[DuHan Plastic Surgery Lip Surgery] - [Micro Fat Grafting for Fuller Lips]

Micro fat grafting for the lips

This is a procedure that adds volume to lips that lack fullness or have many wrinkles, while smoothing wrinkles and creating fuller lips.

Sometimes it is also performed to reduce the difference in volume between the upper and lower lips.

Indications for micro fat grafting to the lips

○ Hollowing in the center of the lips (open lips) ○ When the upper and lower lips differ greatly in size ○ Lip asymmetry ○ When the upper lip is short and the lips cannot close fully ○ Lips that are too thin ○ Severe lip wrinkles

How the fat grafting procedure is performed for lip correction

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

• Because local anesthesia (pain-free 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 remove local anesthetic and serum.

The purpose of centrifugation is to remove impurities, reduce side effects after grafting, and increase the fat survival rate.

3. The fat that has been centrifuged goes through a secondary concentration process to remove moisture and oil.

To achieve a fat survival rate of at least about 50%, the fat must undergo a two-step purification process after centrifugation to remove oil and moisture.

The grafted fat must be free of impurities for a higher survival rate and better results.

In practice, a single centrifugation step is often not enough to sufficiently concentrate the fat.

By removing oil and moisture, nearly 100% concentrated fat can be obtained.

The purified fat is measured in the required amount using a 1 cc syringe.

For lip fat grafting, about 2 cc of concentrated fat is grafted into each of the upper and lower lips.

For the chin (mandibular area), about 5 cc to 7 cc of concentrated fat is grafted.

4. The fat is grafted into the area where local anesthesia has already been administered.

At our clinic, we use a micro needle (micro grafting cannula) developed in-house.

The micro needle is a special grafting cannula used only at our clinic that enables ultra-precise grafting.

Fat grafting is performed after the tunneling process creates space for the fat to be placed.

The principle of fat grafting is to distribute the fat evenly and uniformly across the grafted area so that it does not clump, while also maximizing the survival rate as much as possible.

To do this, small amounts of concentrated fat must be precisely grafted per unit area and spread evenly across multiple areas.

Even if a large amount of fat is grafted into one area, fat without blood supply will eventually necrose and be absorbed.

Example of micro fat grafting for the lips

When the lip border is thin, three-dimensional fat grafting is performed.

The fat is mainly grafted within the orbicularis oris muscle of the lips,

and is evenly placed in both the deep and superficial layers of the muscle,

maximizing the survival rate of the fat while creating a soft lip shape.

An additional effect of fat grafting is smoothing lip wrinkles.

Advantages of lip correction with micro fat grafting

○ The procedure is simple.

○ Unlike fillers such as Restylane and Artecoll, it rarely causes the lips to become hard or leads to issues such as inflammation.

○ Because the procedure does not require skin incision, there is no concern about scarring.

○ Since it uses the patient’s own tissue, the result is soft and natural in shape.

○ The grafted fat remains permanently as the patient’s own tissue, so the effect can last for a long time.

○ It has the effect of softening vertical lip wrinkles.

Disadvantages of lip correction with micro fat grafting

○ The lip area tends to swell more after the procedure than other areas.

○ The lip area has a higher fat absorption rate, so second procedures are more common.

Precautions when correcting with micro fat grafting

○ After the procedure, do not press on the area or apply impact until the fat has settled.

○ Running and other vigorous exercise should be avoided for about a month because movement can reduce the fat survival rate.

○ Avoid alcohol and smoking for about a week.

○ Do not open or purse the mouth too widely, so that fat absorption is reduced.

Number of procedures for micro fat grafting to the lips

In the case of the lips, the fat survival rate is lower than in other areas.

If the average fat survival rate is considered to be 50%, the lip area is around 30%.

This is because the lips are a constantly moving area, making it a less favorable environment for fat cells to survive.

Compared with areas that move less, such as the chin and cheeks, the survival rate is lower,

so for the lips, an average of about two fat grafting procedures should be considered.

There is a method of grafting a larger amount during the first procedure so that even if much of the fat is absorbed, the absolute amount that survives will still be large,

but if too much fat is grafted at once, the lips may swell excessively right after the procedure, which can interfere with daily life.

In addition, excessive fat grafting can actually reduce the survival rate

and increase the chance of side effects, so it is better to graft an appropriate amount.

