Indications

As early as 1893, Neuber reported that adipose tissue transplant material could survive only in the smallest particles. This is the most important condition for a successful fat transplant.

In 1922, Lexer stated that if the adipose tissue is not damaged by bleeding either when it is removed or when it is implanted, it can survive for 3 years.

In 1950, Peer announced that up to 50% of transplanted fat survives if excessive negative pressure is not exerted on the fat during extraction by suction and excessive positive pressure is not exerted on the fat during injection. Vascularization of the fat droplets takes place after 4 days and until that time survival is guaranteed as a result of diffusion.

In 1986, Coleman reported that fat can only survive as a tissue compound and not as an individual cell. Oil, blood, and local anesthetics must be separated from the structural fat by gentle centrifugation. The individual particles of adipose tissue must be positioned close to the vessels to be fed to facilitate independent anchoring in the surrounding tissue. Thus, all the criteria for a stable transplant would be fulfilled.

Indications:

• To replace atrophied or wasted structures resulting from aging or the <5^

sequelae of inflammatory skin diseases (e. g., acne) w

• To strengthen existing structures g

• To create harmonious and aesthetically pleasing facial features by replacing wasted tissue with fan-shaped, three-dimensional implantation of autologous fat particles

• Congenital or acquired deformities of the osseous and connective tissue structures (sequelae of burning, blunt soft-tissue injuries, facial fractures, cleft lips, midfacial hypoplasia, hemifacial atrophies, micrognathia)

■ The overall appearance of the face and the proportions can be improved by emphasizing specific facial structures (e.g., the chin appears smaller when the lips and the margins of the lower jaw are augmented).

■ The fat must be removed under sterile conditions in the operating room.

■ Sites for fat removal are those where contours can be achieved without creating hollows (e.g., double chin, lower abdomen, medial side of the thigh, knee).

■ Following tumescent anesthesia, the fat is removed using low-vacuum liposuction (-0.2 atm; this is approximately 20-30% of the vacuum used with normal liposuction) with a blunt 2 ml suction cannula.

■ The diameter of the cannula openings should correspond to a Luer-Lock so that the fat particles can pass through the equipment without being damaged further during the later transplantation = gentle curettage of the tissue with minimal vacuum.

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