Fat Injection to Face the cosmetic procedures have seen exponential growth. From hair to toe, all body areas have been modified suitably. Facial features, which are the most important parts of the body, are the first choice in many areas and countries. The reasons are multifactorial. Nowadays, we have the understanding and knowledge to prevent aging. Hence, facial anti-aging procedures have become the most common in the cosmetic surgery field. Plastic and reconstructive micro-surgeons are focusing on head-to-toe reconstruction, especially for oncological, trauma, and congenital cases.
A detailed anatomical understanding of facial fat is remarkably important. The facial fat was harvested via a small punch graft to confirm fat harvesting from the face. An alternative method to fat injection was injected into half of the face to improve facial rejuvenation. This establishes and encourages the role and importance of fat injection to the face as one of the safe, easy, simple, and non-invasive facial rejuvenation techniques. There are controversial areas regarding safe alternative methods for the fat injection procedure, the bridge design of the needle for effective injection, fat harvesting areas, facial scoring pattern, and the facial indications for injecting fat.
Fat injection to the face, also known as fat grafting or facial fat transplantation, is defined as a cosmetic procedure that collects excess fat cells from the body, processes them, and re-injects the purified fat into the face of the same individual to improve the volume and contour of the treated area. It is a process that obtains fat from areas where excessive fat is not desired and uses this fat to build up the volume of the leading curves of the face. It helps to diminish the appearance of tiredness, as it enables one to regain a youthful image without forming facial lines. The concept of fat grafting can be considered both a process of a facelift, liposuction, and rejuvenation.
If people want to give some volume to the face by providing a better contour in specific areas and if there is an adequate amount of fat in the body, this treatment can be applied to all individuals with respect to their skin and general health condition. Although it is similar in function to fillers, the differences between these two methods can be listed as follows: it provides a more natural way to manage fine lines and gains a vital facial texture. Additionally, it is the most preferred method due to its safety and the increase of collagen in the applied area. Furthermore, this method can be accepted as bringing a youthful appearance without forming facial lines artificially. It is possible to describe fat injection as a tunnel technique since it ensures a good transgression between the fat sections. Therefore, applying radiance from the facial lines towards an upper level. Similarly, a representation of rejuvenating a three-dimensional facial lifting can be performed.
Taking the importance of fat injection, one must scrutinize the related scientific background of the technique. When one considers the mechanisms involved in fat injection into facial structures, the process usually consists of first harvesting fat from a donor site. Once harvested, the fat is subjected to certain manipulations such as purification, concentration, and sometimes expansion. Then, the prepared fat is placed into the target site. Both harvesting and placement are equally important processes. The techniques for placing the fat can be classified into two main groups, which are called injection techniques if the fat is injected with a cannula, and depot technique if it is placed by direct injection.
Liposuction has been a widely applied technique for obtaining fat for use in autografting. Fat cells are confined to the well-vascularized soft tissue spaces in which they are injected. If taken, injected, and handled improperly, they can behave like any other foreign body. The cells elicit a foreign body giant cell response, are devoid of blood supply, necrose, and form a foreign body granuloma. If taken, injected, and handled properly, the fat cells survive and over time become a living, vascularized graft. It has been postulated that the body is capable of integrating the grafted cells with a low metabolic side effect process called creeping substitution, although the exact mechanism is unknown. Swiftly, the resident nutrition is slowly replaced by vascularity, and consequently, the grafted cells show more signs of tissue vitality, such as normal appearance, normal cell structure, proper function, and sensitivity to normal stimuli.
The process of fat injection mostly contains three steps, which include the harvest of fat, purification with a centrifuge, and injection using a specially designed injector or syringe. There have been many methods described to harvest fat. The most commonly used methods have some association with the purpose of fat collection, the use of equipment, and the skill required, but there have been few descriptions about the selection of donor sites. It is generally thought that some fat harvesting techniques offer some fat embolization, which leads to occult or transient inferior results, resulting in irregular lumping at the site of fat injection. As a concept, more fat cells with more living cells per unit volume is the main experience for minimally invasive techniques to be applied below the cervical line on either the face or body. Every technique can infiltrate neighboring avascular adipocytes with Ringer’s lactate or saline, which would force local fat fluid through these areas of minimal vascular resistance, causing the above problems.
