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11 The Use of Radiofrequency for Facial Rejuvenation
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Erez Dayan and Christopher T. Chia
Abstract
A treatment gap exists among patients who are
not candidates for or prefer to not undergo traditional facelift and/or necklift. In these cases, radiofrequency has been shown to achieve approximately
30% soft-tissue contraction through thermal injury
to the dermis and underlaying fibroseptal networks.
Subsequent collagen remodeling angiogenesis, lymphangiogenesis, as well as elastin reorganization
function to visibly improve soft-tissue laxity in these
cases.
Keywords: radiofrequency skin tightening, radiofrequency, FaceTite, bipolar radiofrequency
Key Points
●
Through impedance of electromagnetic current, radiofrequency (RF) energy leads to differential heating across distinct tissue types
consistent with Ohm’s law (energy = current
impedance × time). For example, adipose tissue is
less conductive than water (higher impedance),
and leads to generation of higher temperatures
than muscle. Once soft-tissue temperatures reach
50 °C and skin surface reaches from 40 to 42 °C,
there is a trigger to induce neocollagenesis, angiogenesis, and elastogenesis.
●
Through different applications of RF energy (i.e.,
monopolar, bipolar, multipolar, microneedling),
subdermal adipose remodeling (SAR) and longterm soft-tissue contraction can be safely and
consistently achieved.
2
11.1 Patient Considerations
Radiofrequency (RF) treatment of the face and
neck area is intended for the “treatment gap”
patient population (30s–50s). This typically refers
to patients who have some soft-tissue laxity that is
not severe enough for an excisional procedure
(▶ Fig. 11.1 and ▶ Fig. 11.2). A detailed medical history and physical is obtained on all patients prior to
treatment. Exclusion criteria include the following:
pregnancy, open wounds, active infection, dermatologic conditions, bleeding disorders, immunocompromised state, and implantable devices. Patients
who have excessive laxity (i.e., advanced age,
massive weight loss) require excisional procedures and are not optimal ca ndidate for RF skin
tightening.
Risks and benefits are discussed at length including the possibility for thermal injury, sensory and/
or motor nerve injury, or poor contour/scarring.
Patients are counseled at length regarding expectations. It is important for patients to have a
clear understanding that RF treatments deliver a
controlled thermal energy, which ultimately is intended to upregulate growth factors such as vascular endothelial growth factor (VEGF) to allow for
neocollagenesis, angiogenesis, elastin remodeling,
and lymphangiogenesis.
and dependent on the patients’ overall soft-tissue
contraction after treatment. Often, we counsel patients on excisional options ahead of time as potential revisional procedures (i.e., mini-facelift/neck
lift) in the event that the RF treatment does not
provide satisfactory soft-tissue contraction.
×
Patients are marked in the sitting position by
first identifying the mandibular border and jowls
bilaterally. The jowls were subdivided into zone 1
(above the mandibular border) and zone 2 (below
the mandibular border). Areas of localized adiposity in the lower face and neck region are marked.
Nontreatment zones are identified by carrying a
line inferiorly perpendicular to the lip commissures
(i.e., marionette lines). The area medial to these
lines are avoided to preserve marginal mandibular
innervation to the depressor anguli oris, mentalis,
and depressor labii inferioris. Five access points are
identified: (1) the submental midline, (2) 1 to 2 cm
inferior to the mandibular parasymphyseal/body
junction, and (3) two postauricular sites. Depending
on clinical circumstances and patient desires, cases
were performed under either general or local
anesthesia. In cases of local anesthesia, patients
were premedicated with oxycodone (5 mg) and/or
benzodiazepine (5 mg).
1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18
1
The result can be variable
11.2 Technique
The patient is placed in a supine position and is
prepped and draped in the standard fashion.
Water-soluble sterile ultrasound gel is placed over
the treatment areas. Access sites are each injected
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The Use of Radiofrequency for Facial Rejuvenation
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with 2 to 4 mL of 2% lidocaine with epinephrine.
Typically, these access ports are inferior to each
ear lobule and at the submental midline for full
access to the central and lateral neck. A 14-gauge
needle is then used to make access ports that are
slightly dilated with Stevens scissors. A spinal needle
was used to slowly infiltrate tumescent solution (1 g
lidocaine per liter of lactated Ringer’s solution) from
deep to superficial, starting in the preplatysmal
plane and moving to the subdermal plane (~100–
150 mL of tumescent total). At the conclusion of tumescent infiltration, the cannula was passed throu gh
the subdermal plane to confirm adequate analgesia
and to allow f or discontinuous undermining.
