This describes structural fat grafting of the face. 0.5% lidocaine with 1 in 200,000 adrenaline is infiltrated into the incision sites. And this is also infiltrated as a tumescent solution into the area to be harvested. Though for larger areas of suction, 0.2% lidocaine with 1 in 400,000 epinephrine is used. A small stab incision is made. And the local anesthetic solution is infiltrated into the area to be grafted. The amount of infiltrate is usually equivalent to the amount of fat that's going to be harvested. This particular system allows the syringe to be filled and constantly repeated and repeated while the local anesthetic is infiltrated Second stab incision is made for secondary access and again local anesthetic is infiltrated This plastic sheeting is displaced so as to minimise the amount of friction during the harvesting process. This is a cannula that was used to infiltrate the local anesthetic with multiple small side ports. And this is the harvesting cannula, which is a two-hole Coleman cannula attached to a 10cc syringe. And this allows for small amounts of fat to be aspirated. The plunger of the syringe is just pulled back a little ways so as to minimize the amount of suction, the amount of trauma to the fat. And the fat is then harvested. The first couple of syringes tend to have more tumescent solution while the later syringes tend to have more blood. As the fat is harvested and the syringes are filled, a lure lock plug is placed on the end and the plunger is removed and the syringe is placed in a centrifuge. This is a curved cannula that allows for easy harvest around the costal margin and minimizes the risk of stabbing injury or puncture injury Once the second syringe is prepared, the plug is placed, plunger removed and the syringe is placed in the centrifuge And centrifugation is at 1286 G for two minutes, and this concentrates the fat so that the aqueous components, i.e. the local anesthetic in the blood, can be removed very easily, as will be seen in a minute. And while this is being prepared, further suction is being carried out to harvest more fat. This is a very time-efficient way of harvesting and preparing the fat. Meanwhile, on the back table, everything is prepared. Then by removing the Luerlock plunge, or the Luerlock plug, the aqueous part of the solution will just drain out, and then a Telfer sponge placed into the syringe will remove any of the oily deposit and broken-down fat cells. In this way, the fat for injection is as pure as it can possibly be. Planning is important and you can see that the estimated amounts of fat that are going to be injected in the various parts of the face have been mapped out on the whiteboard. The empty syringes are kept on the table so that a count can be made of the amount of fat that's already been injected. The fat is transferred to 1cc syringes for injection in the face and 3cc syringes for injection in other parts such as the breast. Here the lower lip is being augmented through a stab incision at the oral commissure on each side. The inset shows where the fat deposits are going to be placed, one centrally and two laterally, one on each side. It's very important to inject this fat in very small aliquots. Here the lateral element is being injected, and here on the left side, through a similar stab incision, the lateral part of the lower lip is being injected. It's important to measure exactly how much fat has been injected so that symmetry can be achieved. And here are the amounts of fat being injected into this lower lip. In this case, in four separate aliquots. and this is why it's important to keep tabs on the amount that has been injected with each pass. Now the upper lip is going to be augmented, and the initial pass will place a line of fat on the upper part, just around the white lip roll, just inside the vermilion, in order to accentuate the white lip roll. These injection cannulas are 17 gauge. So a line has been placed all across the upper lip, as shown, to accentuate the white lip roll. Again taking care to ascertain the amount of fat that has been injected each time. Now the lateral aspect of the upper lip will be seen as shown in the inset here. Once again, the amount of fat that's going to be injected is predetermined and measured and marked on the patient preoperatively as can be seen here. and measuring the amount of fat that has been injected. And now the lateral element of the left upper lip is being injected. And that completes the injection of the lips.

structural fat grafting

local anesthetic

cannulas

centrifuged fat

lip augmentation