Surgery Spotlight: Structural Fat Grafting of the Face-Surgery Spotlight: Structural Fat Grafting of the Face

Video Transcription

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 repleted while the local anesthetic is infiltrated.  The second stab incision is made for secondary access and again local anesthetic is infiltrated through this stab incision also.  This plastic sheeting is just placed 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 cost margin  and minimizes the risk of stabbing injury or puncture injury. Once the second syringe is prepared, the plug is placed,  the 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 and 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 lure lock plug, the aqueous part of the solution will just drain out  and then a telpha 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. And the fat is transferred to one cc syringes for injection  in the face and three cc 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 Coleman injection cannulas.  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.  Again, measuring the amount of fat that has been injected.  As can be seen in the inset.  Thank you for watching!  And now the lateral element of the left upper lip  is being injected.  Again, as seen in the inset.  And that completes the injection of the lips.

Video Summary

The structural fat grafting video covers facial procedures using different lidocaine and adrenaline concentrations for local anesthesia, with techniques for both harvesting and injecting fat. A step-by-step guide is given for incision, anesthetic infiltration, and fat extraction using specialized cannulas and syringes, followed by centrifugation to purify the fat. The purified fat is then injected in small, measured amounts into facial areas, such as the lips, to ensure symmetry and desired enhancement. The video emphasizes efficiency, accuracy in fat amount, and pre-operative planning to achieve optimal aesthetic results.

Asset Caption

This video, narrated by Peter Neligan, MD, demonstrates structural fat grafting of the face.

Surgeon Sydney R. Coleman, MD; Alesia P. Saboeiro, MD

Source

Neligan, P. C. (Ed.). (2012). Plastic Surgery: 6-Volume, 3^rd Edition. Philadelphia: Saunders.

Disclosure This material is presented thanks to a generous licensing grant from Elsevier, and is taken from Plastic Surgery: 6-Volume Set, 3rd Edition edited by Peter C. Neligan, MD. "Three-Stage Folded Forehead Flap" appears in Volume 3: Craniofacial, Head and Neck Surgery and Pediatric Plastic Surgery. This product is not certified for CME.

Keywords

surgery spotlight

Surgical Videos

Aesthetic

Sydney R. Coleman MD

Alesia P. Saboeiro MD; Memben

structural fat grafting

local anesthesia

fat extraction

facial enhancement

aesthetic results