[Duhan Plastic Surgery Wrinkle Correction] - [Wrinkle Improvement Using Fat Grafting]

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Information on Fat Grafting for Wrinkle Correction

When can fat grafting be used to remove wrinkles?

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

Commercial fillers such as Restylane, Juvederm, Artecoll, and Lofilan are mainly used for fine lines, while deep and broad expression wrinkles such as nasolabial folds, frown lines, forehead wrinkles, and 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 glabellar wrinkles

Under-eye depressed wrinkles

How fat grafting is performed for wrinkle removal

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

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

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

2. The harvested fat is placed in a centrifuge to obtain pure concentrated fat.

The purpose of centrifugation is to obtain pure concentrated fat in order to reduce side effects after grafting and increase the fat take rate.

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

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

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

Examples of wrinkle correction with fat grafting

Indentation and wrinkles of the forehead

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

Glabellar wrinkles

For glabellar wrinkles, fillers such as Restylane or Juvederm can be used for fine wrinkles, but deeper vertical glabellar wrinkles may show better results with fat grafting.

Under-eye wrinkles

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

Nasolabial folds around the mouth

When fat grafting is performed for nasolabial folds beside the nose or wrinkles around the mouth, sufficient correction can be achieved even in severely indented wrinkles.

Advantages of wrinkle correction with fat grafting

1. The procedure is simple.

2. Because no foreign material is used, unlike fillers (Restylane, Radiesse, Artecoll), there is no concern about side effects.

3. Since the procedure does not require skin incisions, there is no concern about scars.

4. Because it uses the patient’s own tissue, the result looks natural.

5. There is almost no swelling or bruising.

6. You can return to daily life immediately after the procedure.

7. Because the fat tissue takes hold, the effect can be maintained for a long period of time.

Precautions when having wrinkle surgery with fat grafting

1. Some of the fat is absorbed, so one procedure may not be enough, and a second procedure may be needed after 2 to 3 months.

2. It is difficult to use for fine lines around the eyes or under the eyes.

Number of wrinkle procedures with fat grafting

For most fat grafting procedures, including nasolabial folds, satisfactory results can usually be achieved with an average of about two sessions.

The interval between procedures is 2 to 3 months, and for repeat procedures, the frozen fat stored at the time of the first fat grafting can be thawed and used.

Long-term effects of fat grafting

Some people say fat grafting is ineffective because much of the fat is absorbed, but if performed correctly, it can produce satisfactory results.

Once the grafted fat takes hold, it is no longer absorbed and remains as your 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 a semi-permanent, satisfying wrinkle improvement effect.

Side effects of fat grafting

Of course, good results should be achieved, but depending on the surgeon’s skill and experience, unavoidable problems can sometimes occur.

Unsatisfactory results due to a low take rate, unnatural shape, asymmetry, severe swelling, inflammation, fat necrosis, calcification, irregularity, sagging, and pigmentation may occur.

How to address side effects from overfilled fat grafting

If fat grafting is performed in a way that goes against the principles because the practitioner has no experience, or if too much fat is injected due to poor control of the amount, the grafted area may become severely swollen, or even after the swelling goes down, the treated area may remain too protruding and look unnatural.

This problem usually occurs when a large amount of poorly refined fat with many impurities is forcibly injected.

In most cases, it will subside over time, but if the swelling is too severe, hyaluronidase, which reduces swelling, may be injected into the treated area to help it go down faster. If too much fat has been injected, a microcannula can be inserted to suction out and remove the grafted fat again.

Overfilled fat can be removed more easily if it is suctioned out again within 3 months.

Sometimes the grafted fat becomes necrotic and calcified, hardens, and must also be removed by suction.

However, if fat grafting is performed properly, these problems rarely occur.

Inflammation	Occurs when bacteria enter during the procedure, or when fat does not take hold and dissolves during the take process
Necrosis	A state in which fat that failed to take hold lacks proper blood supply during the take process, so the dead residual material rots and melts away
Calcification	A phenomenon in which fat fails to receive proper blood supply during the take process, hardens, and calcium deposits form, creating a firm mass
Irregularity	A phenomenon in which the fat is not grafted evenly, or is concentrated in only one area, resulting in an uneven and lumpy appearance
Sagging	If too much fat is grafted or grafted in the wrong location, sagging of the face may occur.
Pigmentation	If bruising and swelling are severe, depending on the person’s constitution, iron remaining in the bruise may deposit in the skin and oxidize, turning brown; this can sometimes occur after under-eye procedures depending on the patient’s constitution
Asymmetry	Occurs when the take rate differs between the left and right sides, or when the amount is not properly controlled during the first procedure, causing imbalance between both sides
High absorption rate	A phenomenon in which not enough fat takes hold to create the desired contour, and a large amount is absorbed, so the appearance before and after the procedure does not change much
Unnatural shape	A phenomenon in which too much fat takes hold or the fat is grafted into the wrong place, disrupting the overall balance of the face

Issues with side effects from fat grafting

Because fat grafting uses the patient’s own fat, it has almost no side effects, unlike commercial filler materials.

Except for some swelling and bruising after the procedure, it can be said to have no side effects at all.

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

However, this applies only when fat grafting is performed properly. If the procedure is not done according to the principles, side effects can sometimes occur, such as a bumpy shape, fat necrosis and hardening, inflammation, or an unnatural shape due to excessive injection.

This is determined by the practitioner’s experience and skill; it is absolutely not an inherent problem with fat grafting itself.

Therefore, if the procedure is performed correctly, these side effects almost never occur.

