Micro-Fat Graft: Replacement Technique

Autologous fat graft became generalized with structural microfat graft by Coleman. Functioning as an important surgical technique for plastic surgeons, it has been utilized not only in augmentation of facial soft tissue, but also as biological fillers and anti-aging procedures. For maximal survival and minimal resorption of the grafted fat tissue, meticulous caution must be taken in all process of the autologous fat graft from selection of the donor site to aspiration, refinement, injection and replacement. This article emphasizes the techniques, such as selection of adequate anesthesia, selection of cannula for injection, injection technique, replacement layer and volume for in the fat tissue to be injected for operating plastic surgeons who are at initial stage of autologous fat graft. Autologous fat graft techniques by Coleman, multi layer injection technique, minimal volume injection technique, meticulous handling of fat tissue and minimal hemorrhage are generalized concepts and knowledge with must be acquired by the operator. However, the amount of injection and degree of over-correction must be carefully considered.

Correction of Sunken Upper Eyelids Using Incisional Double Eyelidplasty and Autologous Microfat Grafting into Orbital Septum

Sunken upper eyelids are one of the common and complicated problems that occur with an aging process or after double eyelidplasty. Autologous microfat grafting is a technique that has frequently been used for sunken eyelids. The traditional blind method of microfat grafting has a some complications. Therefore, we performed the open method with incisional double eyelidplasty. Between June, 2005 and February, 2008, we performed incisional double eyelidplasty and autologous microfat grafting into orbital septum in 63 patients(124 cases) with sunken upper eyelids. The fat was harvested from periumbilical regionand centrifuged at 3000 rpm for 3 minutes. After the middle fat layer was obtained by 1cc syringe, we made skin incision and separated orbital septum(inner layer) and levator aponeurosis. And then, we injected the microfat into orbital septum with 0.9 mm blunt cannula. At this time, one of the important things was to make the patient gaze upward during the fat injection. All the patients were satisfied, except 5 cases which were 3 cases of undercorrection and 2 cases of asymmetry. Surgical revision was required for only the above 5 cases(4%). Patients with some transient complications of ptosis (13 cases), overcorrection(4 cases) and nodular appearance(2 cases) were self-improved. We found that the method using incisional double eyelidplasty and autologous microfat grafting into orbital septum has many advantages which include less traumatic, less complication rate, less absorption rate of fat. and less burden of patients.

Correction of Sunken upper Eyelids Using Autologous Microfat Graft

The amount of the soft tissue of upper eyelids is aesthetically important. The soft tissue of thick eyelids need to be removed, whereas the sunken eyelids need to be augmented. The sunken eyelids make someone look older and more tired. The aesthetical use of the autologous fat has been advocated for tissue augmentation for over a century and microfat graft is a popular procedure to augment the soft tissue. We had corrected the sunken eyelids of 11 patients without any history of aesthetical surgery or trauma of upper eyelids using autologous microfat graft. The fat had been harvested from periumbilical area, centrifuged at 3000rpm for 3 minutes. The middle fat tissue layer was obtained using 1cc syringe and injected in the upper eyelids. All procedures were performed under local anesthesia. There were no major complications except undercorrection in two cases. Though survival rate of injected microfat is variable, it is predictable in upper eyelid compare to other areas. As a result, autologous microfat graft should be considered as a good choice for correction of sunken eyelids.