Injectable adipose tissue is a versatile and promising material for various applications in cosmetic, functional and regenerative surgery. In this presentation, I will provide an overview of the history, the current state and the future prospects of this technique, based on my own experience that spans over three decades. I will also discuss the evidence-based practice and the challenges and opportunities of using injectable adipose tissue in different surgical settings.
You will see some before and after examples of the outcomes of injectable adipose tissue in cosmetic, functional and regenerative surgery.
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Injectables Adipose Tissue. Past Present and Future.pptx
1. Injectable Adipose
Tissue (IAT). Past,
Present and Future
Prof. Osama B. Moawad, MSc.,
MD.
President of
Egyptian Society of Cosmetic
Surgery and Laser (ESCSL)
3. History
ā¢ Historically, the use of fat grafts to
correct congenital deformities and
complex traumatic wounds was
proposed in 1893 by Neuber,
Hollander in 1912, Neuhoff in
1921, and Josef in 1931.
ā¢ The liposuction technique was
introduced by Fisher in 1974,
followed by the tumescent
technique by Klein in 1985.
email address: askprof@moawadskininstitute.com 3
4. History
ā¢ In 1986, Ellenbogen
described the
utilization of fat
grafting in aesthetic
surgery.
ā¢ In 1987, Coleman
standardized fat
grafting.
email address: askprof@moawadskininstitute.com 4
5. History
ā¢ In the early nineties, I
was fascinated with Dr.
J. Fulton and how he
used fat grafting in acne
scars.
Dr. J. Fulton email address: askprof@moawadskininstitute.com 5
6. History
ā¢ I did the first case
of IAT to treat acne
scars (1997) at a
Security Forces
Hospital in Saudi
Arabia.
email address: askprof@moawadskininstitute.com 6
7. History
ā¢ Rohrich and
Pessa, in 2007,
described the
anatomy of fat
compartments of
the face.
email address: askprof@moawadskininstitute.com 7
8. History
ā¢ Tonnard et al.
coined the term
āNanofatā in
2013.
email address: askprof@moawadskininstitute.com 8
9. Indications
ā¢ IAT is indicated
for any volume
loss in soft tissues
and/or bone, due
to congenital,
aging, weight loss,
disease or other
causes.
email address: askprof@moawadskininstitute.com 9
10. Indications
ā¢ A matrix classification
of small-volume versus
large-volume and
regenerative versus
non-regenerative cases
yields four distinct
indications.
The surgeon should remember that the first is not to harm
email address: askprof@moawadskininstitute.com 10
12. Physical
Examination
. Aging vs.
Aesthetics
ā¢ Aging of the Face is easy
to diagnose, and it is
manageable.
ā¢ Ideal aesthetics of the
face are challenging to
define and much more
difficult to achieve.
email address: askprof@moawadskininstitute.com 12
13. Why Aesthetics
and Anatomy?
ā¢ Knowing the anatomy of
the aging face and the
ideal aesthetics will
better inform us about
optimal injection
materials and the
required volumes in an
economized approach.
email address: askprof@moawadskininstitute.com 13
14. Dermal White
Adipose Tissue
(dWAT)
ā¢ Dermal white adipose
tissue (dWAT) in the papillary
dermis contains adipocytes
with phenotypical and
functional properties that
differ from those located
deeper in the subcutaneous
white adipose tissue (sWAT).
email address: askprof@moawadskininstitute.com 14
15. Dermal White
Adipose Tissue
(dWAT)
ā¢ dWAT adipocytes could be
involved in spatially local
crosstalk with skin cells in
aging, wound healing,
scarring, hair growth, and
inflammatory and
pigmentary skin conditions.
email address: askprof@moawadskininstitute.com 15
16. The Reverse of
Aging Face
ā¢ The skin
rejuvenation
paradigm shifts
neocollagenesis
to spatial
modification of
AT.
KSA. Riyadh. 2000
email address: askprof@moawadskininstitute.com 16
17. Dermal White
Adipose Tissue
(dWAT)
ā¢ The non and minimally
invasive aesthetic
procedures will target
dermal adipocytes
in the hypodermis
instead of
fibroblasts in the
dermis.
email address: askprof@moawadskininstitute.com 17
18. Why Should I
Choose IAT?
ā¢ It is autologous.
