to fine wrinkles around the eyes, fine forehead wrinkles, fine wrinkles around the mouth, and small depressed scars.

If the filler is not a hyaluronic acid-based product, then once a wrong shape or side effect appears after filler treatment, correction is almost impossible.

There are many cases where people visit this clinic for correction after a bad filler procedure at another hospital, but even here there is no special correction method for such cases, so caution is necessary.

How to Handle Side Effects Caused by Using Fillers Outside Their Intended Purpose

If the filler is a hyaluronic acid-based product, there is an antagonist called hyaluronidase.

It is an enzyme that dissolves hyaluronic acid and is mainly used to reduce swelling after surgery, but as many clinics have caused problems through indiscriminate filler procedures, hyaluronidase is also used to dissolve hyaluronic acid fillers.

If you were treated with Restylane, Juvéderm, or Perlane, it can be dissolved using hyaluronidase.

However, for fillers made with other ingredients, there is no antagonist that can dissolve them, so once side effects occur, correction is almost impossible.

There are many cases where people ask this clinic for correction because of wrong filler procedures at other hospitals, but even here there is no special corrective method for such cases, so filler injections for contour correction under the eyes, on the nose, or on the face should never be performed.

Fat Grafting for Wrinkle Correction

When Fat Grafting Can Be Used to Remove Wrinkles

This is mainly an effective procedure for deep expression wrinkles on the face.

Commercial fillers (Restylane, Juvéderm, Artecoll, Rofilane) are mainly used for fine wrinkles, while deep and broad expression wrinkles (nasolabial folds, glabella wrinkles, forehead wrinkles, under-eye depressed wrinkles) can achieve satisfactory results with fat grafting.

Wrinkle Areas Where Fat Grafting Can Be Applied

• Wrinkles around the mouth and nasolabial folds beside the nose

• Deep forehead wrinkles

• Vertical glabella wrinkle between the eyebrows

• Under-eye depressed wrinkles

Effect of Wrinkle-Removal Fat Grafting

Rather than injecting a large amount into one area using a tunneling technique, we perform three-dimensional micro fat grafting with 100% concentrated fat distributed evenly across multiple layers. A delicate and thorough injection method allows for customized design. Fat grafting also includes a process called “tunneling,” which helps the fat maintain contact with the surrounding abundant blood vessels so it can continuously receive nutrients.
Tunneling means creating a space for the fat just under the skin using a micro-needle. Since space is created as if making a tunnel and then the fat is injected, even after all the fat is inserted it does not sag in the direction of gravity or become bumpy.
Because the tunneling technique includes separation beneath the wrinkle, fat grafting under the separated wrinkle improves the wrinkle more clearly than fat grafting at other clinics.

Fat Grafting Procedure for Wrinkle Correction

1. Fat is harvested from areas where the body stores a lot of fat, such as the lower abdomen, waist, or thighs.

For wrinkle correction, a large amount of fat is not needed, so harvesting from the lower abdomen is preferable.

• Because local anesthesia (painless sedation anesthesia) is used, there is no pain at all.

• A thin liposuction cannula is used to collect fat into a syringe.

2. The harvested fat is placed in a centrifuge to remove impurities (local anesthetic, serum, red blood cells, etc.).

The purpose of centrifugation is to remove impurities contained in the fat, increase the fat concentration, and improve the fat graft survival rate.

3. After centrifugation, water and oil are removed in a second concentration process.

By removing water and oil, almost 100% concentrated fat is obtained.

4. The purified fat is transferred to a thin 1cc syringe and grafted into the desired area.

The fat is transferred again to a thin 1cc syringe and grafted into the desired area.

A micro-needle (micro grafting cannula) developed in-house is used.

The micro-needle is a special grafting cannula used only here, enabling ultra-precise grafting.

When grafting, pre-subcutaneous tunneling must be performed first so that the fat can be grafted accurately into the wrinkle area and the wrinkles can be corrected effectively.

Fat Grafting for Forehead Depressions and Wrinkles

For the forehead, fat grafting is performed when there are depressed areas or deep forehead wrinkles.

Fat Grafting for Glabella Wrinkles

For glabella wrinkles, fine wrinkles can be treated with filling materials such as Restylane or Juvéderm, but for deep vertical glabella wrinkles, fat grafting can produce better results.

