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Glabellar Wrinkles

Glabellar fat grafting is a procedure that corrects indentation between the eyebrows or vertical wrinkles.

It aims to correct the appearance in cases where the habit of frowning makes the face look unfriendly.

Indications for glabellar fat grafting

○ Deep vertical wrinkles in the glabella

○ Indentation of the glabella

Fat grafting procedure for wrinkle removal

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

In cases for wrinkle correction, not much fat is needed, so it is preferable to harvest it from the lower abdomen.

• Because local anesthesia (painless sleep 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 impurities (local anesthetic, serum, red blood cells), etc.

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

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

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

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

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

At our clinic, we use a self-developed microneedle (micro grafting cannula).

The microneedle is a special grafting cannula used only at our clinic that allows ultra-precise grafting.

When grafting, pre-subcutaneous tunneling should be performed before the fat is grafted so that it can be accurately placed in the wrinkle area and the wrinkle can be effectively corrected.

The principle of fat grafting is to distribute the fat evenly throughout the area where it will be grafted so that it does not clump together, while also maximizing the survival rate as much as possible.

Examples of wrinkle correction with fat grafting

| In the case of glabellar wrinkles, for fine lines, filler materials such as Restylane or Juvederm can be used, but for deep vertical frown lines, fat grafting is effective. Glabellar wrinkles are usually caused by overuse of the corrugator muscle in the forehead. Since surgery to fundamentally remove the corrugator muscle is difficult, fat can be placed between the skin and the corrugator muscle to block its influence to some extent. |

Advantages of wrinkle correction with fat grafting

① The procedure is simple.

② Because no foreign substances such as Restylane or commercial filler materials are used, there is no need to worry about side effects.

③ Because the procedure is performed without cutting the skin, there is no concern about scars.

④ Because it uses the patient’s own tissue, the appearance is natural.

⑤ Swelling and bruising are minimal.

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

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

Precautions when performing wrinkle correction with fat grafting

□ If you laugh excessively or frown strongly right after the procedure, the grafted fat may be compressed and absorbed more, so be careful.

□ Do not press on or massage the area immediately after fat grafting.

□ Running exercises can negatively affect the survival rate of the fat, so you should avoid running exercises for about a month.

Number of fat grafting sessions for glabellar wrinkles

In the case of glabellar wrinkles, there are various variables in the treatment effect.

If you laugh or frown strongly after the procedure, the fat cells will be compressed and the effect will be reduced by half.

For the grafted fat to take hold properly, there must be no pressure from external forces.

Therefore, in the case of wrinkle fat grafting, facial expression control should be maintained well for about a month.

For fat grafting of the glabella or nasolabial folds, satisfactory results can usually be obtained with 1 to 2 sessions.

The second procedure is performed between 3 and 10 months after the first procedure, and during the repeat procedure, fat that was stored at the time of the initial fat grafting is thawed and used.

Long-term effect of fat grafting for glabellar wrinkles

Some people say fat grafting has no effect because much of the fat is absorbed, but this applies to cases where the procedure was done at a clinic with somewhat limited experience in fat grafting, or where the fat grafting was done poorly.

If fat grafting is performed accurately, a satisfactory result can be obtained, and 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.

Some people say fat grafting has no effect because much of the fat is absorbed, but if the procedure is done accurately, a satisfactory result can be obtained.

However, no procedure lasts forever.

Wrinkles are a sign of aging, so there is no way to prevent aging; what matters is making the wrinkle treatment effect last as long as possible.

Once an area has undergone fat grafting, the tissue under the skin is reinforced, so it resists the forces that cause wrinkles and wrinkles do not form easily.

Although individual results vary, the wrinkle improvement effect of fat grafting can be said to last longer than that of any other procedure.

Side effects of fat grafting for wrinkle procedures

Fat grafting for wrinkles is one of the procedures that requires a very high level of precision.

To achieve the effect of smoothing the wrinkle line by grafting into it, an appropriate amount of fat must be grafted at an appropriate depth and volume after tunneling.

If fat grafting is done poorly, areas other than the wrinkle line may bulge more, and there may be side effects of protrusion beyond the wrinkle correction effect; conversely, there may be cases where there is almost no effect, or cases where the patient suffers from severe swelling immediately after the procedure.

Also, fat grafting is not applicable to all wrinkles, so it should be applied only to wrinkles that can benefit from fat grafting. Unlike contour correction, wrinkle procedures are more difficult, so as a rule, they should not be performed by someone with limited experience or by a non-board-certified plastic surgeon.

How to resolve side effects of overfilled fat grafting

When fat grafting is performed in a way that deviates from the principles due to lack of experience, or when the amount of fat is misjudged and too much fat is grafted, the grafted area may swell severely or, even after the swelling subsides, the treated area may remain overly protruded and look unnatural.

This is usually a problem that occurs when an excessive amount of fat containing many impurities that has not been properly purified is forcefully injected.

Usually it subsides over time, but if the swelling is too severe, hyaluronidase for reducing swelling may be injected into the treatment area to bring the swelling down faster. In cases of excessive fat injection, a microcannula may also be inserted to suction out and remove the grafted fat again.

Excess fat can be more easily removed by suctioning it out again within 3 months.

In some cases, the grafted fat becomes necrotic, calcifies, and hardens; in such cases, it must also be removed by suction.

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

How to perform 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 and sterilized with a high-pressure steam sterilizer so that no fat residue remains inside the used suction cannula or grafting cannula, and anesthesia solution and saline must also be carefully managed to prevent contamination.

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

Several stages of fat purification

Fat purification must completely remove impurities 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 grafting is done.

Preconditioning before fat grafting

With a high survival rate, it should be possible to obtain a satisfactory result in just one procedure if possible.

The fine fat must be planted evenly in multiple layers, and before that, space must be secured at the grafting site so that the previously grafted fat is not compressed by the surrounding tissue, allowing the fat to take hold well without pressure.

Precise and even grafting into multiple tissue layers

The key to fat grafting is expressing a soft and natural contour.

To achieve a soft contour, it is better to graft in a three-dimensional manner by distributing it evenly across multiple layers.

The grafting sites include the subcutaneous layer, muscle layer, and fascia layer, and the fat should be spread throughout the tissue as if sowing seeds evenly to achieve a smooth contour without irregularities.

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