ā¢ Inexpensive.
ā¢ Easy to obtain.
ā¢ It integrates into tissues giving
long-lasting results.
ā¢ It is a dynamic tissue with
regenerative capabilities.
email address: askprof@moawadskininstitute.com 18
19. When Should I Not ?
ā¢ It might be expensive initially.
ā¢ Downtime afterward is at least two
weeks.
ā¢ Results are unpredictable.
ā¢ Weight fluctuations are a problem.
ā¢ Temporary filler patients should
wait at least one year.
ā¢ Semi-temporary or permanent
implant patients are not a
candidate.
email address: askprof@moawadskininstitute.com 19
20. When Should I Use
Synthetic Fillers?
ā¢ I use filler when I treat
patients who are not ready
for IAT.
ā¢ A younger patient who
needs minimal filling, no
downtime, cannot afford
IAT, and needs accurate
filling in hypoplastic lips or
a deep nasolabial fold.
email address: askprof@moawadskininstitute.com 20
21. When Should I
Not?
ā¢ Fillers are associated
with significant
complications such as
hypersensitivity and
infections.
Non-autologous filler injected at home by non-doctor
develop ?biofilm 3 years later
email address: askprof@moawadskininstitute.com 21
22. Autologous.
vs. Non-
autologous
ā¢ It will be years before
new generations of
fillers offer the cells and
the tissue benefits
beyond volume surgery.
email address: askprof@moawadskininstitute.com 22
23. IAT and
The Face
ā¢ IAT represents a simple
tool for creating the
aesthetic "ideal,"
targeting site-specific
reduction,
augmentation, or
straightening facial
features in a holistic
approach.
email address: askprof@moawadskininstitute.com 23
24. IAT and The
Face
ā¢ Using IAT, I can
reshape the
forehead, cheeks,
nose, chin, and
mandible without
needing implants
or bone surgery.
email address: askprof@moawadskininstitute.com 24
26. Medial Eyebrow
and Upper
Eyelid
ā¢ I can restore uniform fullness and a unified
transition between the upper eyelid and
eyebrow devoid of shadowing.
email address: askprof@moawadskininstitute.com 26
27. Upper
Eyelid
ā¢ I can correct the "A deformityā of the
upper eyelid by IAT intraocularly through
a lower transconjunctival incision.
email address: askprof@moawadskininstitute.com 27
28. The Tail of
Eyebrow and
Lateral Upper
Eyelid
ā¢ I can correct
temporal
hollowing, brow
descent and
crowding of the
upper lid using
IAT.
email address: askprof@moawadskininstitute.com 28
29. The Tail of
Eyebrow and
Lateral Upper
Eyelid
ā¢ I can lift the
brow by
augmenting the
temple and
lateral forehead.
email address: askprof@moawadskininstitute.com 29
30. The Midface
ā¢ Rejuvenating
the midface is
focused on
restoring the
dominance of
midface volume.
email address: askprof@moawadskininstitute.com 30
31. The Midface
ā¢ Dominance can
be achieved by
selectively
targeting deep fat
compartments,
especially the
pyriform space.
email address: askprof@moawadskininstitute.com 31
32. Lower Eyelid,
Infraorbital
Rim and Tear
Trough
ā¢ When treating the
lower eyelid, tear
trough and upper
cheek, I must do it
simultaneously as
these areas overlap.
email address: askprof@moawadskininstitute.com 32
33. Lower Eyelid,
Infraorbital
Rim and Tear
Trough
ā¢ At the same
time, I can
improve skin color
by injecting
nanofat into the
dermis.
email address: askprof@moawadskininstitute.com 33
34. The
Midface
ā¢ Using IAT
transforms the whole
face into a youthful
convex platform
dominated by unified
highlights.
email address: askprof@moawadskininstitute.com 34
35. The
Midface
ā¢ IAT of the midface
will lessen the
appearance of the
NLF, marionette, and
jowls and straighten
the jawline.
email address: askprof@moawadskininstitute.com 35
37. The Nose
Regions
ā¢ The nasal base and
the dorsum could be
augmented for
patients with a mild
hump, short , or
saddle nose.
email address: askprof@moawadskininstitute.com 37
38. The Nose
Region
ā¢ The nasal tip
can be enlarged,
re-contoured, or
elevated.
email address: askprof@moawadskininstitute.com 38
39. The Lips ā¢ In 2001 I did lip augmentation for the first
time.
