Fat grafting in aesthetics

Autologous fat transfer is an increasingly popular aesthetic and reconstructive technique for facial rejuvenation, breast contouring and augmentation, and buttock augmentation. The grafted fat is a living tissue and contains stem cells with tissue regenerative properties, which makes this a very unique filler. Historically, a major issue with this technique has been long-term graft viability and retention; however, each step of the autologous fat transfer process is being optimized in pursuit of the ideal protocol that maximizes graft survival. We review the major variations in the autologous fat transfer method, its aesthetic applications, and our own experiences.     

Skin filling. Collagen and other injectables of the skin

Minimally invasive soft tissue augmentation of the face with injectable substances has been performed for more than a century. During this period, many substances have been used to cosmetically improve soft-tissue defects and deficiencies. Some have lasted; most have not. These procedures have become increasingly important as more patients seek aesthetic improvement without major surgical procedures. This article reviews the current status of these materials and techniques.     

Liquid injectable silicone: history,mechanism of action,indications, technique,and complications

Medical grade liquid injectable silicone can be used for soft tissue augmentation to correct and replace lost volumes of the subcutaneous tissue. It is potentially a permanent tissue augmentation agent and is the most effective filler for certain indications. This article presents the history, mechanism of action, indications and contraindications, technique, and the possible complications of silicone and their treatment.     

Recent advances in soft tissue augmentation

Soft tissue augmentation has become increasingly important as more individuals seek aesthetic improvement without major surgical procedures. The choice of an appropriate subcutaneous implant, whether solid or injectable, requires a thorough understanding of the materials available. This review of the literature addresses autologous fat and dermis transplantation, autologous and allogeneic human collagen, bovine collagen, acellular dermal allograft, hyaluronic acid derivatives, expanded polytetrafluoroethylene, polymethyl-methacrylate microspheres, and other potential biomaterials. The search for the perfect material to eradicate rhytids, smooth scars, and fill traumatic detects continues. New products appear, sometimes with great fanfare, which fail to fulfill the promise of a better alternative to what we use now. For this reason, an in-depth understanding of implant materials is necessary for any physician performing soft-tissue augmentation procedures.     

Fat transplantation for treatment of the senescent face

For more than a century, clinicians have attempted to utilize fat for the treatment of tissue deficiencies and contour abnormalities. Autologous fat transplantation for soft tissue augmentation has become increasingly popular in recent years. This has occurred as a result of the present authors' comprehension that the aging face is not simply as a result of gravity-induced ptosis, but also as a result of volume loss secondary to the atrophy of tissues. The popularity of tumescent liposuction has brought renewed interest and accessibility of fat for transplantation. Newer techniques and approaches to augmentation have provided more predictable and reproducible results. Fat augmentation has become an effective, safe, and reliable method for restoring volume and correcting the atrophy that accompanies senescence. In this review, the present authors describe their approach and technique of fat transplantation for the aging face.     

Soft tissue augmentation--use of hyaluronic acid as dermal filler

Soft tissue augmentation has revolutionized the treatment of the aging face. It is a technique in which a substance is injected under the skin. The concept of utilizing materials for soft tissue augmentation actually began around 1950 with the use of fluid silicone. Today we have a large armamentarium of implant materials to delay the tell tale signs of aging. Filling has replaced conventional surgery in facial rejuvenation. In this article, the emphasis will be on hyaluronic acid as this substance is easily available in India and ranks among the most widely used dermal fillers.     

Prospective 3D analysis of facial soft tissue augmentation with calcium hydroxylapatite

Background: Facial rejuvenation is an expanding field with an increasing number of treatment modalities. Several non-autologous filler materials are available for soft tissue augmentation. Calcium hydroxylapatite (CaOH) is aimed at increasing collagen neosynthesis and thereby producing long-term augmentation effects. Despite a multitude of observational reports, the field is suffering from lack of quantitative morphometric evaluation methods. Objective: The objective of this proof-of-principle study was to investigate whether the effects of facial tissue augmentation with CaOH (RADIESSE?) can be quantified and followed up using 3D surface scanning. Methods: 3 female subjects received augmentation of the mid and lower face with CaOH. The faces were recorded prior, directly after, and two weeks and six months after the injection using standardized photos and 3D scanning. Computational analysis allowed quantifying the change in volume and displacement of the facial surface. Additionally, a patient satisfaction questionnaire was administered. Results: In all subjects, increase in facial volume could be quantified and was present after two weeks and six months. Conclusions: 3D surface scanning is an adequate tool for objective quantification of changes after facial augmentation with filler materials. Persistent volume augmentation after CaOH injections could be quantified after two weeks and six months. Evidence level: IV.     