Bipolar RF is performed first using the FaceTite
(InMode, Lake Forest, CA) probe. The device’s internal and external thermometer is tested on the
surgeon’s hand prior to treatment and confirmed
to be appropriately recording temperatures. The RF
settings included an internal temperature cutoff of
68 °C and external cutoff temperature of 38 °C.
These temperatures are preset and the device will
automatically regulate temperatures to not exceed
these limits. Soft-tissue contraction is a function of
time versus temperature in an Arrhenius relationship. This means that a similar soft-tissue contraction can be achieved in two scenarios: (1) higher
temperature for a shorter time or (2) lower temperature for a longer time. We believe that the aforementioned temperature settings allow for a safe yet
efficient soft-tissue contraction. The RF cannula is
used to pretunnel treatment areas for ease of treatment and to ensure that the cannula does not
become misguided during treatment. The predetermined treatment areas are systematically heated
row by row to avoid heat loss when treating wide
areas. RF application is applied on retrograde movement of the cannula and stopped within 1 cm of
the access port to prevent overheating this area at
each pass. Audible and visual cues from the RF console are used to assess temperature of tissues and
treatment is stopped after 1minute of reaching target internal and external temperatures. The device
automatically provides a double and subsequent
triple beep once target temperatures are reached
internally and externally.
Fractional RF (Fractora modif ied to Morpheus8,
InMode) is subsequently used at a depth of 4, 3,
and 2 mm and energy of 30 with 50% overlap. The
handpiece is applied firmly and perpendicular to
the treatment area prior to delivery of RF energy
pulses. In patients with thinner skin or darker Fitzpatrick types, energy settings are reduced by 20%.
The addition of fractional RF provides subdermal
thermal injury, which remodels reticular dermis
and also improves soft-tissue texture, as opposed
to bipolar RF, which focuses energy on the fibroseptal networks. At the conclusion of the treatment,
the patients’ facial nerve function is assessed. This
is compared to the assessment performed preoperatively. Specific attention is paid to the patients’
marginal mandibular nerve function. In cases of
neuropraxia, it is noted in the patients’ record and
reassessed in follow-up visits to ensure that it is either from the local anesthesia effect or temporary
due to heat or traction injury. In the authors’ expe-
rience, neuropraxia is uncommon (2–3% of cases)
and resolves over the coming 4 to 8 weeks. Patients
are seen at intervals of 1 week and 1, 3, and 6
months for follow-up.
11.3 Postoperative Care
●
Patients are seen at 1-week and 1-, 3-, and 6month intervals.
●
Patient are instructed to not use any skin products for the first 3 to 4 days after fractional RF
treatment.
●
The usual postoperative course involves some
edema and ecchymosis. This typically resolves
in 1 week.
●
A facelift-type headwrap with moderate compression is applied for 3 to 4 days.
●
Patients are instructed to not use cold compresses.
●
Most patients return to work the next day.
11.4 Common Pitfalls
●
Proper marking of the patient and identifying
danger zones are key to avoid heating distal aspects of the marginal mandibular nerve.
●
Avoid patients with excessive soft-tissue laxity
who are more fit for excisional procedures.
●
Use of ample tumescent functions as a “heat
sink” to avoid thermal injury and also allows for
optimal transmission of RF injury.
11.5 Case Examples
11.5.1 Case 1
A 34-y ear-old woman 6 months after
radiofrequency-assisted liposuction of the lower face
and neck using FaceTite (InMode; ▶ Fig. 11.1).
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11.6 Conclusion
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Fig. 11.1 (a–e) A 34-year-old woman 6 months after radiofrequency-assisted liposuction of the lower face and neck
using FaceTite (InMode).
11.5.2 Case 2
A 24-year-old woman 8 months after
radiofrequency-assisted liposuction of the lower
face and neck using FaceTite (InMode; ▶ Fig. 11.2).
11.6 Conclusion
Internal and external generation of heat via combined bipolar RF and fractional RF serves to initiate
neocollagenesis, elastogenesis, and subderm al
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Fig. 11.2 (a–e) A 24-year-old woman 8 months after radiofrequency-assisted liposuction of the lower face and neck
using FaceTite (InMode).
