Author: Dr Xavier Tenorio

Description
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This technique, also known as ‘lipo-filling’ allows the transfer of fat cells from one location of the patient to another in order to restore volume. Since the fat cells belong to the same patient, there is no chance of rejection.

The aesthetic uses in the face are: the filling or attenuation of certain wrinkles (nasolabial fold), restoration of the volume of the cheeks, jawline, eyelids and the treatment of the volume of the lips.

Lipostructure can also be use for breast enlargement, aesthetic treatment of the dorsum of the hand and in combination with liposuction in contour surgery.

Definition
As soon as the first liposuctions were carried out, Plastic Surgeons developed the idea to re-use the aspirated fat to re-inject  in other places of the body with a filling purpose. This technique, called lipo-filling, was initially disappointing since a significant proportion of the injected fat tended to reabsorb, making the results random and transitory. However, the techniques to treat the fat cells before re-injecting them have significantly evolved making lipostructure a very reliable method today. The principle is to perform a true auto-graft of fresh fat cell from one part to the body into another. Lipostructure can be applied to a great number of sites including natural or post-traumatic depressions (hollows).
The uses of this type of surgery can be summarised as follows:

• Uses of an aesthetic nature:
• To fill and attenuate certain facial wrinkles.
• To restore the “plenitude” lost during the first stage of facial ageing.
• To restore the volumes and shapes of the face.
• As a complementary procedure associated with certain face lifts.
• After a facelift to improve the contour of middle third of the face without having recourse to a new face lift.

• Uses in reconstructive surgery:
• To fill depressions following traumatisms
• To correct secondary irregularities of liposuction.
• To restore the facial deposits of fat in patients under HIV treatment.
• To improve the tissue quality after radiation
• Full breast reconstruction by multiple séances of lipostructure can also be possible.

It is necessary to keep in mind that lipostructure is a serious surgical operation which must be undertaken by a qualified plastic surgeon, specifically trained for this type of surgery.

Before the surgery

Dr X. Tenorio, specialist in Plastic and Reconstructive Surgery, will perform a meticulous, clinical and photographic study. Previous photographs can be helpful in the decision-making process. A preoperative general assessment will be carried out in accordance with the federal regulations. If needed, you will have an appointment with the anaesthetist at the latest 48 hours before the surgery. Drugs containing Aspirin must be stopped 10 days preceding the surgery.

Types of anaesthesia and hospitalisation

Anaesthesia. Lipostructure is usually carried out under local anaesthesia sometimes associated to sedation. General anaesthesia can also be used in some cases. The choice between these various techniques will result from the discussion between you, the surgeon and the anaesthetist.
Hospitalisation This surgery is practically always carried out on an ambulatory basis (no hospitalisation). The patient arrives in the morning and then is discharged 3 to 6 hors after the surgery.

The surgery

The procedure begins choosing the sites where the fat is going to be lipoaspirated (donor sites).
The liposuction is carried out using a very thin tube that is inserted by a small incision hidden in a natural fold.
Then, the aspirated fat is centrifugation for a few minutes in order to separate the cells from the liquid.
The re-injection of fat cells is done using very thin tube. The graft is performed in several layers up to the point to obtain the desired volume.
The duration of the surgery is determined by the volume of fat to be reinjected and the number of localisation to be treated. It can vary from 30 minutes to 2 hours

Follow-up and results

Pain is not very significant and generally well tolerated. Swelling (oedema) and bruises appear during the 48 hours following the surgery and will be reabsorbed in 5 to 15 days .
Thus, physical recovery is usually fast because of the light and superficial character of the intervention. It is advisable not to expose the operated areas to the direct sun or U.V for at least 4 weeks.

The final result can be observed within 3 to 6 months after the surgery. The depressions in rule are filled and the volume is restored. The evolution of the result will adapt to the natural continuation of the ageing process.

Imperfections and complications

In general, we have observed that correctly administered lipostructure results in excellent patient satisfaction. Certain minor imperfection (not real complications) are rare but may be present. These include:
Localized hypo-correction, light asymmetry and irregularities. They all can be corrected by a complementary treatment.

Possible complications

Includes infection, which is prevented by the use of a prophylactic antibody. Hyper-correction (the most common complication) related to an excessive injection of fat and can be unaesthetic. Its treatment can be carried out by a simple liposuction but it may require a more complex surgery to excise the excess of fat.

Conclusion

To resume, there is need to overestimate the risks, but it is important to be aware that any surgical procedure, even apparently simple, always comprises a small share of risks. Choosing a qualified plastic surgeon decreases the rate of these complications, and ensures an effective correction treatment if required.