아름다운나라 성형외과 Facial Contouring and Rejuvenation with the Use of Fat Injection 아름다운나라 성형외과 김진영

아름다운나라 성형외과 Plastics for Soft Tissue Augmentation Gold Silver Rubber Paraffin Silk Silicone Injectable silicone BioPlastique Collagen Goretex Alloderm Polymethylmethacrylate Polyacrylamide Hyaluronic acid

아름다운나라 성형외과 History of Free Fat graft 1893 Neuber : depression of scarred area  tiny fat parcels transplantation  successful take rate depend on the size of the fragments 1910 Lexer : depression after zygomatic arch fracture  fat tissue block transplantation  importance of atraumatic technique 1950 Peer : 50% survival rates in the free fat transplants  neovascularization occurs after 4 days

아름다운나라 성형외과 Development of Fat Injection 1977 Illouz : Advent of liposuction 1981 Fournier : Syringe liposculpture 1986 Coleman : Lipostructure

아름다운나라 성형외과 Survival of Transplanted Fat Cell Host Replacement theory Cell Survival theory

아름다운나라 성형외과 Experimental study of Fat cell survival 1993 Carpaneda : adipose graft viability study Transplanted fatty tissue should be within 1.5mm of living, vascularized tissue for optimal survival.

아름다운나라 성형외과 Analysis of Lipocyte viability after liposuction (1) - Matthew J. Concannon, M.D., University of Missouri - Case : 16 women, 4 men ( age yrs ) - Centrifugation 10, 30, 50, 100g 2, 4, 6, 8 min interval - Number of viable cells in top, middle, and bottom layers of the fat segment

아름다운나라 성형외과 Analysis of Lipocyte viability after liposuction (2)

아름다운나라 성형외과 Analysis of Lipocyte viability after liposuction (3)

아름다운나라 성형외과 Applications of Fat Injection ▶ Face ▶ Hand dorsum ▶ Breast ▶ Hip ▶ Liposuction Complication

아름다운나라 성형외과 Effects of Fat injection in the face Facial recontouring : tired, sad  healthy, attractive, softening strengthen, straighten the nose voluminous lip, chin, forehead Facial rejuvenation restore fullness of youth

아름다운나라 성형외과 Fat Harvesting sites ▶ Abdomen ▶ Medial thigh ▶ Lateral thigh ▶ Medial knee ▶ Buttock ▶ Upper arm

아름다운나라 성형외과 Fat Injection solution Ringer’s lactate solution Lidocaine 2% Sodium bicarbonate 8.4% Epinephrine 1: cc cc 3 cc 0.3 cc

아름다운나라 성형외과 Recipient sites preparation Block anesthesia : Supraorbital nerve Trochlear nerve Infraorbital nerve Mental nerve Local anesthesia

아름다운나라 성형외과 Techniques of Fat Harvesting - Gentle manipulation - Avoid high negative pressure - Syringe liposuction - Blunt tipped cannula 3mm diameter - 10cc Luer-lock syringe

아름다운나라 성형외과 Techniques of Fat Transfer and Purification - Minimal air exposure - Removal of nonliving components (anesthetic solution, blood, oil,..) - Avoid washing, filtering, or straining - Sedimentation and Centrifugation 3000RPM, 2 min

아름다운나라 성형외과 Techniques of Fat Injection - Maximize contact with recipient vascularized tissues - Minimal positive pressure - Blunt tipped cannula 2mm diameter - 1cc Luer-lock syringe - Linear deposition of fat with each withdrawal of infiltrating cannula passes injection per 1ml - Layered injection of fat parcels - Slight overcorrection

아름다운나라 성형외과 Reinjection and Frozen storage of fat - Better results in 2nd and 3rd injection  increase of neovascularization in 1st injection - Frozen storage at –20 o C  inhibit enzymatic activity, free radical, oxidation, bacterial growth  block fat cell degradation

아름다운나라 성형외과 Complications of Fat Injection Prolonged edema Under-correction Over-correction Infection Necrosis Irregularity Hyperpigmentation Fat embolism

아름다운나라 성형외과 Fat Embolism in Fat Injection - MCA occlusion  Cerebral Infarct - Retinal or ophthalmic artery occlusion  Blindness - Cause : Acute increase in local pressure Well vascularized tissue Pretraumatized tissue Periorbital area Damaged facial vessels

아름다운나라 성형외과 Cases

아름다운나라 성형외과 Results of Fat Injection A frequent question asked about fat grafting is, "How much of the grafted fat will survive?" I do not know. I know that 10 cc of fat has one result in the dorsum of the hand, 20 cc has another, and 30 cc has still another. My concern is to have the grafted fat survive evenly and predictably. - Sydney R. Coleman

아름다운나라 성형외과 Conclusion Fat Injection is natural long-lasting method of soft tissue augmentation, especially in the facial contouring and rejuvenation. But attention must be paid to the nature of fatty tissue.