■ The fat should be injected in a fan shape and in two to three layers. The face is built up and stabilized with fat droplets using a three-dimensional technique, as if in a honeycomb.
■ The supraorbital, infraorbital; and mental nerves can be blocked to provide anesthesia. The individual injection sites may also be treated with local anesthesia.
■ The fat removed using the tumescence technique is spun at 3,000 rpm for 4 min so that only vital, purified fat is used for the fat injection. The fat is transferred into 1-ml Luer-Lock syringes using a special adapter. The globules of fat can be positioned, as if they are a string of pearls, using a 20- or 23-Gg needle. This ensures surface contact with the surrounding capillaries and also allows the fat implants to become firmly anchored in the surrounding connective tissue.
■ Three-dimensional implantation of fat globules is particularly effective. With this technique, several channels are placed on top of one another in a fan-shaped pattern at various levels within the subcutaneous tissue. It is best to begin with the deepest fan-shaped layer and then place the fan-shaped layers on top of one another. In addition, particularly pronounced mimicry wrinkles on the forehead and in the nasolabial area can be treated separately using the intracutaneous serial point-by-point technique with a fine needle, in a similar way to the point-by-point collagen technique.
■ It is important that all the areas treated by injection are massaged with the finger when the treatment is completed so that there is no bulging and no nodules form. This applies particularly to sites treated by injection in the lip, nasolabial, zygomatic arch, and forehead areas. Lip modeling can be performed easily with this technique, but three injections will be required (at 0, 6, and 12 months).
■ The survival of the transplanted fat globules can only be guaranteed if the maximum distance to well-perfused host tissue is 1.5 mm. Otherwise, the fat transplant will die, it will be absorbed, or it will become calcified.
■ First, a tunnel is created at the tip using the cannula and without exerting any pressure. This is filled with purified fat when the cannula is pulled back, by exerting slight, uniform pressure on the plunger. A row of channels is then created with the cannula, and these are filled with fat when the cannula is pulled back.
■ Compression bandages are only necessary if there is concern about possible displacement of the implant. Areas with pronounced mimicry, e.g., the glabella, are immobilized with Steri-Strips. Cooling for 2-3 days is advisable. Antibiotic cover is given.
■ Several sessions (up to three) are usually necessary, as the connective tissue septa of the subcutaneous tissue will only allow in a certain quantity of adipose tissue transplants. Otherwise, the fat globules will be traumatized. A certain amount of edema also always develops in the host area as a result of the infiltration.
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