25.1 Indications
Key words: cheekbone prominence, cleft lips, contouring of mandibular border and angle, deep skin faults, filling of nasolabial faults, frown lines, lipodystrophy, scarred skin defect
Fat grafting can be performed for medical and esthetic reasons. The transitions are also fluid in orthognathic surgery. Autologous fat grafting is valuable on the one hand for the treatment of regional facial lipodystrophy, and on the other for the restoration of contours in syndromes and malformations in the facial region, such as a secondary measure after surgically treated cleft lips. It can also be used to reline retracted facial scars or to make lip contours more esthetic. Contour improvements in the entire facial area may also be indicated after reconfiguration osteotomies. Fat grafting is particularly suitable for camouflaging bony jaw defects at the horizontal mandibular margin, after chin wing surgery in the mandibular angle region, or for accentuating the mandibular angle contour in vertical mandibular growth with only minor bony mandibular angle expression. The shaping of the cheekbone prominence can also be indicated for esthetic reasons. The most frequent indication for fat grafting in the existing patient population is the filling of deep nasolabial folds. Deep frown lines of the forehead are also often an occasion for fat tissue transplantation (Fig 25-1a), when the elimination of mimic muscle functions by botulinum toxin alone is no longer sufficient to smooth the skin surface.
Figs 25-1a and 25-1b A case description of autologous fat grafting for facial rejuvenation.
Figs 25-1a and 25-1b (a) Pronounced facial wrinkling of the glabellar region, both nasolabial folds, and smile lines were present at the corner of the mouth due to habitually pronounced facial expressions (43 years, 4 months). (b) The folds were marked before induction of peroral intubation anesthesia, because their appearance changes under relaxation in general anesthesia and in horizontal position. At the same time, blue dot marking of the seven injection sites of the forehead for simultaneous botulinum toxin injection into the depressor supercilii muscle and frontalis muscle on both sides and M. procerus was performed.
Figs 25-1c to 25-1j A case description of autologous fat grafting for facial rejuvenation.
Figs 25-1c to 25-1e (c) Periumbilical liposuction was performed under careful manual counterpressure with a 5-mm diameter blunt cannula after injection of 300 to 400 mL of standard tumescent solution. (d) The filled 10-mL aspirating tubes are centrifuged for 5 minutes at 3,000 rpm. (e) Storage of all filled suction cannulas in the stand.
Figs 25-1f to 2-25j (f) Removal of fat oil floating on the graft using a swab with a pointed tip. (g) Drainage of the tissue fluid. (h)
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