Patient is a great Teacher
email address: askprof@moawadskininstitute.com 39
40. The Lips
ā¢ After twenty years, I can say that the IAT should be
injected to duplicate the lips' beauty and not simply
make the mouth larger or make "sausage-shaped"
lips.
Immediate Result
email address: askprof@moawadskininstitute.com 40
41. LABIO-MENTAL
CREASE
ā¢ Support for the lower lip and chin interface is
achieved by restoring the volume of the labio-
mental area.
email address: askprof@moawadskininstitute.com 41
43. I can correct age-associated volume loss,
projection, vertical height or atrophic skin of the
chin.
The Chin
email address: askprof@moawadskininstitute.com 43
44. The
Mandible
ā¢ IAT of the jawline benefits patients with
long faces seeking beautification.
email address: askprof@moawadskininstitute.com 44
45. The Mandible ā¢ Augmentation of the mandible not only
delineates the jawline but also borrows skin from
the neck, enhancing the cervical mental angle.
email address: askprof@moawadskininstitute.com 45
46. Complementar
y
Procedures
ā¢ In an aging face with soft tissue atrophy and
decent, IAT might be combined with facelift
surgery.
email address: askprof@moawadskininstitute.com 46
47. ā¢ It will effectively address the central face soft tissue
atrophy and improve the appearance of the tear
trough, cheeks, and NLF.
Complementary
Procedures
email address: askprof@moawadskininstitute.com 47
49. Breast
Lipofilling
ā¢ Breast lipofilling is almost painless compared to
submuscular implant placement, with shorter
recovery and minor morbidity.
Immediate Results
MSI
email address: askprof@moawadskininstitute.com 49
50. Breast
Lipofilling
ā¢ Diffuse distribution of AT is ensured by placing
fat subcutaneously in different directions.
ā¢ No fat is placed into the mammary glands or
the pectoralis muscles.
Immediate Results
2002 Riyadh, KSA
email address: askprof@moawadskininstitute.com 50
53. Breast
Reconstruction
ā¢ In breast
reconstruction, IAT
provides an option to
treat pectus excavatum,
irradiated breast as a
primary or secondary
procedure.
email address: askprof@moawadskininstitute.com 53
54. Breast
Lipofilling
ā¢ It offers more
precision and
tailored
augmentation than
those obtained with
silicone implants in
tuberous breasts.
email address: askprof@moawadskininstitute.com 54
58. Buttocks
Lipofilling
ā¢ IAT may replace
implant-based
buttocks
augmentation if
the patient has
enough fat.
email address: askprof@moawadskininstitute.com 58
60. Hands and
Feet
Lipofilling
ā¢ Compared with synthetic fillers, IAT
works much better regarding longevity,
regenerative effect, and cost-
effectiveness.
email address: askprof@moawadskininstitute.com 60
62. Lipofilling of the
Dorsum of the
Foot
ā¢ Applying the same
technique, I
augmented the
feetās dorsum
Fifteen years ago.
email address: askprof@moawadskininstitute.com 62
63. Lipofilling of
the Ankles
ā¢ Another case
report, was done ten
years ago, although I
do not recommend
ankle augmentation.
email address: askprof@moawadskininstitute.com 63
65. Body Contour
Deformities and IAT
ā¢ Body deformities can be
corrected by removing fat
from the excess, liposhifting
into the depressed area, or
with IAT.
email address: askprof@moawadskininstitute.com 65
66. Body Contour
Deformities and
Lipofilling
ā¢ Liposuction of the arm
may demand lipofilling
of the bicipital triangle
to achieve an even
distribution of the fat.
email address: askprof@moawadskininstitute.com 66
68. Scars,
Fibrosis, and
Wounds
ā¢ IAT is used in
scars, fibrosis,
and wounds
based on its
ability to add
volume and
regenerative
properties.
email address: askprof@moawadskininstitute.com 68
69. Scars,
Fibrosis and
Wounds
ā¢ IAT has changed
my practice
intensely in
acne scars
treatment.
email address: askprof@moawadskininstitute.com 69
70. Scars, Fibrosis
and Wounds
ā¢ Initially, I used the Nokor
needle to subcise
adhesions and found space
to add fat.
