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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_577_Библиотеки_им_академика_М_И_Перельмана
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T.-M. Lin et al.
Fig. 12.10 This 22-year-old woman met an accident and had a visible
scar over the right cheek with soft tissue deciency cephalic to the scar.
Implantation of 6.0mL of fat was performed to recontour the soft tissue
deciency and rejuvenate the depressed scar. After 3months of a single
tion over the skin. Laser treatment seems to have a limited
effect, and other strategies, such as silicone gel/sheet, lasers
(ablative, non-ablative, fractional, or radiofrequency), steroid or toxin injection, various ller injections, and other
regenerative procedures (platelet-rich plasma injection or
micro-needling) [34], cannot achieve sufcient volume restoration and tissue rejuvenation simultaneously. However,
the MAFT technique might provide an alternative solution
for these problems and offer a single effective strategy for
dealing with soft tissue problems in a single procedure. The
long-term effects shown in Fig.12.10 illustrate sustainable
volume restoration and improved scar appearance. Similar
maneuvers for acne scars have also demonstrated promising results. Figure12.11 shows a favorable long-term follow-up of intractable acne scars. For MAFT application in
scar tissue, a 16-G (1.6mm in diameter) blunt cannula is
preferred to manipulate the touch brotic tissue. Each parcel size might be 1/60 or 1/90 mL through a nearby
insertion.
MAFT session, the scar was invisible (rejuvenating effect) with good
volume restoration (recontouring) (left/right: pre-/post-MAFT) (closeup AP view)
Managing infraorbital dark circle is challenging.
Recontouring the depression of the tear trough and deformity over the lid-cheek junction can improve the depressive darkness with the restoration of facial fullness. In
addition, the increased thickness of the dermis [35] and
the shading effect caused by a thin surviving fat grafting
layer between the dermis and the orbicularis oculi muscle
could alleviate dark circles [28]. An 18-G injection cannula with 1/240mL per delivered fat parcel was adopted,
and three- layer transplantation similar to our earlier
descriptions was performed. Precise fat grafting was
ensured because of the above-mentioned mechanism,
resulting in a high survival rate. Satisfactory results were,
therefore, demonstrated at long-term follow-up
(Fig.12.12). The same maneuver might be applied to treat
ne wrinkles, such as infraorbital wrinkles or crow’s feet.
The rejuvenating effect noted after the MAFT technique
reduced the depth of wrinkles and aging dyschromia and
improved skin quality (Fig.12.13).
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Fig. 12.11 This 29-year-old man had an acne scar over the temple and
the cheek area following various treatments (laser and skin peeling). A
single session of the MAFT procedure with implantation of
Fig. 12.12 This 24-year-old woman requested a comprehensive treatment of her infraorbital dark circle, mild eye bag, and a tear trough
deformity. A single session of the MAFT procedure was performed by
delivering 4.0mL/3.5mL of fat at 1/240mL per parcel to the left and
right tear trough/lid-cheek junction deformities, respectively. After
3years and 10months of MAFT, the grafted areas showed good results
(upper/lower: pre-/post-MAFT, close-up AP view)
4.0mL/6.0mL of fat to the left temple/cheek area was performed. After
4months of MAFT, the scar was invisible, and the skin texture improved
(left/right: pre-/post-MAFT, close-up oblique view)
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Fig. 12.13 This 80-year-old woman wanted to improve her lateral
cheek wrinkles and crow’s feet and restore the youthful skin texture. A
single session of the MAFT procedure was performed by delivering
5mL of fat to the crow’s feet and 7mL to the right lateral cheek area.
12.5.5 Adjunctive Strategy forLower
Blepharoplasty
By avoiding the potential complications after fat grafting and
ensuring a higher survival/retention rate, the MAFT technique might be an adjunctive procedure combined with
transcutaneous or transconjunctival lower blepharoplasty,
depending on the lower eyelid skin redundancy. In both situations, the appropriate orbital fat was removed, with the
After 8 months, an excellent outcome was noted. Restoration of the
volume and rejuvenation of the skin are illustrated (left/right: pre-/postMAFT, close-up lateral view)
transcutaneous or transconjunctival fat removed rst. Instead
of variable manipulations of orbital fat by redraping or
reposition/transposition, the authors preferred to immediately deliver fat grafting using the MAFT technique over the
tear trough and the lid-cheek deformity. Lesser lower
blepharoplasty- related complications, such as ectropion, and
better recontouring of the tear trough and lid-cheek junction
illustrated the indispensability of MAFT as an adjunctive
procedure for lower blepharoplasty (Figs.12.14 and 12.15)
a
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b
Fig. 12.14 This 52-year-old woman presented with a severe baggy lower
eyelid, prominent tear trough, and lid-cheek junction. Skin-only transcutaneous lower blepharoplasty and MAFT for recontouring the tear trough
deformity and lid-cheek junction were performed. The total resected
orbital fat volumes were 0.23g and 0.31g (R’t and L’t, respectively), and
the total amount of fat volumes grafted to the tear trough and lid-cheek
junction were 2.0 and 2.0mL (R’t and L’t, respectively). The improved
appearance of her lower eyelid at 1year and 8 months after a single
MAFT and lower blepharoplasty is shown (a). The recontoured tear
trough and lid-cheek junction with recontouring of the baggy lower eyelid are shown in the oblique view (b). Downward-looking view further
illustrates that the contouring of the infraorbital area was well preserved
(c) (left/right and upper/lower: pre-/post-MAFT) (a: AP view, b: oblique
view, c: close-up downward-looking view)
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c
Fig. 12.14 (continued)
[28, 31]. A maneuver to deliver tiny parcels (1/240mL per
parcel) in multiple layers and recontour the tear trough deformity and lid-cheek junction depression with an 18-G injec-
tion cannula by the MAFT technique should be performed to
improve long-term outcomes.