Fat Grafting for Under-Eye Wrinkles

For under-eye wrinkles, satisfactory results can be seen in depressed wrinkles between the eyes and nose.

Fat Grafting for Nasolabial Folds Around the Mouth

If fat grafting is performed for nasolabial folds beside the nose or wrinkles around the mouth, sufficient corrective effect can be obtained even for severely sunken wrinkles.

Advantages of Wrinkle Correction with Fat Grafting

The procedure is simple.
Because foreign substances like fillers (Restylane, Radiesse, Artecoll) are not used, there is no need to worry about side effects.
Because the skin is not incised, there is no concern about scars.
Because it uses the patient’s own tissue, the result looks natural.
There is almost no swelling or bruising.
You can return to daily life immediately after the procedure.
Because the fat tissue survives and integrates, the effect can last for a long time.

Precautions When Performing Wrinkle Surgery with Fat Grafting

Because some of the fat is absorbed, one treatment may not be enough, and a second treatment may be needed after 2 to 3 months.
It is difficult to use for fine wrinkles around the eyes or under the eyes.

Number of Fat Grafting Procedures for Wrinkles

For most fat grafting procedures, including nasolabial folds, satisfactory results can usually be obtained after about two treatments on average.

The interval between treatments is 2 to 3 months, and for repeat treatment, the fat that was stored at the time of the first grafting is thawed and used.

Duration of Fat Grafting Results

Some people say fat grafting has no effect because a lot of it is absorbed, but if it is performed correctly, satisfactory results can be obtained.

Once the grafted fat takes hold, it is no longer absorbed and remains as the body’s own fat tissue for life, so it is considered one of the safest and most effective methods.

On average, two fat grafting sessions can provide semi-permanent wrinkle improvement with satisfactory results.

Side Effects of Fat Grafting

Of course, good results are desired, but depending on the surgeon’s skill and technique, unavoidable issues may sometimes occur.

Poor results due to low survival rate, awkward shape, asymmetry, severe swelling, inflammation, fat necrosis, calcification, contour irregularities, sagging, and pigmentation may occur.

How to Address Side Effects from Overfilled Fat Grafting

If fat grafting is performed against the basic principles due to lack of experience, or if too much fat is grafted because the amount was not properly controlled, the grafted area may swell significantly or, even after the swelling goes down, the treated area may remain overly protruded and look awkward.

This usually happens when a large amount of poorly purified fat containing many impurities is forcefully injected.

In most cases, it settles down over time, but if the swelling is too severe, hyaluronidase used to reduce swelling may be injected into the treatment area to help it subside more quickly. If too much fat has been grafted, it can also be removed by inserting a microcannula and aspirating the grafted fat again.

Overfilled fat is easier to remove if it is aspirated again within 3 months.

In some cases, grafted fat may necrose and calcify, harden, and need to be removed by aspiration.

However, if fat grafting is performed properly, these problems almost never occur.

Inflammation	Caused when bacteria enter during the procedure, or when the fat does not take hold and melts during the graft survival process
Necrosis	A state in which fat fails to receive proper blood supply during the graft survival process, rots, and leaves behind melted remnants
Calcification	A phenomenon in which fat fails to receive proper blood supply during the graft survival process, hardens, and becomes a firm mass as calcium deposits
Contour irregularity	A phenomenon in which fat is not grafted evenly or is concentrated in one area, preventing a smooth shape and causing bumps
Sagging	If too much is grafted or grafted in the wrong place, sagging of the face may occur
Pigmentation	If bruising and swelling are severe, the iron components left in the bruise may deposit in the skin and oxidize, turning brown; depending on the constitution, this may sometimes occur after under-eye procedures
Asymmetry	When left-right survival rates differ or the amount is not properly balanced during the first procedure, causing imbalance
High absorption rate	When enough fat does not survive to create the desired contour and a large amount is absorbed, so the shape before and after the procedure does not change much
Awkward shape	When too much fat survives or it is grafted into an inappropriate area, breaking the overall balance of the face

Side Effect Issues with Fat Grafting

Because fat grafting uses autologous fat, unlike commercial filling materials (fillers), there are almost no side effects.

Except for slight swelling and bruising after the procedure, side effects can be said to be virtually nonexistent.

