Fat transfer for aesthetic body contouring

1.

FAT TRANSFER FOR AESTHETIC BODY
CONTOURING
Sarukhanov G, Levitskaya M, Kochneva I.
Clinic of Aesthetic Surgery "Abriell", St. Petersburg, Russia.
2013

2.

214 patients (2003-2012)
Procedure
Gender
Age
Cases
Lipofilling of
breasts
women
23 – 45
56
Lipofilling of
calves
Lipofilling of
buttocks
women
114
19 – 59
men
2
women
41
23 – 45
men
1

3.

The three stages of the
procedure
I - Harvesting of adipose tissue from a
suitable donor site
II - Purification of the aspirated fat tissue
(lipoaspirate) to eliminate the acellular oily
supernatant and excess solution
III - Reinjection of the purified fat via a
three-dimensional reimplantation technique

4.

I stage
Fat harvesting
The main principles :
1 - Volume of infiltrating fluid is close to the
volume of anticipated fat withdrawal;
2 – harvesting of fat under controlled constant
low negative pressure - no more than 280 mm Hg;
3 - diameter of cannulas 3, 4 and 5 mm with lots of
holes;
4 - harvesting of the fat predominantly from the highest
local fat deposits - "bags";

5.

I stage
Fat harvesting
Cannulas 2.0 and 3.0-mm diameter and a pump for
the infiltration of donor area

6.

I stage
Fat harvesting
A special closed system for a large
volume fat harvest (more than
200 cc).
Fat harvesting performed by two surgeons simultaneously

7.

I stage
Моя версия
Fat harvesting предыдущег
A closed system for
a large volume fat
harvest (more than
200 cc).
Fat harvesting performed by two surgeons simultaneously

8.

I stage
Fat harvesting
Suction cannulas 3.0-3.5 mm in diameter with lot of
holes

9.

I stage
Fat harvesting

10.

I stage
Моя версия
Fat harvesting предыдущег

11.

II stage
Fat processing
no consensus on the method
of preparation of fat today.

12.

II stage
Fat processing
Centrifugation method by Sydney Coleman

13.

II stage
Fat processing
Сonstantino G. Mendietta, 2011

14.

II stage
Fat processing
Raul Gonzalez , 2006

15.

II stage
Fat processing
Roger Khouri

16.

II stage
Fat processing
Fat is transferred from a sterile container to
a large syringe 150 cc filling it to a half.

17.

II stage
Fat processing
Washing
Another half is filled with saline.

18.

II stage
Fat processing
Sedimentation
Removal of excess fluid and blood cells.

19.

II stage
Fat processing
The purified fat is transferred to the 10.0
or 20.0 cc syringes.

20.

II stage
Fat processing
Photo of purified fat

21.

III stage
Reinjection of fat.
Basic principles:
1 - the volume of injected fat should not exceed the
recipient area capacity.
2 - fat is expelled on retrograde moves of cannula,
with even distribution of beads in each pass;
3 - multi-layered placement;

22.

III stage
Reinjection of fat.
- straight and curved 2mm cannulas with one hole for
lipofilling of calves, breast and buttocks ;

23.

III stage
Reinjection of fat.
diameter of the hole
of the injection cannula
diameter of the hole
of the aspiration cannula

24.

Technical guidelines for
lipofilling of calves, breast and
buttocks

25.

Lipofilling of calves
Indications:
- increase in volume;
- correction of varus deformity;
- hypotrophy of muscles;
- asymmetry;
- Iatrogenic defects

26.

Lipofilling of calves
Anatomy and planes of infiltration of fat to the calf
(schematical)

27.

Lipofilling of calves
Passes of the cannula

28.

Lipofilling of calves
Infiltration of the recipient site 2-mm cannula
a solution with epinephrine

29.

Lipofilling of calves
Reinjection of fat (intramuscular)

30.

Lipofilling of calves
Reinjection of fat (subcutaneous)

31.

Lipofilling of calves
The final form after procedure

32.