关于假体隆乳术后疝出的康复治疗

目的：介绍修复乳房假体疝出的一种方法。方法：将近疝区周围的非疝出区隆乳术后形成的包膜瓣重叠缝合加厚疝区薄弱组织,使疝得到修补。结果：38例患者40侧隆乳术后假体疝患者经疝区周围的非疝出区包膜瓣修补后,随访两年半均未复发。结论：利用非疝区的隆乳术后所形成的包膜修复疝区薄弱组织使疝得到修补,是一种手术操作简单,效果好,值得推广的方法。     

Botulinum toxin A in the mid and lower face and neck

Botulinum toxins have been smoothing hyperkinetic lines in the upper face for over 15 years. More recently, their use has widened to include applications in the mid and lower face and neck to smooth, shape, and sculpt, blurring the line between science and art. Their use in the lower face, however, requires a thorough and detailed knowledge of not only facial and cervical anatomy, but also the complex interactions of muscles and the aesthetic and implications of a misplaced injection. Although proper patient selection and injection techniques do not guarantee optimal results, poor selection and techniques almost certainly guarantee disappointing results. In addition to its use as primary procedure, botulinum toxin is also an effective adjunct to other cosmetic procedures, enhancing and prolonging the benefits of surgery, soft tissue augmentation, and laser resurfacing.     

脱细胞异体真皮基质医用组织补片在阴茎增粗成形中的应用

目的：探讨脱细胞异体真皮基质医用组织补片移植治疗阴茎短小综合症的可行性,观察阴茎增粗成形术的临床效果.方法：采用脱细胞异体真皮基质医用组织补片“C”状移植于阴茎体背侧BUCK筋膜与白膜之间,治疗阴茎短小综合症10例,术中同时行阴茎悬韧带松解及阴茎背深静脉结扎.结果：9例恢复良好,阴茎自然状态下平均延长3.0～5.0cm,周径平均增加2.0～3.0cm,患者对阴茎增粗效果均表满意;仅1例因组织补片自溶导致手术失败.结论：脱细胞异体真皮基质医用组织补片移植用于阴茎增粗成形,治疗阴茎短小综合症,方法安全可行,临床效果满意.     

The role of orthodontics as an auxiliary tool to lip augmentation

In recent years, facial esthetics excellence has become a major focus in health professional offices and for the public worldwide. Among the main concerns of the patients is lip augmentation, since it has been associated with beauty and youth. This procedure has been increasingly performed and studied by dermatologists and plastic surgeons. Although good outcomes for lip augmentation have been achieved with different techniques, literature shows several complications and collateral effects. This paper demonstrates, through two clinical cases, how Orthodontics may be an excellent tool to assist in lip augmentation, highlighting the need for an interdisciplinary approach to enhance a more effective strategy to achieve facial esthetics goals.     

Generalized livedo reticularis induced by silicone implants for soft tissue augmentation

Silicone is one of the most widely used filler for facial cosmetic correction and soft tissue augmentation. Although initially it was considered to be a biologically inert material, many local and generalized adverse effects have been reported after silicone usage for cosmetic purposes. We present a previously healthy woman who developed progressive and persistent generalized livedo reticularis after cosmetic surgery for volume augmentation of buttocks. Histopathologic study demonstrated dermal presence of interstitial vacuoles and cystic spaces of different sizes between the collagen bundles, which corresponded to the silicone particles implanted years ago. These vacuoles were clustered around vascular spaces and surrounded by a few foamy macrophages. General examination and laboratory investigations failed to show any evidence of connective tissue disease or other systemic disorder. Therefore, we believe that the silicone implanted may have induced some kind of blood dermal perturbation resulting in the characteristic violet reticular discoloration of livedo reticularis.     

