[Duhan Plastic Surgery Facial Autologous Fat Grafting] - [Paranasal Augmentation Three-Dimensional Micro Fat Grafting]

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Paranasal Augmentation - Three-Dimensional Micro Fat Grafting

What is paranasal augmentation?

When the front part of the face is flat or sunken,

or when there are depressions beside the nose,

this refers to contour plastic surgery that enhances that area.

It creates the effect of making the front part of the face look three-dimensional and fuller. The treatment area ranges from the sunken area beside the nose and nasolabial folds,

to a wider area that includes the under-eye wrinkles, the front part of the cheeks, and the nasolabial fold lines.

Indications for paranasal augmentation

○ When the front part of the face beside the nose lacks volume and looks flat

○ When the front part of the face beside the nose is sunken and looks hollow

○ When there are sunken fold lines beside the nose (nasolabial folds)

Three treatment areas for paranasal augmentation

○ When only the sunken fold line beside the nose (nasolabial fold) is treated

○ When the under-eye area is sunken and the front part of the face beside the nose is also sunken and flat, so both the under-eye area and the front part of the face are treated

○ When the front part of the face beside the nose is sunken (including the under-eye sunken line) and there is a nasolabial fold line, so the front part of the face and the nasolabial fold line are treated at the same time

� Paranasal augmentation is an informal term rather than an official plastic surgery term, and because it is unreasonable to strictly limit the treatment area, the treatment area is applied more broadly and in various ways.

As shown in the photos below, treatment is usually performed in three types.

Depending on the sunken area of the face, its position, and the treatment area, paranasal augmentation is performed by accurately marking the area with an appropriate design method.

Methods of paranasal augmentation

● Method using an implant

It can be corrected by making an incision inside the mouth and inserting a solid artificial implant such as Gore-Tex or silicone Medpor.

In such cases, surgery must be performed with an incision of about 2 cm inside the mouth, and there is the burden of having a foreign body inside the body.

In addition, it is common for the shape to look awkward when smiling, or for a foreign-body sensation to occur, leading to frequent removal of the implant.

� ● Method using fat grafting

It has the advantage of being customizable for each individual, allowing treatment to be designed in various ways and applied to the desired area in the desired shape.

There are no restrictions on the treatment area or extent.

Because it uses the patient's own tissue, it does not feel like a foreign body, the shape does not look awkward, and it looks natural. Another advantage is that daily life can resume immediately.

Fat grafting procedure

http://www.microfat.net

1. Fat is harvested from areas where your own fat is stored in large amounts, such as the lower abdomen, waist, or thighs.

For wrinkle correction, not much fat is needed, so harvesting from the lower abdomen is preferable.

• Since local anesthesia (sedation pain-free 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 obtain pure concentrated fat.

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

� 3. After centrifugation, the fat undergoes a second concentration process to remove water and oil.

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

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

Examples of paranasal fat grafting procedures

Advantages of paranasal fat grafting

■ The procedure is simple.

■ Because implants such as silicone or Gore-Tex are not used, there is no concern about complications.

■ Since the procedure does not involve incisions inside the mouth, normal eating is possible immediately.

■ Because it uses the patient's own tissue, the shape looks natural.

■ There is almost no swelling or bruising.

■ Daily life can be resumed immediately after the procedure.

■ If the fat tissue takes hold, the effect can be maintained for a long time.

Number of sessions and intervals for paranasal fat grafting

For paranasal augmentation and most other fat grafting procedures, satisfactory results can usually be obtained after an average of 1 to 2 sessions.

The interval between procedures should be at least 3 months, and when performing a repeat procedure, the fat that was stored at the time of the first fat grafting can be thawed and used.

Duration of effect of paranasal fat grafting

Some people say fat grafting is ineffective because much of the fat is absorbed, but this applies when the procedure is performed at a clinic with somewhat limited experience.

In principle, if fat grafting is performed correctly, satisfactory results can be obtained, and once the grafted fat takes hold, it is no longer absorbed and remains as your own fat tissue for life, making it one of the safest and most effective methods.

