Objectives: Facial rejuvenation with lipofilling: from macro to nanograft

Purpose: Autologous fat injection of the head and neck region can be considered a valid alternative to major invasive surgical procedures both for aesthetic and functional purposes.

Introduction: The favourable outcomes of autologous fat injection
are due to the filling of soft tissue and, mainly, to the potential regenerative effect of adipose-derived mesenchymal stem cells.

Materials / method: In our experience, three fat samples were analyzed. The first sample was a classic lipoaspirate (macrofat).The second sample was microfat, harvested with a multiport small-hole cannula. The third was microfat processed into nanofat. Processing consisted of emulsification and filtering of the lipoaspirate.

Results: The results were related to the treatment of a large number of patients with different indication and problem from aesthetic to reconstructive surgery (e.g. Romberg sindrome)

Conclusion: Conclusion:
Macrograft injection can be used succesfully to restore large volume in the face , in the body defects and generally in the loss of substance.
Microfat injections might become a new concept in the lipofilling area.
In particular clinical situations, nanofat seems to be suitable for skin rejuvenation purposes.

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Objectives: This short presentation is designed to teach the anatomy of the deep and superficial fat compartments of the face and specific areas of bone loss such as around the pyriform aperture and mandibular body and ramus. In addition, the audience will learn the differences in milli, micro and nanofat and how they are used for anatomic tissue replacement of soft tissue and bone loss in the face. Lastly, the techniques used for injection of the different types of fat grafts will be presented.

Introduction: Introduction: Fat grafting has been around for over 100 years. Coleman standardized the procedure and little changed until the early 2000’s when stem and regenerative cells were identified in fat, catalyzing the resurgence of interest in both small and large volume fat grafting. One of the key components of facial aging is loss of soft tissue and bone volume. This is not a uniform process and takes place to some extent in both the deep and superficial fat compartments of the face as well as in predictable areas of the craniofacial skeleton.

Materials / method: Materials and Methods: Over the past 5 years, a new approach to facial fat grafting has been developed in which the face is dynamically analyzed over the patient’s lifetime to determine the specific areas of fat and bone loss that have occurred. The degree of tissue decay in the deep structures as well as the dermis and epithelium are evaluated and a treatment plan is devised that replaces all soft tissue and bone losses simultaneously with anatomically precise fat grafts that are placed in the region(s) of loss.

Results: Results: Studies by Rigotti have confirmed histologic regeneration of elastin and collagen as well as neoangiogenesis using mechanical stromal vascular fraction enriched fat grafts prior to facelift surgery. A recent study by our group has shown for the first time a reduction in the rate of tissue decay when ITR2 is combined with facelifting. ITR2 has been converted into a non-operative technique and can be performed under local anesthesia. Complications have only been seen in 3 patients in whom excess fat in the lower eyelids has been surgically excised without sequelae.

Conclusion: Conclusions: As we learn to model the morphologic changes in tissues as they decay, management of facial aging is changing. New strategies such as ITR2 are designed to reduce the rate of tissue decay and restore the losses with “like” tissues placed into their proper anatomic locations once these changes become phenotypically bothersome to the patient. Tools are being designed to help the clinician see these subtle changes and understand the anatomic changes in the affected deep and superficial fat compartments and areas of bone attrition.

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请注明名称（个人，公司，学会等等）: Tulip- royalties pending; Millenium Medical- royalties on kits, stock options in lieu of consulting fees

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请注明名称（个人，公司，学会等等）: Unpaid Consultant (Unrestricted Research Grant/Disposables) for Harvest-Terumo BCT, BioTime, Medical Tech., Eclipse Aesthetics and Unpaid Investigator (Unrestricted Research Grant/Disposables) LipoGems

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请注明名称（个人，公司，学会等等）: Paid Consultant for, BioTime, Follica, Inc, Eclipse Aesthetics, and Bergen Medical

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这项工作的完成感谢以下机构的支持： Medical Advisory Board member for the following Boards; Board of Regents Aesthetic Stem Cell Society, Lightstim, Inc., Follica, Inc., Eclipse Scientific Advisory Board, and Aesthetic Guide Advisory Board.