Acne Scars
email address: askprof@moawadskininstitute.com 70
71. Scars, Fibrosis
and Wounds
ā¢ Nowadays, I do not
recommend using
sharp instruments or
microneedling.
Acne Scars email address: askprof@moawadskininstitute.com 71
73. Scars, Fibrosis
and Wounds
ā¢ I can create clean, multiple
linear tunnels to insinuate fat
parcels into a welcomed
recipient site.
Acne Scars
email address: askprof@moawadskininstitute.com 73
74. Scars, Fibrosis
and Wounds
ā¢ If adhesion is extensive, I use a
spatula-tipped cannula attached
to an oscillating power motor.
Acne Scars
email address: askprof@moawadskininstitute.com 74
75. Scars, Fibrosis
and Wounds
ā¢ I am applying the same concept to treat any
atrophic depressed scars.
Before
After
Traumatic Scar
email address: askprof@moawadskininstitute.com 75
76. Scars,
Fibrosis, and
Wounds
ā¢ IAT decreases the healing time, diminishing
scar thickness and allowing for more skin
flexibility due to its anti-fibrotic properties.
Burn Scar
email address: askprof@moawadskininstitute.com 76
78. Scars, Fibrosis,
and Wounds
ā¢ It reduces inflammation and immunoreactions
lessening pain and itchiness.
ā¢ Mixed with PRP, I used IAT in a patient with
hypersensitivity to an orthopedic fixation device.
Hypersensitivity Reactions
email address: askprof@moawadskininstitute.com 78
79. Scars, Fibrosis,
and Wounds
ā¢ In wounds with full-thickness soft tissue
loss, adding healthy AT can promote neo-
angiogenesis, granulation and
epithelialization of the ulceration.
email address: askprof@moawadskininstitute.com 79
80. ā¢ Putting together, you can achieve a result
beyond all other means.
Scars, Fibrosis, and Wounds
email address: askprof@moawadskininstitute.com 80
81. Dupuytren and Peyronie's Diseases
ā¢ IAT and breaking the fibrotic cord
of Dupuytrenās contracture
showed excellent results and
minimal recurrence rates.
ā¢ Would I apply the same treatment
for Peyronie's disease?
email address: askprof@moawadskininstitute.com 81
83. Craniofacial Deformities
ā¢ In other maxillofacial syndromes, IAT is necessary as the primary
step or as a secondary procedure.
email address: askprof@moawadskininstitute.com 83
84. Autoimmune
Diseases
ā¢ It has the same effect on
āen coup de sabreā of
scleroderma.
ā¢ The addition of a stem
cellās fraction of AT has
been proposed to treat
the symptoms of the hand
in systemic sclerosis and
rheumatoid arthritis.
email address: askprof@moawadskininstitute.com 84
86. Complications and
Management
ā¢ Although IAT is considered a safe
procedure, there are reports of
associated morbidity.
ā¢ The mild ones are the most common,
such as edema, ecchymosis, and
asymmetries due to hypo- or hyper-
correction, hypertrophy, reabsorption, or
displacement.
email address: askprof@moawadskininstitute.com 86
87. FAT EMBOLISM
AND VASCULAR
OCCLUSION
ā¢ Damage to the underlying
structures can occur in
reconstructive surgery
because surgeons use
sharp instruments in
deeper planes.
ā¢ It is never reported using a
blunt cannula.
email address: askprof@moawadskininstitute.com 87
88. Complications.
(Liposuction)
ā¢ The best way to treat
complications is to avoid
them.
ā¢ In large-volume lipofilling,
physicians should limit the
lipoaspirate to less than 5%
of the body weight and treat
less than 30% of the body
surface in one session.
email address: askprof@moawadskininstitute.com 88
89. Complications
and
Management
ā¢ Beware of the harms of
pervasive industry influence
on research, practice, and
education in healthcare.