Lipofilling of calves
Before
2 years Post Op
Before
2 years Post Op
1 Grafting Session – 140 cc injected in each calf

33.

Lipofilling of calves
P/O marking
Before
1 year Post Op
Before
1 year Post Op
1 Grafting Session – 200 cc injected in each calf

34.

Lipofilling of calves
Before
1,5 year Post Op
Before
1,5 year Post Op
1 Grafting Session – 140 cc injected in each calf

35.

Lipofilling of calves
Before
2 years Post Op
Before
2 years Post Op
1 Grafting Session – 130 cc injected in each calf

36.

Lipofilling of calves
Before
1 year Post Op
Before
1 year Post Op
Implant (160cc) left leg was replaced by 60 cc, injected 158 ml of fat
into the left calf, 78 ml – into the right calf (subcutaneously)
Надпись на слайде совершенно непонятна. Лучше убрать слайд

37.

Lipofilling of calves
Before
6 months Post Op
Before
6 months Post Op
1 Grafting Session – 210 cc injected in each calf

38.

Lipofilling of calves
Before
2 years Post Op
Before
2 years Post Op
1 Grafting Session – into the right calf 190 cc, left – 150 cc
injected

39.

Lipofilling of calves
Before
1 year after 1-rst session
6 months after 2-nd session
1-st Grafting Session - 170 cc, 2-nd – 190 cc injected
in each calf

40.

Lipofilling of calves
Before
1 year after 1-rst session
6 months after 2-nd session
1-rst Grafting Session - 170 cc, 2-nd – 190 cc injected
in each calf

41.

Lipofilling of calves
Before
4 years after
2-nd session
Before
4 years after
2-nd session
2 grafting sessions – 230 cc on each side Injected
in total

42.

Lipofilling of calves
Before
4,5 years after
2-nd session
Before
4,5 years after
2-nd session
2 Grafting Session – 235 cc in each side Injected
in the total

43.

Fat grafting to the breast
Indications:
- The volume increase;
- correction of local depressions;
- Asymmetry;
-Moderate ptosis;
- Visibility of implants edges after breast
augmentation;
- Scar deformation, including after resection of the
breast

44.

Fat grafting to the breast
Anatomy and planes of infiltration of fat to the breast

45.

Fat grafting to the breast
Local anesthesia at the incision site

46.

Fat grafting to the breast
Length of skin incision is 2 mm

47.

Fat grafting to the breast
Тот же вопрос зачем инфильтрация,
если раствор уже содержится в липоа
Infiltration of retromammary space

48.

Fat grafting to the breast
Subcutaneous infiltration

49.

Fat grafting to the breast
Fat grafting to retromammary space and pectoral muscles.

50.

Fat grafting to the breast
Fat grafting subcutaneously

51.

Fat grafting to the breast
The final form after procedure

52.

Fat grafting to the breast
1 Grafting Session – 200 cc in each side Injected
(before and 1 year after)

53.

Fat grafting to the breast
Before
7 years after
2-nd session
1-st grafting session - 230 cc, 2-nd - 250 cc injected
in each breast

54.

Fat grafting to the breast
Before and 6 years after 2 sessions – 280 cc in each side
Injected in total

55.

Fat grafting to the breast with periareolar mastopexy
Before and 6 months after 1 Grafting Session – 230 cc in
each side Injected

56.

Fat grafting to the right breast
after sectoral resection
Before and 6 months after 3 Grafting Session – 580 cc into the
right breast Injected in the total

57.

Fat grafting to the breast
Before
After
Before
After
Before and 6 months After 2 Grafting Session: 1-rst - 290 cc to the right
-230cc to the left ; 2-nd - 350 cc and 300cc, respectively, injected

58.

Fat grafting to the tubular breast
Preoperative photos

59.

Fat grafting to the tubular breast
Preoperative marking

60.

Fat grafting to the tubular breast
periareolar de-epithelialization, the purified fat, reinjection of fat –
450cc in each side, the final form after procedure in sitting position

61.