The noticeable variation, which is easier to learn and also offers fewer complications, is preferred and described as “the local anesthetized fat harvesting technique.” Several variations to the method of depositing a fat cell have been discussed and described. The various fat depositing techniques are most commonly found in the literature, with developing and improving fat collection. There have been numerous survey methods and studies to predict the survival rates of grafted fat to the face. Besides the different fat harvesting techniques, donor site choice can affect the behavior of the grafted fat cells as well. It is generally thought that suctioned adipose tissue should be washed to remove blood, secondarily anesthetized by infiltrating a long-acting local anesthetic solution. However, in the cases of the face, mixing with an anesthetic solution or hematoma from the recipient surface snares of the skin was also a problem. The most theoretically elegant pre-special syringe or other container.
Injections of fat using the patient’s autologous material restore the contour of the face and rejuvenate the skin. Injections are especially suited to reducing baggy lower lids, fullness in the nasolabial fold, and buildup of the chin. Skin responds rapidly, effectively, and smoothly to the presence of underlying fat. A detailed evaluation of the patient must be performed for any facial rejuvenation procedure. The ideal candidate for fat injection is an individual of any age or sex with healthy skin. Demographics especially suitable for consideration in this type of rejuvenation include 20- to 40-year-old patients, males, and darker-skinned individuals. Patients should have good skin turgor and tone with few wrinkles or rhytides indicating suitable skin resilience. Thin skin, often with a teardrop depression under the eyes, in association with the trapezoidal facial framework, is an ideal combination for this fat technique. Obviously, healthy patients with no contraindications would be more likely to be suitable. The age of ideal candidates is under fifty-five, but many people in their sixties and seventies have sufficient capacity for this type of procedure. Measurements of the face and head can add considerably to an understanding of the appropriate surgical techniques. Measurement of the fat volume using non-invasive techniques in the lips and the hands, plus undermineralization of the fat, will improve the results of injections to these areas. A thorough assessment of the patient is essential in tailoring their treatment to their specific concerns. Patient understanding of the achievable results is a major factor that is investigated in the consultation process.
A detailed understanding of different areas of the body plays a vital role in planning a prospective surgical or non-surgical modality like facial plastic procedures. Global demand for invasive and minimally invasive facial rejuvenation has prompted the development of various materials and methods ranging from conventional to autologous and allogeneic materials. Candidate selection for facial fat injection and autologous fat transplantation may be based on several surgical perspectives. Potential patient candidates could be those who have a relatively high body mass index, although the abdomen may not appear to contain excess adipose tissue, often due to the intrinsic narrow angle of the waist compared to that of the shoulder. However, actual fat reserves determined by anthropometric or volumetric analysis are more important criteria.
Patient selection is important based on their mental status since adverse surgical results may occur if they have a psychological problem. There may be a psychological reserve as it can tolerate a certain level of stress and have a relatively reasonable expectation about the surgery outcomes. Older people have a longer recovery time than younger people as the adhesion of blood vessels in the elderly is weaker and more fragile. It is concluded that the treatment should be deferred until the diseases are cured or controlled. The diet is effective for obesity caused by overeating, but it is not effective for nutritional intake disturbances. Thus, a proper healthcare program should be established to enhance intrinsic resistance such as sleep patterns, healthy eating, and regular exercise. Various kinds of clinical evaluations, including dermatological examinations, photographic documentation, and three-dimensional image analysis, were performed to ensure the safety of the surgery before the procedure. In addition to the selection criteria reported in this study, the above-mentioned factors are important because facial fat injection or grafting is currently considered to be an adjunct to facial bone contouring or rejuvenation rather than a primary procedure in older patients with decreased volume of bone and soft tissue. The patient selection thus needs an individual’s comprehensive assessment and proper, not total, indication.
Deep sedation may not be a necessary part of the fat injection to the face, and we do not use any skin sutures; the patient directly leaves the operating room. They need to stay in the hospital for the first hour to monitor. They should not wash their face with water for 2 days. Some suturing is performed to close the incisions during the bleeding-controlled process. Cold salves will be applied to the face within the first 72 hours postoperatively. The patient has minor complaints of pain, and nonsteroidal anti-inflammatory drugs are recommended. Procedures to prevent any infection are recommended.