ā¢ Surgeons should take the
time to learn the procedure
correctly and introduce it
into their practice gradually
and conservatively.
email address: askprof@moawadskininstitute.com 89
91. Evidence Based
Medicine
ā¢ I retrospectively
reviewed patients' charts
and photos who
underwent body
contouring and IAT
procedures in KSA and
Egypt between 2002 and
2022.
email address: askprof@moawadskininstitute.com 91
92. Evidence Based
Medicine
ā¢ I assembled my clinical
practice, journal
publications, and books
read to provide unbiased,
evidence-based medicine
and practice data,
concerning IAT's benefits
and harms.
email address: askprof@moawadskininstitute.com 92
93. Evidence-based
Medicine
ā¢ The most crucial
consideration for IAT
is to respect and
maintain the tissue
architecture of living
adipocytes.
email address: askprof@moawadskininstitute.com 93
94. Evidence-based
Medicine
ā¢ There is no evidence to
support the superiority
of one processing
technique over another.
ā¢ New closed systems
have not been an
advantage over regular
"openā systems.
email address: askprof@moawadskininstitute.com 94
95. SURVIVAL OF
THE IAT
ā¢ In reviewing the literature, whether IAT is
enriched or not, reabsorption of graft is
around 40ā50 % of the injected volume.
ā¢ The Donor-site selection seems unimportant
from a cell survival standpoint.
6m 12m 24m
First session Second Session Third Session
email address: askprof@moawadskininstitute.com 95
96. Evidence-based
Practice
ā¢ Lipoextraction should be the same whether you are
extracting large or small volumes.
ā¢ Using machine suction or energy-dependent liposuction is
damaging to the delicate architecture of adipose tissue.
ā¢ In regenerative surgery, the hypodermis is a better plane
for harvesting.
email address: askprof@moawadskininstitute.com 96
97. Evidence-
Based Practice
ā¢ Processing AT should be the same
whether you inject large or small
volumes.
ā¢ In large volumes, I need more help to
re-inject the AT as soon as possible.
ā¢ I choose the lower third of the fatty
layer as it contains more stem cells in
regenerative surgery.
email address: askprof@moawadskininstitute.com 97
98. Evidence-Based
Practice
ā¢ Adipose tissue should be
replaced with adipose
tissue.
ā¢ Adipose tissue should be
placed where adipose
tissue is, and not into
the surrounding
muscles.
email address: askprof@moawadskininstitute.com 98
MSI
100. Research and The Future
ā¢ We need to understand better the
mechanism of how AT survives.
ā¢ We need studies specifically designed to
elucidate the role of adipose-derived
stem cells.
ā¢ Future studies will be needed to
understand the role of AT in facial aging
and how to fight skin aging the best.
email address: askprof@moawadskininstitute.com 100
101. Conclusion
ā¢ Based on clinical studies, IAT is an effective and safe
operation.
ā¢ It can be usedas a stand-alone treatment.
ā¢ It is combined with other procedures to achieve
results that exceed the core surgery alone.
ā¢ Regenerative medicine is heading towards using
autologous materials versus allogenic biological
products.
email address: askprof@moawadskininstitute.com 101
102. The Take Home
Message
We are injecting adipose tissue,
knowing little about it.
email address:
askprof@moawadskininstitute.com
102
Editor's Notes
Injectable Adipose Tissue(IAT).
Prof. Osama B. Moawad
History
Historically, the use of fat grafts to correct congenital deformities and complex traumatic wounds was proposed in 1893 by Neuber, Hollander in 1912, Neuhoff in 1921, and Josef in 1931.
The liposuction technique was introduced by Fisher in 1974, followed by the tumescent technique introduced by Klein in 1985.
History
In 1986, Ellenbogen described the utilization of fat grafting in aesthetic surgery.
In 1987, Coleman standardized fat grafting.
History
As a dermatologist in the early nineties, I was fascinated with Dr. J. Fulton's videos and how he treated acne scars using fat grafting.
History
I did the first case of IAT to treat acne scars (1997) at a Security Forces Hospital in Saudi Arabia.
History
Rohrich and Pessa, in 2007, described the anatomy of fat compartments of the face.
IAT. History
Tonnard et.al. coined the Nanofat in 2013.
IAT. Indications
IAT is indicated for any volume loss due to aging, infection, disease, congenital, or other causes of soft tissue deficiency.
IAT. Indications
A matrix classification of small-volume versus large-volume and regenerative versus non-regenerative cases yields four distinct categories.
IAT of The Face
Physical Examination. Aging vs. Aesthetics
Face aging is easy to diagnose, and it is manageable.