On average, after 1 to 2 fat grafting sessions, a permanent and satisfactory facial contour correction effect can be obtained.

Comparison of paranasal fat grafting with other procedures

	Silicone, Medpor (implant)	Fat grafting
Incision required	Incision inside the mouth or nose	No incision is needed.
Procedure time	1 hour	30 minutes
Wrinkle improvement effect	Not effective for wrinkles around the mouth.	Also effective for improving wrinkles around the mouth.
Treatment area	The area is limited.	Can be applied to a wide and varied range of areas
Return to daily life	Returning to daily life is possible, but pain and swelling are severe, and when an incision is made inside the mouth, eating is difficult.	Returning to daily life is possible, and there is only a slight amount of swelling.

Side effects of fat grafting

Fat grafting is among the procedures with the fewest side effects.

Side effects may occasionally occur due to the practitioner’s lack of experience.

Excessive fat injection can cause severe swelling, calcification due to fat necrosis, uneven contours, reduced effect due to excessive fat absorption, and redness due to inflammation. These are issues related to the surgeon’s experience and skill.

As a principle, fat grafting should not be performed by someone with limited experience or by a non-specialist in plastic surgery.

Types of side effects of fat grafting

Of course, good results are expected, but depending on the surgeon’s skill and technique, sometimes unavoidable problems can occur.

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

Inflammation	Occurs when bacteria invade during the procedure, or when the fat fails to take hold and dissolves during the graft survival process
Necrosis	A condition in which fat that failed to take hold due to insufficient blood supply during the graft survival process has decayed and dissolved, leaving residual matter behind
Calcification	A phenomenon in which fat that failed to take hold due to insufficient blood supply during the graft survival process hardens and calcium is deposited, forming a firm mass
Unevenness	A phenomenon in which the fat is not grafted evenly, or is concentrated in only one area, resulting in an irregular and bumpy appearance instead of a smooth shape
Sagging	If too much fat is grafted or grafted in the wrong place, sagging of the face may occur.
Pigmentation	When bruising and swelling are severe, the iron components remaining in the bruise may, depending on the individual’s constitution, deposit in the skin and oxidize, turning brown. This may occasionally occur after under-eye treatment depending on the individual’s constitution.
Asymmetry	When the left and right graft survival rates differ, or the initial amount injected was not properly adjusted, causing imbalance between the two sides
High absorption rate	A phenomenon in which enough fat does not survive to create the desired contour, and much of it is absorbed, so the shape does not change much before and after the procedure
Awkward shape	A phenomenon in which too much fat survives or fat is grafted to the wrong area, disrupting the overall balance of the face

How to perform fat grafting without side effects

■ Perform the procedure in a sterile state

As with all surgeries, fat grafting must also be performed using completely sterilized instruments and materials.

After the procedure, the inside of the suction cannula should be thoroughly cleaned with a brush so that no fat residue remains inside the cannula or grafting tube, and then disinfected with a high-pressure steam sterilizer. Anesthetic agents, saline, and other materials must also be carefully managed so that they are not contaminated.

Thorough disinfection and proper management of materials can help prevent bacterial infection and inflammation.

� ■ Several stages of fat purification

Fat purification must remove impurities completely through several stages in order to maximize the effect.

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 the grafting is done.

� ■ Preliminary preparation before fat grafting

A high graft survival rate should make it possible to achieve satisfactory results with a single procedure if possible.

Fine fat must be layered evenly in multiple layers, and before that, space must be secured at the grafting site so that previously grafted fat is not compressed by surrounding tissue. This allows the fat to avoid pressure and survive well.

� ■ Precise and even grafting into multiple tissue layers

Achieving a soft and natural contour is the key to fat grafting.

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

The grafting locations include the subcutaneous layer, muscle layer, and fascial layer. The fat should be spread through the tissue like scattering seeds so that a smooth contour without unevenness can be obtained.

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