Facial Rejuvenation with Staged Injections of Cryopreserved FAT and or TISSUE Cocktail, A CLINICAL OUTCOME In the Last TEN YEARS
Facial rejuvenation with autologous fat transfer is one of the commonly performed procedures in aesthetic plastic surgery. However most people who are interested in facial rejuvenation may not accept even a minor surgery and looking for readily available fillers. The main drawback is resorption of facial tissues and the injected tissues over time requiring repeated harvesting and micro grafting with injection. Cryopreservation of the excess harvested fat and or tissue cocktail has the advantage of subsequent utilization. Experience involving the utilization of autologous tissue injections in more than 5000 procedures is summarized
Methods/Technique:
Fat grafts were harvested utilizing a 50-cc syringe and 3 or 4-mm cannula. Harvested fat grafts were centrifuged at 3000rpm for 3 minutes. Tissue cocktail composed of dermis, fascia, and fat prepared from excised scar tissue, or tissue excised during abdominoplasty and or reduction mammoplasty. Freezing and Thawing Protocol After the required amounts of fat and or tissue cocktail were injected, remaining fat and or tissue cocktail were cryopreserved: Specimens were put into 10, 20, and/or 50 cc sterile tubes, labeled and immersed in a liquid nitrogen tank, frozen at -196°C, and then transferred to a refrigerator (Electrolux UF 601medical refrigerator.) and stored at -80° C. For thawing, 12 hours before the procedure, estimated amount of cryopreserved grafts to be used were taken from the medical refiregerator (-80°C), transferred to regular refrigerator(-15 C) , and one hour before use thawed slowly at room temperature.
Results/Complications:
A total of 5199 cryopreserved fat and or tissue cocktail injections were performed in 2439 patients. Ages ranged from 19 to 80 years. Nasolabial folds and lips were the most commonly sites injected. Chin Augmentations were rouninely made with tissue injections. Three to six times of cryopreserved fat graft injections at 3-6months intervals were performed in nearly half of the patients. The clinical outcome was very satisfactory in the majority of the patients and the required contour was achieved in almost all of the patients after repeated injections. Also texture and color of skin improved considerably probably with the effect of stem cells. Our theory is that if we start micro fat grafting at early ages of 28-32 years,the graft act like a preventive medicine of aesthetic surgery, for skin and face aging. We have many examples of patients who look much younger after ten years follow up Longevity of survived grafts in chin region after the final injection are almost permenant, on the mid face and the areas where early bone resorption occurs, and repeated facial expresions present, partial resorption of tissues required reinjections. As a complication no single infection is encountered probably due the complete sterile conditions were injections performed and the addition of prophylactic antibiotic to the graft material. Asymmetries were observed in early post-operative period after injections, which disappeared after edema was resolved.
Conclusion:
Currently, autologous tissues seem to be the ideal filler for facial rejuvenation with variable degrees of resorption. After cryopreservation, the injectable tissue is readily available for future use and acceptance by the patients is much greater than repeated fresh harvesting. The demand from patients increased considerably during the last ten years. With this approach the interest shifted from fillers to autologous tissues. The survival rate of tissue cocktail, a mixture of grafts, has been superior in terms of graft take and maintaining longevity when compared with pure fat grafts. Cryopreservation of excess tissues for future injection is promising treatment modality for aging face. In our clinical experience the results are comparable with the fresh grafts.
Starting the micro fat grafting at early ages of 28-32 years is acting like preventing medicine of aesthetic surgery for skin and face aging. We have many examples of patients who look much younger after ten years of follow up. The debate regarding the best method of fat graft harvesting, preparation and cryopreservation will continue until optimal method is designed. We may hypothesize that, the horizon in facial rejuvenation with autologous tissues is cryopreservation of tissues of young people for future utilization when they become older in age .