Ideal aesthetics are challenging to define and much more difficult to achieve
Why Aesthetics and Anatomy?
Knowing the anatomy of the aging face and the ideal aesthetics will better inform us about optimal injection materials and the required volumes.
Dermal White Adipose Tissue (dWAT)
Dermal white adipose tissue (dWAT) in the papillary dermis contains adipocytes with phenotypical and functional properties that differ from those located deep in the sWAT
Dermal White Adipose Tissue (dWAT)
dWAT adipocytes could be involved in spatially local crosstalk with skin cells in skin aging, wound healing, scarring, hair growth, and inflammatory and pigmentary skin conditions.
The Reverse of Aging Face
Recently it has been proposed to shift the paradigm of skin rejuvenation from the neocollagenesis in the dermis to the spatial modification of the AT and activation of adipose-derived stem cells.
Dermal White Adipose Tissue (dWAT)
The noninvasive and minimally invasive aesthetic procedures in facial skin rejuvenation should target dermal adipocytes instead fibroblasts.
Why Should I Choose IAT?
It is autologous,100% biocompatible
It is inexpensive.
Fat extraction is easy.
It is an active and dynamic tissue composed of several different cell types that fulfill regenerative requirements.
It is naturally integrated into tissues giving natural, long-lasting results.
When Should I Not ?
The initial expense of surgery.
The downtime.
The unpredictable resorption.
Weight fluctuations of the patient.
Patients with a history of temporary filler should wait at least one year.
Patients with a history of semi-temporary or permanent implants are not a candidate.
When Should I Use Non-autologous Fillers?
I use filler when I treat patients not ready for IAT.
A younger patient who does not need too much filler needs minimal downtime, cannot afford IAT, and needs accurate filling in hypoplastic lips or a deep nasolabial fold.
When Should I Not?
Fillers are associated with significant complications such as migration, hypersensitivity reactions, and infections.
Autologous. vs. Nonautologus
It will be years before new generations of fillers offer the cells and tissues benefits beyond volume surgery.
IAT and The Face
IAT represents a simple tool for creating the aesthetic "ideal," targeting site-specific reduction, augmentation, or straightening facial features in a holistic approach.
IAT and The Face
I can reshape the forehead, nose, cheeks, chin, and mandibles without needing implants and osteotomy.
The Forehead
Augmentation of the forehead is performed when there is a noticeable frontal deficiency to create or restore facial harmony.
Medial Eyebrow and Medial Upper Eyelid
IAT can restore a youthful upper eyelid with uniform fullness and a seamless transition between the eyelid and eyebrow devoid of an infrabrow shadow.
Upper Eyelid
It can correct the "A deformityā of the upper eyelid by injecting it intraocular through a lower transconjunctival incision.
Tail of Eyebrow and Lateral Upper Eyelid
It can quickly correct a brow descent and crowding of the upper lid.
Tail of Eyebrow and Lateral Upper Eyelid
Augmenting the temple and lateral forehead helps significantly in brow lifting.
The Midface
Rejuvenating the midface is focused on restoring the dominance of midface volume.
The Midface
It can be achieved by selectively targeting the deep fat compartments.
Lower Eyelid, Infraorbital Rim and Tear Trough
I must do it concurrently when treating the lower eyelid, infraorbital rim" tear trough," and cheek areas.
Lower Eyelid, Infraorbital Rim and Tear Trough
We can improve skin color by injecting nanofat into the dermis.
The Midface
IAT of the midface transforms the face into a youthful convex platform dominated by unified highlights.
The Midface
It will lessen the appearance of the nasolabial fold, marionette, and jowls and strengthen the mandible.
The Nose Area
Whether deformities are due to congenital, iatrogenic ,or aging, IAT can provide an immediately visible result in the nose.
The Nose Region
The base and nasal dorsum can be augmented for patients with a mild hump, short , saddle, and flat noses.
The Nose Region
The nasal tip can be enlarged, re-contoured, and elevated.
The Lips
My first case of lip augmentation was in 2001
The Lips
IAT should be injected to duplicate the lips' beauty and not simply make the mouth larger or create "sausage-shaped" lips.
LABIO-MENTAL CREASE
Support for the lower lip and chin interface is achieved by restoring the volume of the labio-mental crease area.