Fat grafting to the tubular breast
a
b
The final form after “Rigottotomies” in the area
of submammary sulcus: а) prone;
b) sitting

62.

Fat grafting to the tubular breast
Before and 4 months After 1 Grafting Session –
450 cc in each side Injected

63.

Fat grafting to the breasts with simultaneous
removal of implants because of capsular
contracture
Before and 4 months after 1 session –
350 cc in each side (intramuscular and subcuteneosly)

64.

Fat grafting to the breast with simultaneous
removal of the implants
a
b
e
f
c
g
d
h
a - before augmentation; b - after 1 years; c, d – fibrous contracture; d -view
deformed implant and the fibrous capsule; e – 3 months after
capsulotomy&lipofilling; f, g - 2 years after lipofilling (fibrous capsule) ;
h – 2 months after removal of the implants & lipofilling

65.

Fat grafting of buttocks.
Indications:
- Increase in volume;
- Correction:
- Form;
- Asymmetry;
- Local retractions;
- Scar deformities;
- Moderate ptosis.
Этот слайд не читать.
Последующие 4 либо
выбросить, либо
быстро промелькнуть
сопровождая мелькан
словами:
There are many criteri
"ideal" buttocks, as we
deviations from the id
used them in determin

66.

Fat grafting of buttocks.
before
after
WHR – 0, 92
WHR - 0,76
WHR –ideally equal to 0,67-0,80

67.

4 types
V-shaped
A-shaped
Round
Point C - "zones of depression"
Square

68.

ratio of the height of the sacrum and the length of intergluteal crease.
ratio of the length of the buttocks and intergluteal crease.

69.

upper gluteal zone
central gluteal zone
lower gluteal zone
three distribution patterns of volume soft tissue

70.

Fat grafting of buttocks
Anatomy and planes of infiltration of fat to the
buttocks

71.

Fat grafting of buttocks
Patient marking (fat grafting areas are shaded)

72.

Fat grafting of buttocks
The pure fat (about 1600 cc)

73.

Fat grafting of buttocks
Before
After
Intraoperative view of correction at the point C

74.

Fat grafting of buttocks
The final form after procedure

75.

Fat grafting of buttocks.
Before and after correction of
postinjection scarring
deformation of buttocks.
1 session - 250 cc in
each side Injected

76.

Fat grafting of buttocks.
1 session – 270 cc in each side Injected
(before and 1 year after)

77.

Fat grafting of buttocks.
1 session – 890 cc in each side
(before and 1 year after)

78.

Fat grafting of buttocks.
1 session – 650 cc
in each side
(before and 1 year after)

79.

Fat grafting of buttocks.
1 session – 840 cc
in each side
(before and 1 year after)

80.

Fat grafting of buttocks.
1 session – 720 cc in each side
(before and 1 year after)

81.

Fat grafting of buttocks.
1 session – 940 cc in each side
(before and 1 year after)

82.

Postoperative care
- compression garment for 4-6 weeks;
- endermologie therapy is suggested for the areas
of liposuction for improving venous and lymphatic
drainage (microcurrent therapy, polarized light,
magnetic therapy, Traumeel S to the area fat grafting);
- medications: detraleks, askorutin, Traumeel S;
- light massage not earlier than 3 weeks after surgery;
- exclude physical activity, weight lifting; hot baths,
sauna, solarium for 2 months; any pressure on the area
fat grafting (use the special "pillows" or cane chairs);
- wearing shoes with small heel after filling of calves.

83.

Complications:
- seromas;
- indurations and contour irregularities;
- oil cysts;
- infection
- fat necrosis
- aseptic inflammation

84.

Conclusions
The method of transplanting large
volumes of adipose tissue to the breasts,
legs and buttocks brings about aesthetic
results, much more natural than with the
implants. In our hands patient’s satisfaction
was achieved without sophisticated tools
like BRAVA, cell technologies etc. The key is
patient’s
realistic
expectations
and
compliance.

85.

Thank you for your attention