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.     

Fillers: from the past to the future

Modern medical use of injectable soft-tissue augmentation fillers has evolved from the introduction of bovine collage implants to an array of synthesized materials in the current domestic and foreign markets. The concept of augmentation has moved from simple lines, scars, and wrinkles to revolumizing the aging face. A brief overview of the past, present, and future injectable fillers is presented.     

Soft tissue augmentation 2006: filler fantasy

As an increasing number of patients seek esthetic improvement through minimally invasive procedures, interest in soft tissue augmentation and filling agents is at an all-time high. One reason for this interest is the availability of botulinum toxin type A, which works superbly in the upper face. The rejuvenation of the upper face has created much interest in injectable filling agents and implant techniques that work equally well in the restoration of the lower face. One of the central tenets of soft tissue augmentation is the concept of the three-dimensional face. The youthful face has a soft, full appearance, as opposed to the flat, pulled, two-dimensional look often achieved by more traditional surgical approaches. Injectable filling agents can augment and even at times, replace pulling. Additionally, with the lip as the focal center of the lower face, subtle lip enhancement is here to stay, and is in fact, the number one indication for injectable fillers. Moreover, minimally invasive soft tissue augmentation offers cosmetic enhancement without the cost and recovery time associated with more invasive procedures. As more and more physicians take interest in minimally invasive surgery, courses in cosmetic surgery techniques are becoming increasingly popular at the medical meetings of many specialties. Today, physicians have a much larger armamentarium of techniques and materials with which to improve facial contours, ameliorate wrinkles, and provide esthetic rejuvenation to the face. For a substance or device to be amenable for soft tissue augmentation in the medical community, it must meet certain criteria. It must have both a high "use" potential, producing cosmetically pleasing results with a minimum undesirable reactions, and have a low abuse potential in that widespread or incorrect or indiscriminate use would not result in significant morbidity. It must be nonteratogenic, noncarcinogenic, and nonmigratory. In addition, the agent must provide predictable, persistent correction through reproducible implantation techniques. Finally, the substance, agent or device must be approved by the U.S. Food and Drug Administration, which assures purity, safety, and accessibility, as well as much-needed information regarding use. Having a thorough understanding of the filling agents available, their indications and contraindications, as well as having thorough knowledge of implant technique are vital in providing the patient with an esthetically pleasing result.     

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.     

Rejuvenation of the aging hand

This article reviews aging of the hand and the treatment options for cosmetic rejuvenation. Options available for cutaneous rejuvenation include microdermabrasion, chemical peeling, intense light sources, and laser therapy, including pigment lasers, ablative resurfacing, and noninvasive rejuvenation. Protuberant veins of the aging hand can be treated effectively with sclerotherapy. The soft tissue atrophy of the aging hand is best treated with fat augmentation. The article concludes with a mention of new fillers that are just beginning to be used for soft tissue atrophy of the hand.     

Collagen uses in dermatology - an update

Collagen-derived materials have been used in medicine for many decades. Sutures, hemostatic devices and matrices which stimulate cell growth and soft tissue augmentation are the major applications. In this update, we discuss the two major applications for collagen in dermatology: tissue augmentation and wound healing. Copyright (R) 2000 S.Karger AG, Basel     

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.     

Hyaluronidase in the office: a necessity for every dermasurgeon that injects hyaluronic acid.

Soft tissue augmentation plays an increasingly important role in the management of the aging face. The recent explosion of dermal filler use in aesthetic dermatology has brought with it the expected reporting of rare but significant side effects. These include the too-superficial placement of product which can yield an undesirable bluish discoloration due to the Tyndall effect, the use of excessive product, persistent granulomatous foreign-body reactions and, most significantly, the risk of injection necrosis.     

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.     

Hyaluronidase in the office: A necessity for every dermasurgeon that injects hyaluronic acid

Soft tissue augmentation plays an increasingly important role in the management of the aging face. The recent explosion of dermal filler use in aesthetic dermatology has brought with it the expected reporting of rare but significant side effects. These include the too‐superficial placement of product which can yield an undesirable bluish discoloration due to the Tyndall effect, the use of excessive product, persistent granulomatous foreign‐body reactions and, most significantly, the risk of injection necrosis.     