Therefore, it can be considered one of the safest procedures among plastic surgeries.

However, this is based on the premise that fat grafting is performed properly; if it is performed against the principles, side effects may sometimes occur, such as bumpy shapes, hardened fat due to necrosis, inflammation, or awkward shapes caused by excessive injection.

These are issues determined by the operator’s experience and skill, not by fat grafting as a whole.

Therefore, if the procedure is performed according to the principles, such side effects are rarely seen.

How to Perform Fat Grafting Without Side Effects

★ Perform the procedure in a sterile state

As with all surgeries, fat grafting must be performed with fully sterilized instruments and materials.

After the procedure, any residual fat inside the suction cannula or grafting cannula must be cleaned thoroughly with a brush, and then sterilized with a high-pressure steam sterilizer. Anesthetic agents and saline must also be carefully managed to prevent contamination.

Thorough disinfection and material management can prevent bacterial infection and inflammation.

★ Multi-step fat purification process

Fat purification must remove impurities completely through several stages to maximize effectiveness.

Harvested fat usually contains about 80% impurities, and the actually usable portion is only about 20%.

If the remaining impurities (blood, serum, anesthetic, oil, water, etc.) are not removed, the results will not be good no matter how well it is grafted.

★ Preconditioning before fat grafting

A high survival rate should allow satisfactory results from a single procedure whenever possible.

Micro fat must be planted evenly in multiple layers, and before that, space should be secured in the area where the fat will be grafted so that previously grafted fat is not compressed by surrounding tissues; then the fat will not be compressed and will survive well.

★ Precise and even grafting across multiple tissue layers

The expression of a soft, natural contour is the key to fat grafting.

For a soft contour, it is best to graft in a three-dimensional manner, distributing the fat evenly across multiple layers.

The grafting locations include the subcutaneous layer, muscle layer, and fascial layer, and the fat must be spread through the tissue as if sowing seeds evenly to achieve a smooth contour without irregularities.

Procedure for a Second Fat Grafting Session

Fat grafting does not always end with a single session.

Survival rates vary by area, and there are individual differences as well.

Since grafted fat is absorbed by about 50% on average, the initial shape may look good but gradually be absorbed over time, so a second procedure may be needed if necessary.

• Three months to one year after the first fat grafting, visit the plastic surgery clinic again to check the progress.

• If a second fat grafting session is deemed necessary, the frozen fat stored from the first procedure is thawed and reinjected under local anesthesia.

• Since the fat-harvesting process is omitted compared to the first procedure, the procedure time is much shorter, and the cost is about half of the first fat grafting session.

• If the shape is judged to be fine because the fat has taken hold well after the first procedure, no further fat grafting is needed.

In other words, the second procedure is performed only when necessary, and the decision can be made by the patient after looking at the shape.

Fat grafting is usually performed once or twice.

If a second session is needed, it is usually done between 3 and 10 months.

On average, two sessions can provide satisfactory facial contour correction.

Pre- and Post-Procedure Steps for Fat Grafting and Post-Procedure Care

These are the procedures before and after receiving fat grafting surgery.

1. Make a consultation appointment by phone or online.

2. Visit at the scheduled consultation time and have the consultation.

3. If you want the procedure, make a surgery appointment immediately after the consultation and leave.

You can also make the surgery appointment later by phone or online.

4. Visit 30 minutes before the scheduled surgery time, receive an explanation of the fat grafting procedure, and undergo design planning.

5. After the design is completed, change clothes and receive an intravenous injection for painless sedation anesthesia.

6. The procedure time for fat grafting varies by area, and if multiple areas are treated at the same time, it may take longer.

On average, it takes 30 minutes to as long as 2 hours.

7. After the procedure, you will receive antibiotic and anti-inflammatory injections and rest in the recovery room for about 30 minutes.

8. You will be informed of the precautions after the procedure and the next visit date will be scheduled.

9. Visit 2 days after the procedure to check the progress of the fat grafting area, and disinfect the fat-harvesting site.

Showering is allowed starting 2 days after the procedure.

Visit on the 7th day after the procedure to check the progress and remove the stitches from the fat-harvesting site (navel).

If you live too far away and it is difficult to come to the clinic, you do not necessarily need to visit.

10. If a second procedure is needed, you will visit and receive treatment between 3 months and 1 year later.

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