0ver the past l0 years, the popularity of fat grafting has increased substantially, but this is not a new surgical technique– it began as early as 1893 with free fat auto grafts that were used to fill soft-tissue defects. "Throughout the, 20th century, physicians used fat grafts to correct many conditions, including hemi facial atrophy and other soft-tissue defects. Because of recent advances in technique to improve graft "take:' along with -rowing media attention, fat, rafting is more popular that ever.
Before 1981, physicians used excised fat, minced into very small pieces, for grafts. That year, Gerard Illouz, MD, fir used liposuction aspirate for autogenous fat, rafts. Techniques have been refined, and now the fat to be used for -grafting is carefully removed with itsyringe and is processed minimally with a centrifuge to concentrate it. The fat is then grafted in thin strands, and itlattice is constructed to correct a wrinkle or restore volume to a specific area. As a result of’ the success of modern fat grafting, its application has broadened to include lip augmentation, facial hyoids, facial-volume restoration, soft-tissue scar-ring, soft-tissue defects from injury or disease, liposuction defects, and many other new and original procedures and treatment areas. Fat-handling techniques have improved, but multiple or staged procedures are still the norm. Despite the possibility of requiring retreatment, fat grafting compares well to other soft-tissue fillers.
Early soft-tissue fillers included silicone, collagen, hyaluronic acid products, calcium hydroxyapatite, cyanoacrylatc, and autogenous fibroblasts, and they all had benefits and risks. Many new sub-stances for soft-tissue augmentation are in the pipeline, but each has some side effect or disadvantage. Substances that do not react well with tissues have limited effectiveness and wear off in months. Substances that last lower tend to have more problems with lumping, hardness, and foreign-body reactions like granulomas. A product that uses autogenous fibroblasts for augmentation is still awaiting approval from the Food and Drug Administration. It is natural, and it appears to be long-lasting. The ideal soft-tissue‑ augmentation material is inexpensive and durable, feels natural, and has a low risk of adverse reactions. Autologous fat grafts meet these requirements. The procedure can be per-formed on an outpatient basis with local anesthesia, or can be combined with other plastic surgery procedures that are performed under general anesthesia. Preoperative consultation and evaluation are important to identify the areas to he treated.
The procedure preoperative and postoperative care, expectations, and possible adverse reactions should be carefully reviewed and discussed with the patient. Patients must be educated about the effects of weight gain on their grafts. It is easier to perform secondary grafting than to remove fat grafts injected into normal tissues. Photographic documentation is important for planning and follow up.
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