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.     

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.     

Ästhetische Dermatologie

Younger and younger patients are undergoing aesthetic procedures to achieve "wrinkle-free" aging. This has had great impact on the field of aesthetic dermatology. The rapid development of new indications and filler materials requires a critical approach to the available substances particularly concerning side effects and long-term effects. The quality of the chosen approach depends on the applied filler substance, clear indication the compliance of the patient and the experience of the physician. The growing expectations of patients require a critical analysis of the available therapy options. Botulinum toxin A is one of the preferred treatments for wrinkles secondary to facial expression. In addition there are a variety of biologically inert and completely resorbable filler materials such as collagen and hyaluronic acid and autologous materials such as fat implants or plasma gel available. This article gives an overview about the most common fillers and their use in aesthetic dermatology.     

Dermal fillers: Facts and controversies

Dermal fillers have been used for decades in soft tissue augmentation. Currently, filler implementation is among the most common minimally invasive procedures for rejuvenation and body sculpturing. There is a broad variety of filler materials and products. Despite immense experience, a number of controversies in this topic exist. Some of these controversies are addressed in this review, for example, who should perform filler injections, the difference between permanent and nonpermanent fillers, the off-label use of liquid silicone, and the role of pain reduction. Implementation of guidelines and restriction of filler use by trained physicians can improve safety for patients.     

Adipose tissue,fillers, and skin tightening

The role of adipose tissue has long been underestimated in esthetic dermatology. With the development of liposculpture and lipolysis, subcutaneous adipose tissue has gained an increasing interest. Harvested tissue has been used for lipofilling. In recent years, a better understanding of adipocyte physiology and its role in aging opened a new road for targeted treatments. Subcutaneous adipose tissue is no longer an innocent bystander in the combat of aging and the correction in esthetics. Adipose tissue is of importance for metabolic function and thermoregulation. Adipose tissue is involved in inflammation. Adipose tissue is heterogeneous in sense of function, color and size of adipocytes. The tissue is an important source of somatic stem cells.     

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.     

More than just a filler – the role of hyaluronan for skin homeostasis

In recent years, hyaluronan (HA) has become an increasingly attractive substance as a non‐immunogenic filler and scaffolding material in cosmetic dermatology. Despite its wide use for skin augmentation and rejuvenation, relatively little is known about the molecular structures and interacting proteins of HA in normal and diseased skin. However, a comprehensive understanding of cutaneous HA homeostasis is required for future the development of HA‐based applications for skin regeneration. This review provides an update on HA‐based structures, expression, metabolism and its regulation, function and pharmacological targeting of HA in skin.     

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.     

Experimental Investigation on the Tissue Response Induced by Face-Lifting Mesh Suspension Thread in Rats

BackgroundFace-lifting procedures are often performed to hide the effects of aging. Thread-lifting, a minimally invasive technique for the correction of facial aging, has become increasingly popular, and various materials for the procedure have been developed.ObjectiveThis study compared tissue responses to two types of threading sutures placed under rat skin: polypropylene (PP) monofilament mesh suspension thread (a novel face-lifting material) and polydioxanone (PDO) barbed thread.MethodsEight rats each were assigned to the PP monofilament mesh suspension, PDO barbed thread, and control groups. Tissue reactions were evaluated 28 days after subcutaneous loading of the materials.ResultsSignificant increases in tensile strength and the mean area occupied by collagen fibers were evident in skin loaded with PDO barbed thread and PP monofilament mesh suspension thread compared to control skin (p<0.05). Compared to sites loaded with PDO barbed thread, those loaded with PP monofilament mesh suspension thread showed a significant increase in the number of collagen fibers and a lower grade of inflammation (p<0.05).ConclusionPP monofilament mesh suspension thread has skin-rejuvenating effects comparable to those of PDO barbed thread, but induces a less severe inflammatory response. This indicates that it is a safe and effective material for use in thread-lifting procedures on aging skin.