Surgery Spotlight: Blepharoplasty with Fat Injection: Part III-Surgery Spotlight: Blepharoplasty with Fat Injection: Part III

Surgery Spotlight: Blepharoplasty with Fat Injection: Part III

Video Transcription

So the advantage of having put the tumescin in at the very beginning is we've had plenty of time to get some vasoconstriction, better fat, we'll have much less heme in it.  So I think most of the the current literature is very clear, very clear and suggesting that really it doesn't matter so much how you go about preparing the  fat as long as it's a relatively atraumatic technique and you minimize exposure to air. So the preference I have is to either do a strainer or a Telfa  pad. I have for larger volume I'll use a centrifuge but I don't think it's vital and relatively small volumes like this. In this patient I'll probably use less  than 15 or 20 cc's in total and so I don't think it's really necessary to use a centrifuge especially given that most of the literature does not suggest a  survival benefit of using a centrifuge.  So right now I'm just harvesting with a 10 cc syringe using a three-port cannula. So the nice thing I think that that we have currently in terms of the way that  we're looking at aging is the old concept of needing to try to pull somebody as tight as we can or the like. That concept is largely going and  instead we're realizing that there are three phases to rejuvenation. One is the skin which obviously a person with skin of color will tend to be less  susceptible to sun-related damage and then we have loss of volume which is what I'm after right now and then thirdly we have ptosis or sagging of  tissue which is where selective and very strategic surgery comes in. I think it's real important in all the fat injection cases that I do I am careful not to put  sutures in the little port sites it's better to do steristrips to help minimize the risk of skin marks especially in skin of color. So as I  mentioned earlier I do like to start along the submalar area first just a small stab. So I I like to start laterally for my placement.  Good blood pressure looks great and then I like to stay in that submalar line and you can see the edge of my cannula is right here.  And I'm putting in very little as I go. The key is being deep. I think fat transfer and skin of color is ideal for a variety of reasons.  One being, as I'd mentioned, there's less signs of aging in the surface of the skin. I do try to over correct by about 25%.  And then what I like to do is I go lateral.  So what that's done is it's created a three-dimensional lift to her cheek that is significant if you compare the sides. I know that a good portion of this is not going to,  a good portion of about 25 or 30 percent of what I put in probably will not survive. But then I end up with a better overall correction once that 25 or so percent has gone.  But you can see how we've gotten, if you look straight on, you can see how with that volume restoration to the cheek,  we have helped to efface her nasolabial fold in a way that is significant compared to the non-treated side.  So now we're going to go ahead and add some volume to the nasolabial and then the marionette.  Yeah, we'll leave them off for now, yeah, thanks.  This also gives a great opportunity to add volume down by the pure form. It's another technical point that use of the different fillers that are synthetic on the market has shown us  that you can get a significant enhancement to the appearance of the central face by adding volume there, in addition to the nasolabial.  So, what I like to do, again, synthetic fillers has taught us that if you restore some volume to the modiolus  in addition to the marionette line, that you get a better rejuvenation than just the marionette line alone.  So, applying those principles, I'm going to add some volume to the marionette, but then I'm not going to forget the importance of the modiolus as well.  I am deep, and I think that's important. I want to have the actual fat along the lower lip margin.  And then we're going to put just a touch along the motiolus.  That creates just a little bit of commissure turn up.  Great. And so now we can look on and see the difference in what we have if you look at the one side versus the other. So we've got nice cheek fullness.  Like I said, 25-30% of that we're going to lose. We have restoration of both the piriform and the nasolabial, the marionette line.  And then the motiolus here has been restored, which will allow for the commissure to turn up. And we get a nice rejuvenation.  And all of a sudden, the lower lid, what appeared to be preoperative fullness, has now been balanced out.  And really what we were seeing is an illusion of the lower lids appearing full. But in reality, the fullness was relative to the hollow in the midface, which now we've restored.  And you can see this when you push up, that all of a sudden the lower lid actually does not appear to be problematic in terms of fat prolapse.  So as we look on now, we've got a nice volume restoration to the midface here. And then a good effacement of the nasolabial fold, the marionettes, and the nasolabial.  I'd like to thank you for your time during this brief presentation of relevant blepharoplasty considerations.  And it's my hope that some of the principles that have been shared during this brief time will be useful in your clinical practice. Thank you.

Video Summary

The video discusses fat transfer techniques in facial rejuvenation. Tumescence is used initially for vasoconstriction, enhancing fat quality. The technique doesn't necessitate centrifugation, especially for small volumes, as literature suggests no survival benefit. Harvesting is done using a 10 cc syringe and a three-port cannula. The process focuses on three rejuvenation phases: skin texture, volume loss, and tissue ptosis. The speaker highlights a 25% overcorrection in fat transfer to account for anticipated volume loss, emphasizing a balanced, three-dimensional lift. Attention is given to nasolabial folds, marionette lines, and voluminous restoration for facial symmetry.

Asset Caption

Julius W. Few, MD demonstrates a bilateral upper blepharoplasty with fat injection to the mid-face and lower third of the face. Part 3 of 3 demonstrates harvesting of fat, injection of fat and postoperative assessment.

Surgeon Julius W. Few, MD

Disclosure Julius W. Few, MD has nothing to disclose. All ASPS staff members managing this activity have no relevant financial relationships or affiliations to disclose. All identified conflicts of interest have been resolved and the educational content thoroughly vetted by ASPS for fair balance, scientific objectivity, and appropriateness of patient care recommendations. The ASPS also requires faculty/authors to disclose when off-label/unapproved uses of a product are discussed in a CME activity or included in related materials. This product is not certified for CME.

Keywords

Surgical Videos

Surgery Spotlight

Aesthetic

Julius W. Few MD; Memben

fat transfer

facial rejuvenation

three-dimensional lift

nasolabial folds

volume loss