130
References
https://t.me/medicina_free
Video 11.1 Marking for bipolar radiofrequency of the
lower face and neck.
adipose remodeling. This, in combination with
fibroseptal network tightening, allows for safe
and consistent soft-tissue contraction to improve
lower face and neck soft-tissue laxity. This particularly benefits patients who previously may have
fallen into a treatment gap.
11.7 Expert Commentary by
Dr. Slavin
The advances in this area are impressive in terms
of their ability to address the treatment gap on patients who, for a number of reasons, are either not
surgical candidates or prefer to not have a minifacelift or neck lift. The RF technique addresses this
growing population of patients that a plastic surgeon sees daily. It is extending skin tightening to
an ever-younger population who may otherwise
not seek treatment by plastic surgeons. It is reassuring that the incidence of nerve injury remains
low—estimated by the authors at 2 to 3%—and we
hope that it continues to decline. We appreciate
the authors’ point that a mini-facelift may be required, in addition.
The plastic surgeon will need to determine
which patients would best benef it from RF compared with the traditional techniques. It will be
important to stress to the patients that the results
may be variable and we foresee challenges in cautioning patients on the degree of improvement
that can be delivered. Looking into the f uture, it is
reasonable to expect every plastic surgeon performing cosmetic surgery on the face and neck to
be very knowledgeable about these techniques
(▶ Video 11.1 and ▶ Video 11.2).
Video 11.2 Fractional radiofrequency using Morpheus8
(InMode; Lake Forest, CA).
11.8 Expert Commentary by
Dr. Lin
The authors have addressed an important aspect of
caring for the aesthetic patient: those who are not
surgical candidates who wish to have treatment
who fall into the “treatment gap.” Devices for deliv-
ering energy have been developed over a long period of time, and in this current state I appreciate the
authors’ ability to realistically balance the results of
various minimally invasive results. The use of energy in higher Fitzpatrick score patients poses a risk
and so the authors describe their treatment modification in their chapter. In these patients, I would
personally consider a test area away from the
planned treatment area as an option.
References
[1] Dayan E, Chia C, Burns AJ, Theodorou S. Adjustable depth
fractional radiofrequency combined with bipolar radiofrequency: a minimally invasive combination treatment for skin
laxity. Aesthet Surg J. 2019; 39 Suppl_3:S112–S119
[2] Theodorou SJ, Del Vecchio D, Chia CT. Soft tissue contraction
in bodycontouring with radiofrequency-assisted liposuction:
a treatment gap solution. Aesthet Surg J. 2018; 38 suppl_2:
S74–S83
[3] Alster TS, Tanzi E. Improvement of neck and cheek laxity
with a nonablative radiofrequency device: a lifting experience. Dermatol Surg. 2004; 30(4, Pt 1):503–507, discussion
507
[4] Bassichis BA, Dayan S, Thomas JR. Use of a nonablative radio-
frequency device to rejuvenate the upper one-third of the
face. Otolaryngol Head Neck Surg. 2004; 130(4):397–406
[5] Burns AJ, Holden SG. Monopolar radiofrequency tissue tight-
ening: how we do it in our practice. Lasers Surg Med. 2006;
38(6):575–579
[6] Burns JA. Thermage: monopolar radiofrequency. Aesthet Surg
J. 2005; 25(6):638–642
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[7] Dierickx CC. The role of deep heating for noninvasive skin re-
juvenation. Lasers Surg Med. 2006; 38(9):799–807
[8] Doshi SN, Alster TS. Combination radiofrequency and diode
laser for treatment of facial rhytides and skin laxity. J Cosmet
Laser Ther. 2005; 7(1):11–15
[9] Abraham MT, Mashkevich G . Monopolar radiofrequency
skin tightening. Facial Plast Surg Clin North Am. 2007; 15
(2):169–177, v
[10] Abraham MT, Vic Ross E. Current concepts in nonablative ra-
diofrequency rejuvenation of the lower face and neck. Facial
Plast Surg. 2005; 21(1):65–73
[11] Alexiades-Armenakas M, Dover JS, Arndt KA. Unipolar versus
bipolar radiofrequency treatment of rhytides and laxity using
a mobile painless delivery method. Lasers Surg Med. 2008;
40(7):446–453
[12] Kaplan H, Kaplan L. Combination of microneedle radiofre-
quency (RF), fractional RF skin resurfacing and multi-source
non-ablative skin tightening for minimal-downtime, fullface skin rejuvenation. J Cosmet Laser Ther. 2016; 18(8):