Labiomandibular Fold/Crease (marionette)
The marionette fold needs about 2-3 ml of millifat, depending on the atrophy.
The Chin
It can correct age-associated chin volume, projection, vertical height and atrophic appearance of the skin.
The Mandible
IAT of the jawline is advantageous in patients with long faces seeking facial beautification and better overall facial proportion.
The Mandible
Augmentation of the mandible not only delineates the jawline but also seems to borrow skin from the neck, enhancing the cervical mental angle.
Complementary Procedures
More common is the combination with facelift surgery
The combination will effectively address central face soft tissue atrophy.
Complementary Procedures
It improves the appearance of tear troughs, malar eminence, and nasolabial folds.
Breast Lipofilling
Breast Lipofilling
The AT needed is around 40ā50 cc for every quadrant of the breast.
Patients with tight breast are asked to plan for a secondary procedure at least six months later.
Breast Lipofilling
The AT is placed in different directions to achieve a diffuse distribution.
No AT is injected into the mammary glands or in the pectoralis muscles.
Implant Removal and Simultaneous IAT
Lipofilling is indicated for those who suffer from implant complications.
IAT is performed before implant removal.
Breast Reconstruction
In breast reconstruction, IAT has varied indication either as a primary treatment or as secondary procedure.
It provides an option to treat pectus excavatum and irradiated breasts more effectively and conservatively.
Breast Lipofilling
It offers more precision and tailored augmentation than those obtained with silicone implants in tuberous breasts.
Buttocks Lipofilling
Buttocks Lipofilling
Buttock lipofilling allows comprehensive contouring of the entire torso and buttock region.
Buttocks Lipofilling
As with breasts, our main objective is an appropriate volume with a beautiful shape.
Buttocks Lipofilling
The AT is injected only into the subcutaneous planes.
I start deep and walkthrough to the superficial fatty layer.
Hands and Feet Lipofilling
Hands and Feet Lipofilling
Compared with synthetic fillers such as hyaluronic acid, IAT works much better for hand rejuvenation, regarding permanency, regenerative effect, and cost-effectiveness.
Hands and Feet Lipofilling
Immediately after fat grafting, the hands appeared just slightly overfilled.
Lipofilling of the Dorsum of the Foot
Fifteen years earlier, a patient requested to do her dorsum; I searched the literature before doing it and did not find any paperwork.
I applied the same grafting principles to the hands to graft her feet dorsum.
Lipofilling of the Ankles
Another case report done 10 years ago, although I do not recommend ankle augmentation.
Body Contour Deformities and IAT
Body Contour Deformities and lipofilling
Body deformities can be corrected by removing fat from the excess, liposhifting fat into the depressed area, or with IAT
Regenerative and Reconstructive Surgery
Scars, Fibrosis, and Wounds
The adipose tissue is used in scars, fibrosis, and wounds based on its ability to add volume; in addition, the regenerative properties of adipose-derived stem cells (ADSCs)
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Scars, Fibrosis and Wounds
Fat grafting has dramatically changed my practice, mainly in acne scars.
Scars, Fibrosis and Wounds
Initially, I used the Nokor needle to release adhesion and find space to add fat.
Scars, Fibrosis and Wounds
Nowadays, I do not recommend using sharp instruments or multiple skin punctures (microneedling).
Scars, Fibrosis and Wounds
I am trying to avoid indiscriminate tissue trauma and unnecessary bloody recipient site that will adversely affects fat graft intake and survival.
Using a spatula-tipped blunt cannula instead, I can create clean, natural multiple linear tunnels to insinuate fat parcels into a welcomed recipient site.
Scars, Fibrosis and Wounds
I can propose that tunneling is a better way to prepare the recipient site compared to subcision with sharp needles in fat grafting
Scars, Fibrosis and Wounds
I use a spatula-tipped cannula attached to an oscillating power motor if adhesion is extensive
Scars, Fibrosis and Wounds
I am applying the same concept to treat any atrophic depressed scars.
Scars, Fibrosis, and Wounds
IAT decreases the healing time, diminishing scar thickness and allowing for more skin flexibility due to its anti-fibrotic properties.
Scars, Fibrosis, and Wounds
It improves the color and improving the symptoms such as pain or itching.