Lasting effects of micro fat grafting

Some people say fat grafting is ineffective because much of the fat is absorbed,

but this applies to cases where fat grafting was performed at an inexperienced clinic.

If the procedure is performed correctly according to the principles, a satisfactory result can be achieved,

and once the grafted fat survives, it is no longer absorbed and remains the patient’s own fat tissue for life,

making it one of the safest and most effective procedures.

On average, after one and up to two fat grafting procedures,

it is possible to achieve a permanent and satisfying facial contour correction effect.

Side effects of micro fat grafting

Fat grafting is one of the procedures with the fewest side effects.

Side effects can occasionally occur due to the practitioner's inexperience.

Excessive fat injection can lead to severe swelling, calcification due to fat necrosis,

an uneven contour, decreased procedural effect due to excessive fat absorption, and redness due to inflammation,

but these are issues related to the surgeon’s experience and technique.

When the procedure is performed precisely and according to principle, such problems almost never occur,

so it is advisable not to undergo fat grafting with a practitioner who lacks experience or who is not a board-certified plastic surgeon.

Types of side effects of micro fat grafting

Of course, good results are the goal, but depending on the surgeon’s skill and technique,

in some cases unavoidable problems may occur.

Possible issues include poor results due to low survival rate, unnatural shape, asymmetry, severe swelling,

inflammation, fat necrosis, calcification, irregularities, sagging, and pigmentation.

Inflammation	Occurs when bacteria invade during the procedure, or when fat does not survive and dissolves during the survival process
Necrosis	A state in which fat that did not survive due to poor blood supply during the survival process has decayed, leaving behind dissolved remnants
Calcification	A phenomenon in which fat does not receive adequate blood supply during the survival process, hardens, and calcium deposits form into 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 bumpy appearance rather than a uniform shape
Sagging	If too much fat is grafted or grafted in the wrong position, sagging of the face may occur.
Pigmentation	When bruising or swelling is severe, the iron component left in the bruise may deposit in the skin and oxidize, turning brown depending on the person’s constitution; this can occasionally occur after under-eye procedures depending on the patient’s constitution.
Asymmetry	When the survival rate differs between the left and right sides, or when the amount is not properly adjusted during the first procedure, causing left-right imbalance
High absorption rate	A phenomenon in which the fat does not survive sufficiently to achieve the desired contour and much of it is absorbed, so the appearance before and after the procedure does not change much
Unnatural shape	A phenomenon in which the fat survives excessively or is grafted into an inappropriate area, disrupting the overall balance of the face

Methods for micro fat grafting without side effects

Procedure in a sterile state

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

After the procedure, the inside of the suction cannula should be thoroughly cleaned with a brush to ensure no fat residue remains, and then sterilized with a steam autoclave.

Anesthetic agents and saline must also be carefully managed so they are not contaminated.

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

Multiple stages of fat purification

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

Harvested fat typically contains about 80% impurities, and only about 20% is actually usable.

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

Pre-grafting preparation before fat grafting

A satisfactory result should ideally be achieved with one procedure through a high survival rate.

The micro fat should be placed evenly across multiple layers, and before that, space must be secured at the graft site so that the previously grafted fat is not compressed by surrounding tissue, allowing the fat to survive without pressure.

Precise and even grafting across multiple tissue layers

Achieving a soft and 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 fascia layer, and the fat must be spread through the tissue like sowing seeds to achieve a smooth contour without irregularities.

Features of DuHan Plastic Surgery Micro Fat Grafting Clinic

1 All anesthesia is performed as local anesthesia (sedation anesthesia).

Local anesthesia is performed together with sedation anesthesia, and the procedure is carried out without any pain during anesthesia or after the anesthesia is complete.

2 We have a systematic and advanced fat grafting system.

To obtain live fat cells and increase purity, we maximize purity through centrifugation, purification, and removal of unnecessary oil.

Before grafting, subcutaneous tunneling is performed at the graft site to secure space for placement.

Precise grafting is performed using micro fat grafting cannulas.

By grafting evenly across multiple layers in a three-dimensional manner, we maximize the survival rate and create a soft contour.

3 We select appropriate and various donor sites for fat harvesting.

The most commonly used area is the lower abdomen, because after the procedure there is less pain, less swelling and bruising, and it is easier to continue daily life, making it the first choice.