Temporary malar augmentation helps with preoperative planning for a permanent procedure

Background  Cheek augmentation improves the appearance of patients with flat malar eminences, creating a more youthful image. Autologous adipose tissue has been demonstrated to be a safe injectable filling material for malar augmentation.
Methods  Before proceeding to fat transplantation, a rapidly absorbable substance such as normal saline is injected into the cheek with a fine needle to enhance the malar eminence.
Results  This method helps the surgeon to determine the location and amount of fat to be injected. Patients can also see a simulation of the final results.
Conclusions  A temporary malar augmentation could be performed before a potentially permanent procedure, particularly when the surgeon or patient is hesitant about the aesthetic results.     

Fat grafting

Autologous adipose tissue has been used for tissue augmentation for over a century. The technique still remains controversial and some investigators have given up on fat transfer. The authors' objective is to improve the retention of the fat graft by using less traumatic methods to collect the fat, to concentrate it, and to reinject it to obtain more reliable augmentations for the cosmetic improvement of tissue defects. The fat is collected from the donor site following tumescent infiltration of the tissue. A Mercedes cannulae is used with a vented syringe. The fat is centrifuged to remove excess tumescent fluid or demineralized bone powder is added if a more dramatic, firmer augmentation is required. Small filaments of fat are placed in multi-layers throughout the area of the desired contour change. Residual processed fat is frozen for second and third injection sessions, if needed. These fat transfer methods yield retentions of 20% to 120% of the injected volume. After 60 to 90 days the implant is stabilized and becomes permanent. Other than bruising, a rare case of bacterial infection, or an occasional divot at the donor site, the autologous fat transfer has proved a useful method to improve contour defects.     

Rejuvenation of the lip with injectables

As the range of soft tissue augmentation products proliferates, most will be used (with varying degrees of success) to shape and augment the lip. The range of outcomes for this indication depends on the skill of the injector, the anatomy of the patient and the intrinsic properties of the product. Permutations of these interacting factors are infinite and it is the range of combinations that is responsible for the complexity (and fascination) of lip rejuvenation with injectable products. Based on personal experience, the perfect lip is the one that "wows" the patient and makes them happy with the procedure. Individualizing the injection is of paramount importance and should take priority over a formulaic approach that defines each lip injection as identical. This review will discuss some of the factors that should be considered prior to injecting a lip with soft tissue augmentation products.     

Intraoperative tissue expansion: a review.

Tissue expansion is used to facilitate reconstruction procedures following trauma and cosmetic breast augmentation. This article describes tissue expansion, reviews intraoperative expansion techniques, and discusses the nurse's role in the procedure.     

Foreign-body reaction with Mycobacterium abseccus superinfection

Mycobacterium abscessus is a rare cause of skin and soft tissue infections that often results from inoculation with contaminated foreign material. A 41-year-old woman is described regarding an outbreak of M. abscessus following soft tissue augmentation. Clinical features and treatment options are reviewed.     

High frequency ultrasound imaging as a “potential” way of evaluation modality in side effects of lip augmentation – case report

Lip augmentation is a popular procedure performed by esthetic medicine doctors, however, it is associated with a significant number of side effects. High frequency ultrasound imaging helps with diagnosis of side effects.The patient was 43-year-old healthy female, 8 months after lip augmentation.The examination showed a variety of delayed side effects of lip augemntation. Ultrasound imaging revealed an increased echogenicity of lip soft tissue, too deep filler injection, occlusion of the inferior labial artery.     

Persistent inflammatory reaction to hyaluronic acid gel: a case report

Soft tissue augmentation is widely used to enhance or improve a patient's appearance. Hyaluronic acid is considered to be one of the best fillers for cosmetic procedures, mainly because of its lack of immunogenicity. We report a case of a persistent inflammatory reaction to injectable hyaluronic acid gel used for the correction of melolabial folds.