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Fat Grafting to the Nose
Abstract
Background: Autologous fat grafting is a safer and convenient alternative to permanent or semipermanent injectables due to better results and fewer and lesser side effects than synthetic injectables.
Objectives: The author reports his experience in fat grafting to the nose using his personal technique in 48 consecutive patients. The experience covers primary treatments of non-operated noses, treatment of postrhinoplasty deformities, and the combination of fat grafting to the nose with rhinoplasties.
Methods: The technique used by the author for fat grafting to the nose does not differ too much from that used in other body or face areas. It is based in the atraumatic extraction of fat fragments using a multi-orifice cannula and the injection of these fragments using 1.4–1.6-mm cannulas or needles. When combining rhinoplasties with fat grafting, fat grafts were used instead of prosthesis or cartilage grafts in the same location.
Results: The initial analysis of postoperative results showed a good to high level of patient satisfaction, particularly in primary cases, with virtually absence of complication or severe side effects. Some easily corrected side effects were probably learning curve dependent.
Conclusions: Autologous fat grafting is an effective and reliable technique to perform aesthetic and reconstructive nose reshaping in those patients who refuse surgical treatments. Although clinicians can get optimal results with this technique, these are not comparable to those obtained by surgical rhinoplasties, and this is an important issue to discuss with the prospective patient.
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The “permanence” of fat as long-term implant material is a fact that, while controversial for many plastic surgeons, has been proven in clinical practice and in histologic studies. The goal of this article is to describe, first, the technique used by the author for transplanting autologous fat, and second, the instru- ments designed for performing such transplants with increased reliability.This technique is based on the atraumatic extraction under low pressure of 1.5 to 2 mm fat parcels with 3 and 4 mm multi-orifice cannulas designed specially for this procedure. Fat processing includes washing and decantation, but not cen- trifuging. The injection of this tiny fat parcels is performed with special 2 and 2,5 mm blunted tip cannula in multiple pla- nes. Analysis of the described procedure involved 103 lipoim- plants performed on 86 patients since April 1998, with follow up time ranging from 12 to 49 months. The average permanen- ce in all cases was 70% of the implanted volume, with the exception of lip augmentation, where the permanence after 12 months was no better than 50%. Autologous fat grafting with these new instruments and technique is a safe, long lasting and simple procedure reliable for all cases in which volume aug- mentation with autologous material is advisable.
The author presents guidelines and new instruments for transplanting autologous fat. He describes this procedure as effective, predictable, and reliable when performed with careful donor-zone preparation, atraumatic fat extraction, anaerobic sterility, and precise placement in a properly prepared receiving zone. (Aesthetic Surg J 2003;23:213-216.).
The author has used fat transfer, including pearl fat grafts and fat injections, for almost 18 years in practice. Techniques for pearl fat grafting and fat injections are described. Pearls are limited to eyelids and small depressions. Fat injections can be used to augment various facial areas, including chin, cheekbones, nasolabial folds, lips, labiomandibular folds, glabella, forehead, and nose.
Using soft tissue fillers to correct postrhinoplasty deformities in the nose is appealing. Fillers are minimally invasive and can potentially help patients who are concerned with the financial expense, anesthetic risk, or downtime generally associated with a surgical intervention. A variety of filler materials are currently available and have been used for facial soft tissue augmentation. Of these, hyaluronic acid (HA) derivatives, calcium hydroxylapatite gel (CaHA), and silicone have most frequently been used for treating nasal deformities. While effective, silicone is known to cause severe granulomatous reactions in some patients and should be avoided. HA and CaHA are likely safer, but still may occasionally lead to complications such as infection, thinning of the skin envelope, and necrosis. Nasal injection technique must include sub-SMAS placement to eliminate visible or palpable nodularity. Restricting the use of fillers to the nasal dorsum and sidewalls minimizes complications because more adverse events occur after injections to the nasal tip and alae. We believe that HA and CaHA are acceptable for the treatment of postrhinoplasty deformities in carefully selected patients; however, patients who are treated must be followed closely for complications. The use of any soft tissue filler in the nose should always be approached with great caution and with a thorough consideration of a patient's individual circumstances.
Injectable fillers have gained widespread acceptance among the public and provide a nonsurgical means of rejuvenating the face. As the demand for fillers increases, facial plastic surgeons must become not only expert injectors but also experts in managing the complications of fillers. Little scientific data exists regarding the incidence of complications, and more adverse effects may be seen with longer-term follow-up of patients. The purpose of this article is to review the most commonly encountered complications and management thereof.
The author has used fat transfer, including pearl fat grafts and fat injections, for almost 18 years in practice. Techniques for pearl fat grafting and fat injections are described. Pearls are limited to eyelids and small depressions. Fat injections can be used to augment various facial areas, including chin, cheekbones, nasolabial folds, lips, labiomandibular folds, glabella, forehead, and nose.
Although patients with a cleft lip and palate undergo many surgeries and other therapeutic procedures in the course of their treatment, many are still deeply concerned with their handicap and continue searching for perfection in their appearance. Augmentation using the subject's own fat cells involves minor invasion, is readily available, is an unpretentious method regarding time and cost, and has no contraindications. This method can serve to supplement a hypotrophic scarred upper lip and nasal columella, and by improving the volume, it induces a more natural contour, which reduces the stigmatizing deformity as well as the visibility of externally apparent scars. Using this approach, five patients with a complete cleft have been treated. The median follow-up interval is 22 months (through January 2003). The procedure and postoperative course had a pleasing outcome and were without any complications. The disadvantage was the temporary effect of the outcome, which necessitated repeated application every 7 months on average.
The most common aesthetic defects after rhinoplasty are small dorsal irregularities observed mainly in patients with thin dorsal nasal skin. Many techniques have been used in attempts to prevent perceptible irregularities and sharp edges of bone and cartilage in these patients. Adipose tissue transplantation has been used widely in aesthetic surgery as a surgical method to correct surface depression or to augment soft tissue. Recently, this tissue has been considered a potential source of stem cells with regenerative capacity and other benefits. The authors present a simple procedure using lipoinjection of microfat grafts over the osseocartilaginous framework of the nasal dorsum as a routine technique in rhinoplasty.
Open rhinoplasty was performed for all the patients. At the start of the procedure, we aspirated 3 to 5 ml of fat and separated it using the sedimentation method. The fat deposited as sediment (2-3 ml) was injected at the beginning of the procedure, after suture of the incisions and before application of the splint, over the osseocartilaginous framework in the subcutaneous space. The fat acted as a thin layer of soft tissue to thicken the overlying skin and help camouflage minimal imperfections.
Between February 2003 and May 2005, 78 rhinoplasties were performed, with injection of autologous fat. Of the 78 patients, 61 were primary rhinoplasties and 17 were secondary rhinoplasties with a follow-up time of 1 to 36 months. No minor irregularities were observed, and the aspect and quality of the skin improved for all the patients.
Fat injection into the nose as a refinement of rhinoplasty is a fast, easy, inexpensive procedure for obtaining regular and smooth contours on the nasal dorsum that lasts over time.
Instrumental alternativo en los injertos de grasa autóloga
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