The next preferred area is the inner thigh, followed by the outer thigh.

If there is not enough fat to harvest from the thighs, the lower buttocks or flanks may also be used.

There is no fixed rule for which area gives the best fat survival rate.

The results are similar, and while the area with the most fat is ideal as a donor site, it is better to decide based on the amount needed and the patient’s activities after the procedure.

4 We maximize the survival rate through a two-step purification process for the harvested fat.

Among the impurities in harvested fat, the largest proportion is local anesthetic, followed by oil.

Other impurities include serum and red blood cells.

In the first step, the fat undergoes centrifugation for about 3 to 4 minutes, after which it proceeds to the second step of oil removal.

Oil is removed manually through a natural absorption method.

Through the two-step purification process, nearly 100% concentrated fat is obtained, maximizing the effect of fat grafting and increasing fat survival as much as possible.

5 We secure space for fat grafting through subcutaneous tunneling.

Subcutaneous tunneling means creating space in advance at the area where fat will be grafted, and it is an essential process for a high survival rate and even grafting.

Using a thin probe, the tissue under the skin is moved repeatedly in a fan-like pattern to create space for the fat.

The effect of subcutaneous tunneling is to improve the survival rate of the fat and prevent clumping, creating an even and soft contour.

6 A three-dimensional micro fat grafting approach can produce a soft and uniform facial contour.

Although there are exceptions depending on the area, the standard method of fat grafting is the three-dimensional approach.

Fat is divided into multiple layers and grafted evenly in small amounts in each area.

7 Micro fat grafting cannulas are used for precise fat grafting.

In the past, methods using fat injection machines caused various problems because fat was forced under the skin under high pressure.

The absorption rate of fat was high, survival was inconsistent, contours became uneven, and it was difficult to graft into delicate areas such as under the eyes.

To solve these problems, the fat is transferred again into a thin 1 cc syringe during fat grafting and then placed in the desired area.

We use a micro needle (micro grafting cannula) developed in-house.

The micro needle is a special grafting cannula used only at our clinic that enables ultra-precise grafting.

Fat grafting can also be performed on the upper eyelids, lower eyelids, forehead wrinkles, glabellar wrinkles, nasolabial folds, and the bridge of the nose, making fat grafting possible in almost all cases except very fine wrinkles.

8 Mold shaping immediately after fat grafting helps create a uniform and soft facial contour.

Right after fat grafting, delicate molding is performed so that the grafted fat spreads evenly and a soft shape is created.

Molding is the final stage of fat grafting and one of the most important steps.

9 Rapid freezing and sterile storage of the remaining fat makes second procedures easier.

When a second procedure is performed three months after fat grafting, the remaining fat from the first procedure is used without harvesting fat again.

The remaining fat after the first procedure is stored after rapid freezing and sterile processing.

For the second procedure, the stored fat is thawed and can be used more conveniently.

The storage period for the fat is up to 10 months, and if you visit within 10 months, the stored fat will be used for the procedure.

10 Based on more than 20 years of rich clinical experience and know-how, DuHan Plastic Surgery Micro Fat Grafting Clinic performs multilayer fat grafting.

The key to fat grafting is ensuring that living fat cells can achieve a high survival rate.

To increase the survival rate of fat, a large amount is not injected into one place; instead, it is evenly and uniformly grafted across multiple layers.

Between the skin and the bone, there are multiple tissue layers such as the fat layer and muscle layer, and fat must be injected in a multilayer structure without overlap, such as between the periosteum above the bone and between the muscle fascia below and above the muscle.

Multilayer fat grafting lasts 3 to 4 times longer than conventional methods and also has a higher fat survival rate.

The fat grafting procedure at DuHan Plastic Surgery Micro Fat Grafting Clinic also includes a process called "tunneling," which allows the grafted fat to make maximum contact with the surrounding abundant blood vessels and continuously receive nutrients.

Tunneling means creating space for the fat to go using micro needles just beneath the skin. In other words, space is made as if drilling a tunnel, and fat is then injected afterward, so even after all the fat has been placed, it does not sag in the direction of gravity or become uneven.

In addition, delicate injection methods allow for customized design.

After fat grafting, we provide thorough follow-up care and closely monitor the progress until the fat has fully survived.

During follow-up, if necessary, we try to minimize dissatisfaction through swelling-reduction injections, shape correction, and molding.

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