12.5.6 An Innovative Treatment ofGummy
Smile
In the literature, the treatment of a gummy smile (dened
as the exposure of >2–3 mm of the gum while smiling)
includes the surgical intervention of the bony, gingival, or
muscular abnormalities and noninvasive botulinum toxin
injection. However, these strategies have not yet been
established as denitive treatment modalities. In our previous work, we present for the rst time, the development of
a simple and consistent procedure based on the MAFT
technique for treating gummy smile [36]. Parcel volume
was meticulously delivered in the nasolabial groove (4.0–
6.0mL/side), ergotrid area (1.0–1.5mL/side), and upper
lip (1.0–2.0mL) at a size of 1/120mL per parcel. Favorable
outcomes were achieved with sustainable long-term effectiveness, further conrming that this strategy of MAFT is
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a
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b
Fig. 12.15 This 40-year-old woman presented with a prominent baggy
lower eyelid, deepening tear trough, and lid-cheek junction.
Transconjunctival lower blepharoplasty and MAFT were performed to
manage the baggy eyelid appearance and recontouring the tear trough
deformity/deepening lid-cheek junction. The total resected orbital fat
volumes were 0.22g and 0.29g (R’t and L’t, respectively), and the total
amount of fat volumes grafted to the tear trough and lid-cheek junction
were 3.0 mL and 3.0 mL (R’t and L’t, respectively). The improved
appearance of her baggy lower eyelid at 10months after a single MAFT
and lower blepharoplasty is shown (a). The recontoured tear trough and
lid-cheek junction with recontouring of the baggy lower eyelid are
shown in the close-up lateral view (b). Downward-looking view further
illustrates that the recontouring of the infraorbital area was well preserved (c) (left/right and upper/lower: pre-/post-MAFT) (a: AP view, B:
close-up lateral view, c: downward-looking view)
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c
Fig. 12.15 (continued)
an innovative alternative for the treatment of a gummy
smile (Fig.12.16).
12.5.7 Breast Augmentation
Fat transfer for breast augmentation using liposuction
from other body parts has become a popular and
disruptive technique [8]. From the author’s experience of
handling more than 300 such cases, the long-term promising results suggest that this approach might be
preferred.
The fundamental transplantation has emphasized using
a 10-cc type MAFT-GUN [18] for delivering fat in two
layers: the deep layer (retro-glandularly: supra-, intra-,
and retro- pectoralis major muscle) and the supercial
layer (subcutaneously). The lipoaspirated fat was harvested and processed in a way similar to MAFT for the
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a
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b
Fig. 12.16
smile along with fat grafting. MAFT was performed on his nasolabial
groove, ergotrid, and upper lip areas with the placement of a 14-mL fat
graft (R’t//L’t side of the nasolabial groove, ergotrid, and upper lip:
5.0/5.0, 1.5/1.5, and 0.5/0.5 mL, respectively). After 3 years and
This 24-year-old man presented with a severe gummy
10months of a single MAFT session, there was no signicant change
in his appearance, except a slightly increased ergotrid height (a).
However, the gummy smile was improved (b−d). The overexposed gingiva was signicantly improved by increasing the vertical length of the
ergotrid and the thickness (width) of the upper lip
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c
d
Fig. 12.16 (continued)
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face. Another harvest strategy was adopted using waterjet-assisted liposuction (WAL) (Human Med AG,
Schwerin, Germany) with 10min decanting to condense
the lipoaspirate. During transplantation, rst, by using a
blunt 14-G injection cannula through the lateral insertion
site, an average of 80–120 mL (traditional liposuction
with 1200× g centrifugation for 3min) of fat was transplanted into the deep layer evenly in each quadrate
(Fig.12.17). Second, an average of 60–100mL of fat for
the supercial layer was transplanted through peri-areolar
incisions (3 and 9 o’clock) using a 16-G cannula. A
40–50% increase in the volume of transplanted fat was
noted when WAL harvesting was used. Favorable results
with a single session of MAFT were reported in approximately 60% of the total cases in our study [37]. The second session (4–6months after the rst MAFT) resulted in
more satisfactory outcomes (>90%) for those cases who
requested more enhancement of their breast size. No large
oil cyst, macrocalcication, or other severe complications
were reported, further demonstrating that the MAFT technique is feasible for aesthetic or reconstructive mammoplasty (Figs.12.18, 12.19, 12.20, 12.21).
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Fig. 12.17 The insertion sites of the MAFT procedure for augmentation mammoplasty were: point A (infra-mammary fold × anterior axillary line) for the retro-glandular deep layer, and points B1 and B2
(peri-areolar at 3 and 9 o’clock along the nipple-areolar complex border) for the supercial subcutaneous layer. The equally distributed volume of fat grafting in four quartans was transplanted both in deep and
supercial layers, and the ratio of deep and supercial layer volume
was around 60% to 40%
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