438–441
[13] Lee HS, Lee DH, Won CH, et al. Fractional rejuvenation using
a novel bipolar radiofrequency system in Asian skin. Dermatol Surg. 2011; 37(11):1611–1619
[14] Levy AS, Grant RT, Rothaus KO. Radiofrequency physics for
minimally invasive aesthetic surgery. Clin Plast Surg. 2016;
43(3):551–556
[15] Narurkar VA. Lasers, light sources, and radiofrequency devi-
ces for skin rejuvenation. Semin Cutan Med Surg. 2006; 25
(3):145–150
[16] Sadick N, Rothaus KO. Minimally invasive radiofrequency de-
vices. Clin Plast Surg. 2016; 43(3):567–575
[17] Sadick N, Rothaus KO. Aesthetic applications of radiofre-
quency devices. Clin Plast Surg. 2016; 43(3):557–565
[18] Zelickson BD, Kist D, Bernstein E, et al. Histological and ultra-
structural evaluation of the effects of a radiofrequency-based
nonablative dermal remodeling device: a pilot study. Arch
Dermatol. 2004; 140(2):204–209
132
12 Neck Lift and Fat Grafting to the Neck
https://t.me/medicina_free
Aris Sterodimas
Abstract
Facial rejuvenation is becoming increasingly challenging because patients request minimally invasive surgery and rapid surgical course and recovery,
along with fast, tangible, and long-term results. Re juvenation of face, neck, and periorbital areas needs to
be addressed at the same surgery. At our institution,
a systematic approach comprising all of these procedures has been developed, with consistent results.
Our research group has already described the method of stromal enriched lipograft (SEL) in various
parts of the body, a procedure combining fat with
enzyme-based extraction of the stromal vascular
fraction (SVF), with the aim to increase the take and
duration of the grafted fat and the related volume,
thereby determining a more predictable and stable
result in terms of graft survival in the face, and also
improving the skin quality. Recently, a helium-based
plasma technology has been introduced for the percutaneous delivery of plasma energy for the purpose
of soft-tissue coagulation and contraction. A significant skin and soft-tissue contraction in a smooth
and even manner is accomplished in the neck area.
Facial harmony not only depends on achieving a
more natural, tense, and young conformation but
also on restoring volumes and improving the quality
of the faci al and neck skin.
Keywords: stromal enriched lipograft, fat grafting,
face, neck tightening, facelifting, skin tightening,
radiofrequency, minimally invasive, helium plasma
Key Points
●
In this chapter, the technique, the pearls, and
the pitfalls of the SEL technique for facial fat
grafting and the application of cool helium plasma radiofrequency technology for neck tightening are described in detail. A series of patients
who underwent contouring of the neck and
facial lipotransfer assisted by SEL are presented.
●
Careful selection of patients and proper surgical
technique help avoid contour irregularity, and
outcome expectations should be based on realistic preoperative evaluation of the patient’s
age, skin elasticity, and volume of fat to be
transplanted.
●
The SEL technique aims at filling facial atrophy
areas with adipocytes and adipose-derived stem
cells that will survive and become incorporated
into the recipient bed.
●
Improvement of the neck contour can be attained
and maintained through the application of the
percutaneous delivery of plasma energy (Renuvion) for the purpose of soft-tissue coagulation
and contraction.
●
The SEL technique and the application of Renuvion technology can play a significant role as
minimally invasive techniques for face and neck
rejuvenation when properly indicated.
12.1 Introduction
The aging of the face is a complex set of events,
determined by skin and superficial musculoaponeurotic system (SMAS) laxity and redundancy, reabsorption of fat, and diminution of projection on
many face prominences, as well as thinning of the
dermis and decreased quality of the cutaneous
draping.
evident in the face. Changes affecting the appearance of the neck can include an increase or
decrease of subcutaneous fat, platysmal banding,
jowling, and skin laxity. Depending on the severity,
a range of treatment options is available for use
alone or in combination for treating the aging
neck. Face rejuvenation is increasingly challenging
as patients expect minimally invasive procedures
and rapid postt reatment course and recovery,
along with fast, tangible, and long-term results.