Bleeding is present before and after the fat injection to the face, but it will be minimized or completely eliminated to avoid swelling and complications under the skin after the surgery and to ensure good tissue contact of fat cells. Swelling is seen in all faces following fat injection, but it will be minimized or completely eliminated depending on the method and daily care after the process. After about 72 hours post-surgery, one will have forgotten that any fat injection was made and that they passed through the process. We divide the recovery process into three phases: early cure, normal cure, and long-term cure. During these processes, you need to change your usage style. First, you need to be familiar with the clinical changes card. Optimum feeding will be individualized according to the candidate and will be started after several hours of the operation. There are measures that will help us prevent and treat infection. The follow-up and control of the patients ultrasonographically in the first year will provide vital information about the results of performed fat injections. Compliance with medical advice to prevent complications will be essential in the follow-up process since this process is of greater importance compared to other surgeries. Opportunities for early diagnoses should be developed for minor complications that occur in the first month. Compliance with medical advice to prevent complications will provide a proper risk/benefit analysis. This procedure is applied to make the process easier and more understandable for the doctor, albeit to a very minor extent. Complications that are likely to occur in the face will not be even a tenth.
Day of surgery: expected return, same day. Sun-protective hat, sunglasses, and gentle facial cleanser are suggested. Non-strenuous activities are advisable in the early days.
1–3 days: Immediate reaction. In the first several days of recovery, there will be some discomfort over the areas of fat transfer, bruising, swelling, and numbness that should begin to subside. The bruising may appear to move down the face and neck via gravity. Lip balm is recommended for dry lips following facial procedures. Post-operative patients can use topical arnica or oral supplements of arnica to reduce tissue swelling and bruising as long as there are no known allergies or contraindications.
1st week: After the first 5–7 days post-surgery, patients often feel strong enough to resume driving safely. Most people can return to their normal work and relaxation schedules, even if they don’t feel 100%. They are usually still a little bruised and swollen during this first week after surgery. Some patients may also experience some mild depression during this first week, a condition called the “post-operative blues.” This is not persistent but is a perfectly normal and common reaction to the stress of surgery. Pain or discomfort is common at the injection/removal site, but can be managed with pain medication. Patients will need to keep their head elevated for the first week after the procedure.
Aftercare is just as essential as the surgery itself to achieve the desired results. Your medical provider will always provide a follow-up appointment at your consultation. Your initial follow-up will be no later than a day after your procedure. During the appointment, your fat injection areas will be visually examined. The next three follow-up appointments to track your recovery period and the progress of your results will be indicated on the form. Before you leave your initial visit appointment, you’ll also receive a release-to-shower form.
You will feel mild pain for the initial 48 hours post-operatively. Recovering from any substantial liposuction, such as a tummy tuck, at the same time will typically elevate pain levels. Pain relief and swelling management are suggested. You’ll be up and active the following day. Light tasks and having visitors will be allowed the following day. Do not sneeze with your mouth open right away. You should wait two to three weeks to sneeze with your mouth open. Take vitamins A and C daily. A multivitamin will be taken for the first few months following surgery. Your post surgical dressing will be altered if you attend your first follow-up appointment one day after your procedure. You will receive wound aftercare during this session. If needed, additional saline will be added. Additionally, you will be given a clean, dry dressing, as well as an estimate of the number of saline required and our policy for saline refills in the next few days. Most of the time, you will only need to have your postoperative dressing adjusted once.
Immediately following the facial fat injection procedure, ice should be applied to the area to help minimize any bruising or swelling. Apply the ice packs for a minimum of 30 minutes right after the injection. Keep your head elevated and restrict movements of your face. You must not consume alcohol, aspirin, or ibuprofen for 72 hours. These products will thin out your blood and increase the risk of bruising. Reduce any activity as long as there is swelling and bruising. Some activities may increase the swelling and discomfort, so you are advised to rest for a few days after the treatments. Keep your head slightly elevated for 24 hours. Especially for the first 24 hours, you want to do as little as possible and try not to bend, strain, or lift anything. After the first 24 hours, you can slowly begin increasing your activities. Please avoid vigorous sports or any activity that may strain the face for the first 3 days after treatment. Redness, swelling, and bruising are the signs of inflammation. For the first stages of healing, eat a diet of whole and natural foods. In addition, make sure that you drink an appropriate amount of water, which for some people can be up to half a gallon a day. Refrain from sunburn and ultraviolet lights until the redness and swelling have resolved. Schedule your appointment for your follow-up visit. Often, we will follow up with your skin after four weeks or two weeks in order to evaluate your progress. Swelling and redness following your treatment do not always mean a bad result as the skin is still healing. It is important to maintain close and regular follow-up and communication to best assess your healing process. If you have any worries about rapid swelling or changes in the area of treatment overall, don’t wait for the follow-up appointment. Injections in the lips tend to cause swelling first, then resolve, with your lips becoming smaller. Swelling is natural during the first week after the treatment.