Objectives: During the last two decades, lipofilling has been increasingly used to correct the depletion of the adipose component in different areas of the face and improve skin tone and texture. In the aged fase, it can be used as an alternative to face lifting or in association with this.

Introduction: Lipofilling has increasingly indicated by plastic surgeons for aesthetic treatments. Thanks to the improvements of the technique regarding harvesting, proceeding and injecting the adipose tissue, today it is very often used in facial rejuvenation, associated or not to other procedures.

Materials / method: In the Author's clinical experience, the regions mainly used in association with the facial lifting were the tear trough, the zygomatic region, the nasolabial fold and the marionette lines. The amount of fat injected was variable : from about 2 ml per side in cases of simple correction of tear trough , to maximum 36 ml of fat for full face treatment. During th lipofilling, f at was injected in multiple tunnels, in different surgical planes and with cannulas of different diameters: the deeper the infiltration, the larger the diameter.

Results: During the last two decades, lipofilling has been increasingly used to correct the depletion of the adipose component in different areas of the face and improve skin tone and texture.

Conclusion: In the correction of facial aging lipofilling can be used as an alternative to face lift when the loss of skin tone is at an early stage; In the Author's clinical experience, the face lift should always be the treatment of choice in presence of severe skin laxity.

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Objectives: To present a new standardized facial fat grafting technique.

Introduction: Injectable Tissue Replacement and Regeneration (ITR2) is a new, standardized method of fat grafting.

Materials / method: In performing ITR2 the first step is to diagnose the anatomic areas and tissues where volume loss has occurred by evaluating the surface topography of the face. Step two, addresses specific anatomic losses of these different tissues, including skin, facial fat in the deep and superficial compartments, and bone. Step three, replaces these anatomic losses with injectable autogenous or allogeneic fat grafts, de-cellurized bone and cartilage sized for structural replacement of bone and deep fat losses, superficial fat replacement and dermal and epithelial replacement and regeneration.

Results: Since 2015, all fat grafting patients underwent ITR2. ITR2 was performed alone under local or intravenous sedation; with resurfacing fractional lasers; and in patients having facelift or facial rejuvenation surgery. Complications occurred in 2 patients who required transcutaneous (n=1) or tranconjunctival (n=1) fat removal for excess noted in the lower eyelids. No instance of overgrowth has been seen to date with this anatomic approach. Improvement in skin texture and thickness has been noted up to two years after treatment.

Conclusion: Injectable Tissue Replacement and Regeneration is a new standardized means of fat grafting that addresses anatomic areas of skin, fat and bone loss. As newer techniques of injectable bone and cartilage gel are developed, losses in specific tissues can be addressed with “like” tissues, ushering in new approaches in injectable tissue engineering.

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请注明名称（个人，公司，学会等等）: Lipocube- royalties, shareholder; Tulip- royalties; Millennium Medical- royalties, shareholder

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请注明日期: Patent pending, January 28, 2019
和审阅情况: ITR2 is trademarked

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