Scars, Fibrosis, and Wounds
Also, it reduces inflammation and immunoreactions .
I used IAT mixed with PRP to eliminate burning and itchiness and promote healing in a patient suffering from a hypersensitivity reaction to an orthopedic fixation device.
Scars, Fibrosis, and Wounds
In wounds with full-thickness soft tissue loss, adding healthy AT can promote neoangiogenesis and help the granulation and epithelialization of the ulceration.
Scars, Fibrosis, and Wounds
Putting together you can achieve a result beyond all other means.
Dupuytren and Peyronie's Diseases
IAT and breaking the cord of the fibrotic area of Dupuytrenās contracture showed excellent results and minimal recurrence rates.
Would I apply the same treatment for Peyronie's disease?
HEMIFACIAL ATROPHY (PARRYāROMBERG SYNDROME)
IAT is the best option for those suffering from hemifacial atrophy.
Craniofacial Deformities
In other maxillofacial syndromes, lipofilling is necessary as the foremost step in their treatment or as a secondary procedure in the following reconstructive times.
Autoimmune Diseases
It has the same effect on en coup de sabre.
The addition of stromal vascular fraction of At has been proposed to treat the symptoms in the hand of systemic sclerosis and rheumatoid arthritis.
Complications and Complications
Complications and Management
Although fat transfer is considered a safe procedure, there are reports of associated morbidity.
The mild ones are the most common, such as edema, ecchymosis, pain, asymmetries, reabsorption, displacement, hypocorrection, hypercorrection, or hypertrophy.
Severe complications may occur secondary to an infection, injury of anatomical structures, and intravascular injection.
FAT EMBOLISM AND VASCULAR OCCLUSION
Damage to underlying structures (nerves, blood vessels, muscles, and glands) can occur in reconstructive surgery cases because they use sharp instruments in deeper planes.
It is never reported using a blunt cannula.
Complications (Liposuction)
The best way to treat complications is to avoid them.
In large-volume lipofilling, physicians should limit the lipoaspirate to less than 5% of the body weight and treat less than 30% of the body surface in one session.
Complications and Management
Beware of the harms of pervasive industry influence on research, practice, and education in healthcare
Surgeons should take the time to learn the procedure correctly and introduce it into their practice gradually and conservatively.
Evidence Based Medicine
I retrospectively reviewed patients' charts and photos (thousands) who underwent body contouring and IAT procedures in KSA and Egypt between 2002 and 2022.
I assembled my clinical practice, journal publications, and books to provide unbiased, evidence-based medicine and practice data about injectable adipose tissue's benefits and harms.
Evidence-based Medicine
The most crucial consideration for harvesting and refinement in preparation for grafting is to respect and maintain the tissue architecture of living adipocytes.
Evidence-based Medicine
There is no evidence to support the superiority of one processing technique over another.
New commercial systems raised as closed systems have not been a significant advantage over regular "open" systems.
SURVIVAL OF THE IAT
In reviewing the literature, whether IAT is enriched or not, reabsorption of graft is around 40ā50 % of the injected volume.
The Donor-site selection seems unimportant from a cell survival standpoint.
Evidence-based Practice
Lipoextration should be the same whether you are extracting large or small volumes.
Using machine suction or energy-depend liposuction is detrimental to the delicate architecture of adipose tissue.
In regenerative surgery, the hypodermis is a better plane.
Evidence- Based Practice
Processing AT should be the same whether you inject large or small volumes.
In large volumes, I increase the number of the team to re-inject the AT as soon as possible.
When I do regenerative surgery, I choose the lower third of the fatty layer as it contains more stem cells.
Evidence-based Practice
Like AT should be replaced with like (AT).
AT should be placed where AT is and not into the muscles.
Research and The Future
Research and The Future
We need to have a better understanding of the mechanism of how AT survive.
We need studies specifically designed to elucidate the role of adipose-derived stem cells.
Future studies will be needed to understand the role of AT in facial aging and how to fight it.
Conclusion
Based on clinical studies, IAT is an effective and safe operation.
It can be utilized as a stand-alone treatment for an unattractive face.
It has the versatility to be employed with several other procedures to achieve results that exceed the core surgery alone.
Regenerative medicine is heading towards using autologous materials versus allogenic biological products.
We are transferring adipose tissue and not adipocyte