How to achieve fat grafting without side effects

⊙ Perform the procedure under sterile conditions

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

After the procedure is finished, the inside of the suction cannula should be thoroughly cleaned with a brush so that no fat residue remains inside the cannula, and then sterilized with a high-pressure steam sterilizer. Anesthetic agents and saline must also be carefully managed to prevent contamination.

Thorough sterilization and careful management of materials can prevent bacterial infection and inflammation.

⊙ Several stages of fat refinement

Fat refinement must remove impurities completely through several stages to maximize the effect.

The harvested fat usually contains about 80% impurities, and only about 20% is actually usable.

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

⊙ Pre-treatment before fat grafting

A high take rate is needed so that satisfactory results can be achieved with one procedure if possible.

Fine fat must be placed evenly in multiple layers, and before that, space must be secured at the graft site so that previously grafted fat is not compressed by the surrounding tissue. This allows the fat to take hold well without pressure.

⊙ Precise and even grafting into multiple tissue layers

The key to fat grafting is creating a soft, natural contour.

For a soft contour, it is better to use a three-dimensional method that distributes the graft evenly across multiple layers.

The grafted locations include the subcutaneous layer, muscle layer, and fascia layer. The fat must be spread through the tissue like sowing seeds evenly so that a smooth contour without irregularities can be achieved.

The second fat grafting procedure

Fat grafting does not always end with just one session.

The take rate varies by area, and there are individual differences as well.

On average, about 50% of the grafted fat is absorbed, so while the shape may look good at first, it is gradually absorbed over time, and a second procedure may be necessary if needed.

○ After the first fat grafting, visit the plastic surgery clinic again between 3 and 10 months later to check the progress.

○ If a second fat grafting is deemed necessary, the frozen fat stored from the first procedure is thawed and injected again 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 satisfactory because the fat has taken well after the first procedure, no further fat grafting is necessary.

In other words, a second procedure is performed only if needed, and you can decide after looking at the shape yourself.

Fat grafting usually involves one to two sessions.

If a second procedure is needed, it is performed between 3 months and 1 year later.

On average, two procedures can produce a satisfying facial contour correction effect.

Pre- and post-fat-grafting procedures and post-procedure care tips

These are the steps before and after undergoing fat grafting surgery.

1. Make an appointment for a consultation by phone or online.

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

3. If you wish to proceed, make a surgery appointment immediately after the consultation and leave.

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

4. Arrive 30 minutes before the scheduled surgery time to receive an explanation of the fat grafting process and undergo the design planning.

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

6. Fat grafting procedure times vary by area, and if multiple areas are treated at the same time, the procedure may take longer.

On average, it takes from 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 receive post-procedure instructions and schedule your next visit.

9. Visit 2 days after the procedure to check the progress of the fat grafting area, and the fat harvest site is disinfected.

Showering is possible 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 harvest site (navel).

If it is too far from your home and difficult to visit, it is not absolutely necessary to come in.

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

Other procedures

⊙ Method using fillers (Juvederm, Artecoll, Teosyal, Evolence)

Wrinkles around the mouth can also be corrected with fillers or collagen, but the use of fillers is very limited.

Fillers can be considered for fine crack-like wrinkles.

However, for deep depressed wrinkles, fillers are almost ineffective, and the injected filler may be pushed outward by the force of smiling, making the nasolabial folds even deeper.

In severe cases, there is also concern about various side effects such as inflammation.

Nasolabial folds are mostly deep depressed wrinkles.

Therefore, it is difficult to expect satisfactory results from filler procedures.

⊙ Implant insertion method (silicone, Gore-Tex)

Implants are often used for nose augmentation, but they are unsuitable for wrinkle surgery.

Small implants are often inserted through an incision inside the nose or mouth in so-called “noble surgery,” but this is intended to correct slight depressions rather than wrinkles.

However, it is not an appropriate surgical method for correcting long wrinkles, and various side effects may occur.

Because it is a foreign material, you may feel discomfort when smiling, the contour may protrude, and the implant may shift position due to the force of smiling.

Sometimes it can also cause problems such as inflammation, so inserting implants into nasolabial folds is not a desirable method.

In principle, implants should not be inserted into moving areas that make facial expressions.

⊙ Magic lift (a procedure that pulls the facial skin with threads)

There is also a procedure called a magic lift that pulls the face with threads, but it has little effect not only on overall facial wrinkles but also on nasolabial folds.

There is a limit to how much facial skin can be pulled with thread tension, and because wrinkles may quickly recur or side effects such as contour deformity of the face can occur, caution is needed.

⊙ Insertion or injection of artificial dermis AlloDerm (SureDerm)

Correction may also be attempted using artificial dermis such as AlloDerm, which is made by processing human dermal tissue, but precise procedures are difficult.

In addition, because a significant portion of liquid AlloDerm is absorbed, it is difficult to predict the correction effect, and dissatisfaction is common.

Solid AlloDerm is mainly used for tip-plasty to create an upturned nose and is not a desirable procedure for correcting nasolabial folds.

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⊙ Rather than injecting a large amount into one area using a tunneling technique, we perform three-dimensional microfat grafting with 100% concentrated fat distributed evenly across multiple layers.

A delicate and meticulous injection method allows for customized design.

Fat grafting also includes a process called “tunneling,” which helps the grafted fat stay in contact with abundant surrounding blood vessels so it can continuously receive nutrients.

⊙ Tunneling means using micro-needles just under the skin to create space for the fat. Because the space is made like a tunnel before the fat is injected, the fat does not sag downward with gravity or become bumpy even after it has all been injected.

⊙ The tunneling technique includes a dissection process of the wrinkle itself, so fat grafting is performed under the dissected wrinkle, resulting in a much clearer improvement compared with fat grafting at other clinics.

http://www.microfat.net