Rejuvenation of the face frequently requires surgery to multiple areas (the lateral face, the midface, the neck, and periorbital areas), in addition to
the increasing procedures of face sculpturing and
biostimulation through fat injection. At our institution, a systematic approach including all of these
procedures has been developed, with consistent
results.
involve the traditional facelifting surgical procedure, there is a continuous shift toward minimally
invasive techniques that have promoted the advent
of techniques and devices that offer an alternative
to the traditional facelifting techniques.
method of stromal enriched lipograft (SEL) in various
1
The outward signs of aging can be very
2,3
Although the gold standard continues to
Our research group has already described the
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Neck Lift and Fat Grafting to the Neck
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parts of the body, a procedure combining fat with
enzyme-based extraction of the stromal vascular
fraction (SVF), with the aim to increase the take and
duration of the grafted fat and the related volume,
thereby determining a more predictable and stable
result in terms of graft survival.
4,5,6,7
The debulking of fat with suction-assisted liposuction has been shown to provide approximately
10% shrinkage as a result of a simple deflation effect
on the skin envelope and nonthermal inflammation
of the fibrocollagenous matrix that in turn generates new blood vessels, collagen, and scar tissue.
Several technologies including laser, ultrasound,
and radiofrequency (RF) have demonstrated some
skin tightening after liposuction beyond the normal
deflation that accompanies the removal of fat and
beyond the nonthermal skin contraction that accompanies subdermal inflammatory stimulation by
the cannulas. The mechanisms of action for subcutaneous RF devices include the generation of heat
through tissue resistance within the dermis and fat
that results in neocollagenesis, elastin and dermal
matrix remodeling, and mild adipocyte loss. The
contraction of the subcutaneous tissue by deeper
application of cool helium plasma RF technology is
felt to be an additional mechanism that results in
additional neck contouring by soft-tissue contraction. The reduction in volume and tissue surface
area is the result of protein denaturation and collagen contraction after a thermal energy threshold
9
has been transmitted to the tissue.
Recently, a
plasma-driven RF device, Renuvion, was introduced
and Food and Drug Administration (FDA) cleared
for soft-tissue coagulation. The Renuvion system for
the neck utilizes cold helium plasma via a gas ionization process to produce a stable, focused beam of
energy.
12.2 Patients and Methods
Accurate photographic documentation has become
essential in cosmetic plastic surgery for both clinical
and scientific purposes. Generally, informed consent requires that a patient be informed of the risks
of treatment, prognosis, and alternative treatments
before consenting to treatment. Surgical consent is
an ongoing process of communication that continues throughout preoperative, perioperative, and
postoperative care. Areas to be treated typically are
marked with a circle in a topographic pattern.
Zones of adherence and areas to avoid are marked
with hash marks. Grid markings are made in order
to standardize resection and reduce contour irregularities. Incisions should be placed in natural
creases to minimize visibility. It is important to review all markings and access incision locations with
patients in front of a mirror before performing the
surgical procedure.
12.3 Surgical Technique and Fat
Processing and Grafting
●
Markings of the neck area to be lipoaspirated
8
and treated with Renuvion are made while the
patient is in the standing position, as well as
markings on the face lipograft recipient sites.
●
Preoperative sedation in the surgical suite is
administered. The procedure is performed
under sedation, in the supine position. Intraoperative intravenous cefazolin is administered
at induction.
●
After injecting into the neck subcutaneous tissue
normal saline wetting solution c ontainin g
1:500,000 of adrenaline by a small-bore cannula
and waiting 15 minutes, a 20-mL syringe attached
to a 2-mm blunt cannula is inserted through
small incisions in the postauricular crease. Fat is
aspirated by a 2-mm four-hole aspiration blunttip cannula connected to a 20-mL Luer-Lok
syringe. The distal openings of the harvesting cannula are of an appropriate size and shape for harvesting the largest intact fatty tissue parcels that
can readily pass through the lumen of a Luer-Lok
syringe. The combination of slight negative pressure and the curetting action of the cannula’s
motion through the tissues allows parcels of fatty
tissue to move through the cannula, through the
Luer-Lok aperture, and into the barrel of the
syringe with min imal mechanical damage.
●
When liposuction is done, the specific Renuvion
probe for the neck region produced by Apyx
Medical (Clearwater, FL) is then used. The cool
helium plasma RF technology has been adapted
to draw skin closer to underlying fascia via coagulation of the interstitial connective tissue
bands. In the Renuvion system, RF energy from
an electrosurgical generator unit is delivered to
a handpiece and used to energize an electrode.
