Preface: Fat Grafting for Aesthetic Facial Surgery xi
Shahrokh C. Bagheri, Husain Ali Khan, and Behnam Bohluli
The Past, Present, and Future of Facial Fat Grafting 1
James D. Frame
Video content accompanies this article at http://www.oralmaxsurgeryatlas.theclinics.com.
Introduction 1
Past 3
Understanding the superficial and deep fat spaces on the face 4
Methods of fat harvest 4
Injecting technique 4
The future 5
Current Techniques in Fat Grafting 7
Shahrokh C. Bagheri, Behnam Bohluli, and Elizabeth K. Consky
Introduction 7
Preoperative preparations 7
Medical optimization 7
Surgical technique 8
Graft processing 8
Fat transfer 10
Postoperative care 12
Fat Grafting in Facial Aesthetic Units 15
Husain Ali Khan and Seied Omid Keyhan
Introduction and history 15
Facial aesthetic units 15
Goals and outcomes 16
Preoperative evaluation 16
Patient positioning and skin marking 17
Fat harvesting 17
Combination of platelet-rich plasma or platelet-rich fibrin with fat 17
Fat injection in facial aesthetic units 18
Nose 18
Technique and considerations 18
Volume 18
Problems and complications 18
Lips 19
Technique and considerations 19
Volume 19
Problems and complications 19
Cheek 19
Technique and considerations 19
Volume 20
Problems and complications 20
Nasolabial fold and marionette groove 20
Technique and considerations 20
Volume 21
Problems and complications 21
Forehead, brow, temple 21
Technique and considerations 21
Volume 21
Problems and complications 21
Mandible and chin 21
Technique and considerations 21
Volume 21
Problems and complications 21
Orbital rim and periorbital area 21
Technique and considerations 21
Volume 21
Problems and complications 21
Application of buccal fat pad as a donor site 21
Autologous Fat Transfer for Facial Augmentation and Regeneration: Role of Mesenchymal Stem Cells 25
Luigi Clauser, Antonio Lucchi, Ilaria Tocco-Tussardi, Chiara Gardin, and Barbara Zavan
Introduction 25
Nature of the problem 25
Fat components 25
Adipose-derived stem cell isolation 26
Adipose-derived stem cell potential for clinical applications 27
From the bench to the bedside 27
Preoperative planning 27
Procedural approach 27
Postprocedural care 28
Potential complications 28
Contraindications 28
Fat graft take, volume maintenance, and longevity 28
Summary and future perspectives of fat grafting 29
Clinical cases 29
Case 1 29
Case 2 29
Case 3 29
Case 4 30
Case 5 30
Case 6 30
Case 7 30
Case 8 31
Fat Graft with Growth Factors 33
Farzin Sarkarat and Roozbeh Kahali
Introduction 33
Platelet-derived growth factor 33
Insulinlike growth factor 34
Vascular endothelial growth factor 35
Fibroblast growth factors 35
Platelet-rich plasma 35
Discussion 36
Summary 38
Autologous Fat Augmentation of the Face 41
Suzan Obagi and Carolyn Willis
Introduction 41
Anatomic considerations 41
Preoperative planning 42
Medical history 42
Physical examination 43
Preoperative preparation 43
Surgical approach 43
Instruments 43
Fat transfer procedure 43
Additional procedures 46
Potential complications 46
Lidocaine toxicity 48
Opioid overdose 48
Benzodiazepine overdose 48
Anaphylactic reactions 48
“Pearls and pitfalls” 48
Postoperative recovery 48
Clinical results in the literature 48
Summary 49
Fat Grafting as an Adjunct to Facial Rejuvenation Procedures 51
Behnam Bohluli, Sharokh C. Bagheri, and Elizabeth K. Consky
Introduction 51
Mechanisms of facial aging 51
Rationale for adding fat grafts to rejuvenation operations 51
Volume restoration 52
Contour restoration 52
Planning a more conservative approach 52
Skin quality 52
Fat grafting in forehead rejuvenation 53
Fat grafting used as an adjunct to surgical treatment in distinctive anatomic regions of upper face 53
Deep glabellar grooves 53
Temples 53
Deep upper lid sulcus 54
Lateral brow 54
Fat grafting concurrent with middle face rejuvenation procedures 55
Fat grafting used as an adjunct to surgical treatment in distinctive anatomic regions of the midface 55
Fat grafting concurrent with lower face rejuvenation procedures 55
Fat grafting used as an adjunct to surgical treatment in distinctive anatomic regions of the lower face 55
Fat grafting versus fillers and implants for increasing volume of the aging face 56
Autologous Fat Transfer for Maxillofacial Reconstruction 59
Ryan M. Diepenbrock and J. Marshall Green III
Congenital deformities 60
Acquired deformities 61
Traumatic deformities 61
Surgical technique 61
Alternatives 62
Case 1 62
Case 2 63
Case 3 63
Case 4 64
Case 5 65
Case 6 65
Case 7 66
Case 8 66
Summary 66
Periorbital Rejuvenation with Application of Fat Transfer 69
Neophytos C. Demetriades and Dilip D. Madnani
Components of facial analysis 69
Evaluating the periorbital area 70
Fat harvesting and grafting technique 71
Summary 75
Complications in Fat Grafting 77
Angelo Cuzalina and Andre V. Guerrero
Blindness or stroke (intravascular injection) 77
Mechanism 77
Prevention 77
Management 77
Contour irregularity, unpredictability, and overcorrection and undercorrection 78
Mechanism 78
Prevention 78
Management 80
Swelling and bruising 80
Mechanism 80
Prevention 80
Management 80
Summary 80
Fat Grafting: Challenges and Debates 81
Sydney R. Coleman, Samuel Lam, Steven R. Cohen, Behnam Bohluli, and Foad Nahai
To use or not to use 81
Longevity 82
Size of graft material 82
Number of treatments 82
Extensive overcorrection 82
Skin improvement 83
Graft storage 83
Looking ahead 84
