tips face fat transfer

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TABLE 3.6 Master Table for Systematic Fat Infiltration

ORDERSITE CANNULA

ENTRY

SITE

VOLUME

(CC)

AMOUNT

PER PASS

LEVELa

TISSUE

BARRIER PHASE

1 Medial inferior orbital rim

straight A 1 3 to 5 per 1/10 cc

D None Volumetricfoundation

2 Lateral inferior

orbital rim

straight A 1 3 to 5 per

1/10 cc

D None Volumetric

foundation3 Nasojugal

groove

straight A 1 1/10 cc D None Volumetric

foundation

4 Lateral cheek straight A 2 1/10 cc D, I, S None Volumetricfoundation

5 Buccal straight A 2 1/10 cc I None Volumetric

foundation6 Anterior cheek straight B 3 1/10 cc D, I, S Malar

septum

Volumetric

foundation

7 Superior

orbital rim(SOR)

straight or

Amar #7

B 1 3 to 5 per

1/10 cc

D None Volumetric

foundation

8 Lateral canthal

area

0.9-mm

straight

B 0.5 3 to 5 per

1/10 cc

D Fibrous

adhesions

Volumetric

foundation

9 Prejowl sulcus straight C 3 1/10 cc D, I, S Fibrousadhesions

Volumetricfoundation

10 Tear trough 0.9-mmstraight

A 1 3 to 5 per 1/10 cc

I None Refinements

11 Lateral cheek straight A 14 1/10 cc D, I, S None Refinements

12 Anterior cheek straight A & B 12 1/10 cc D, I, S Malar

septum

Refinements

13 Buccal straight A & B 15 1/10 cc I None Refinements

14 Precanine

fossa

straight A 12 3 to 5 per

1/10 cc

D None Refinements

15 Nasolabial foldstraight A 12 3 to 5 per

1/10 cc

S None Refinements

16 Lateral jawline straight C 1 1/10 cc D, I, S None Refinements17 Marionette linestraight or

Amar #7

D 12 1/10 cc S None Refinements

18 Labiomental

sulcus

straight or

Amar #7

D 12 1/10 cc D, I, S None Refinements

19 Inferior margin

of SOR

straight or

Amar #7

B 0.50.75 3 to 5 per

1/10 cc

D None Advanced

20 Central upper eyelid

straight or Amar #7

B 0.30.5 3 to 5 per 1/10 cc

D None Advanced

21 Temple straight or

Amar #7

B 2 3 to 5 per

1/10 cc

S None Advanced

aD, Deep; I, Intermediate; S, Superficial tissue planes.



Technical Pearls Tips

• Selection of donor site prior to the day of surgery may be beneficial in select patients. For example, gaunt patients with sparse donor fat, patients who have undergone extensive body

lipocontouring in the past, or patients who have had prior abdominal surgery when the lower abdom

is an area favored for harvesting.

• For patients who have undergone extensive body liposuctioning, an area often overlooked tcan provide an excellent donor source for harvesting is the waistroll, the roll of adipose that extend

superomedially to inferolaterally along the lower lateral back.• Asking the patient where he or she thinks that he or she has the most fat or where fat is themost difficult to lose is very helpful to guide the surgeon's search for the ideal donor site.

• Infiltration of local anesthesia into the donor site is carried out into the more superficial and

deeper portions of the fat pad, with the central portion left relatively untouched for fat harvesting.

• A different local anesthetic mixture is used for patients under oral sedation versus deeper

sedation (Table 3-4).

• During fat harvesting, avoid tenting or tethering the skin with the cannula, which implies tosuperficial a passage.

• During fat harvesting, the cannula should be almost entirely withdrawn to the skin entry site

after three to four passes to redirect the cannula into another area. Simply turning the angle of the

cannula without withdrawal does not actually move the cannula tip to a new harvesting site, which lead to overharvesting in one area.

• When calculating the total fat that should be harvested, the surgeon should recall that typica

50% of the filled syringe would be comprised of nonviable contents (blood, lidocaine, albumin, andlysed fat cells). A greater amount should be harvested in cases in which more blood is encountered

the syringe, which can raise the nonviable portion of the collected syringe upwards of 70% to 80%

• If a patient needs fat harvested from an area that requires repositioning (Table 3-3), considelighter sedation to permit patient cooperation with repositioning.

• During fat processing, remember to always remove the supranatant first before the infranata

• If the infiltration cannula becomes clogged, the cannula should be completely withdrawn an

then cleared before reinsertion. Doing so will minimize the chance of inadvertently administrating

oversized bolus of fat into a particular area.• Bony landmarks are a key guide to placement of fat, for example, the inferior orbital rim, th

zygoma, and the mandible. The nondominant hand provides tactile feedback to ensure that the cannis passed in the desired area for enhancement.

• The surgeon should complete the standard volumetric foundation first before deciding whet

the additional fat refinement would be justified. Additional placement of fat during the refinement phase can raise the degree of morbidity and should be undertaken with surgical experience and with

proper patient preoperative counseling.

• Advanced techniques should be undertaken only in experienced hands.

• Only skin is removed in an upper blepharoplasty, with occasional removal of a protuberant

medial fat pad as needed.

•

A conservative transconjunctival lower blepharoplasty should be performed, removing anappropriate amount of medial and middle fat pad. The lateral fat pad should be addressed if there issizable protuberance of fat in that area.

• Consider using a malar implant in combination with fat transfer in thin patients who lack

sufficient fat reserves for harvesting.

• The lateral mandible cannot be addressed if a concurrent facelift is performed. Care should

taken to avoid undermining skin in areas of transplanted fat.

tips face fat transfer

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