Helium plasma is generated as helium gas
passes over the energized electrode, allowing
heat to be applied to tissue in two different and
distinct ways. The plasma beam provides heat
through the ionization and rapid neutralization
of helium atoms. A portion of RF energy that
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12.3 Surgical Technique and Fat Processing and Grafting
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passes through the tissue impedance generates
a small amount of additional heat. The device is
activated until a preset subcutaneous temperature in the range of 75 to 85 °C is achieved and
maintained. The neck tissue being treated must
be maintained at that temperature for greater
than 120 seconds for maximal contraction to
occur. The handpiece is moved in the subdermal
plane in a manner similar to that of a liposuction cannula. Emitted energy is fractional. The
pistol grip device is deployed in a retrograde
Video 12.1 Performing neck liposuction using the
syringe method.
manner. The system provides a total of 40 W,
and the energy can be changed based on a percentage of the 40W. Sixty percent setting is recommended for the neck.
10
Once engaged, the
device is drawn backward from the end of the
treatment area toward the entry site. No more
than five strokes are performed for every 2 cm.
The device is disengaged 2 cm from the entry
site to prevent incision burns. The helium gas
needs at least two stab incision sites to have adequate space to escape. The author typically expels the gas manually between moving areas
and uses the 2-mm cannula for liposuction to
gently suction out the helium once completed
in order to reduce the risk of subcutaneous emphysema (▶ Video 12.1).
●
The adipose tissue aspirated by liposuction is
processed in the following manner, as previously described in the medical literature.
two-thirds of the aspirated fat are used to isolate the SVF (▶ Fig. 12.1). Digestion is obtained
with 0.075% collagenase type II GMP grade
(ClZyme AS), produced by VitaCyte LLC (Indianapolis, IN) in buffered saline, and agitation for
45 minutes at 37 °C is performed. Separation of
11
First,
Aspirated fat
Saline
purification
Fig. 12.1 Schematic representation of stromal enriched lipograft.
Collagenase
digestion
Centrafugation
Stem cell-rich
fat graft
Concentrated
adipose-derived
stem cells (ADSC)
Stromal vascular
fraction (SVF)
Purified fat
Stromal enriched lipograft
ready for injection
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Neck Lift and Fat Grafting to the Neck
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the SVF containing adipose-derived stem cells
(ADSCs) is then done by using centrifugation at
1,200 rpm for 5 minutes, according to the protocol already published.
12
The SVF is located in
the pellet derived from the centrifuged fat at
the bottom of the lipoaspirate. All of these
stages of fat procession are obtained through
the Automatic Cell Station, produced by BSL Ltd
(Seoul, Korea). The SVF is derived from the fat
processed in automated cell processing unit
(▶ Video 12.2). The remaining one-third of the
aspirated fat is treated in the following way: with
the syringe held vertically with the open end
down, the fat and fluid are separated. Isotonic salineisaddedtothesyringe,thefatandsalineare
separated, and the exudate discarded. The procedure is repeated until the fat becomes yellow in
color, free of blood and other contaminants,
Video 12.2 The adipose tissue aspirated by liposuction
is processed.
purified, and concentrated. No emulsification is
performed, as this portion of tissue will act as the
scaffold for the processed fraction; therefore, it is
treated as delicately as possible to maintain an intact architecture. The process only involves washing and gravity separation. SVF containing ADSCS
and the purified fat are finally mixed and transferred into 20-mL syringes for application. Each
syringe contains 1.5 mL of SVF and 18.5 mL of purified fat and then transferred into 1-mL syringes
ready for injection. This whole procedure is done
inside the operating theater, by two tissue engineers, and the time required is approximately
45 minutes.
●
Upon completion of the liposuction procedure,
access to the face regions is gained through incisions in the malar, lower mandibular, perioral,
and neck regions (▶ Fig. 12.2).
●
The adipose tissue graft enriched with SVF is
injected through the incisions. The lipograft is
injected at various levels of depth, from the subcutaneous–dermal junction, down to the deep
subcutaneous fat, until the desired project ion;
therefore, a structural sculpturing and symmetry between the two facial sides are obtained.
The fat is introduced as the cannula is withdrawn. Fat molding is performed by gentle digital
manipulation to achieve a uniform distribution
(▶ Video 12.3).
●
Immediate postoperative dressing is applied in
the neck area that was lipoaspirated.
●
The patient remains hospitalized for 24 hours.
Analgesics and anti-inflammatory medications
Fig. 12.2 Schematic representation of autologous fat transplantation to the face and neck.
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