Facial lipofilling: lips, dark circles, wrinkles

Re-injecting one’s own fat is what defines lipofilling, also called liposculpture, which has developed considerably since the late 1990s.

Yet surgeons had always attempted this manoeuvre, with failure rates so high (almost complete resorption of the injected fatty tissue) that the technique itself had been discredited. The reason was a lack of biological understanding of the fragility of fat cells, almost all of which do not survive the suction and re-injection process, unless the protocol developed by Coleman (USA) is followed: very gentle liposuction, low-speed centrifugation, and re-injection with fine cannulas into multiple subcutaneous micro-tunnels.

Thanks to this protocol, a survival rate of the injected tissue close to 70% can be achieved. Despite these strict rules, the survival of this true fat graft remains unpredictable and depends on many factors: age, smoking, blood supply of the recipient site, history of radiotherapy, and the quantity of fat re-injected, as too large a quantity is detrimental to its own survival in the recipient site.

These various parameters make the face an exceptional recipient site because, in addition to the fact that facial ageing is accompanied by a loss of fat in the upper cheeks and cheekbones, the blood supply is excellent and the quantities injected need only be minimal.

It is on this last point that the use of the technique differs from what was initially proposed in the United States, where some suggested rejuvenation by injecting fat alone into the face (far too much!), with results so excessive that they are unacceptable in European practice, where the rule is discretion of the final result.

It is therefore most often in combination with a facelift that this procedure will be offered. The harvest (minimal liposuction) is taken from the inner knees or the lower abdomen, only a few millilitres being needed for re-injection, most often into the cheekbones or cheeks, which restores a very natural appearance through a moderate increase in volume while reducing the need for traction during the facelift.

Nevertheless, this fat re-injection can be performed in combination with eyelid surgery alone, if the state of the face does not yet call for a facelift, or on its own, in a patient who has only an isolated loss of fat in the cheekbones. In the latter case, bruising is practically absent, and there is only an initial swelling, more or less pronounced, which may last a week. This may be combined with a slight initial over-correction, since a loss of at least one third must be anticipated. The final result is visible 3 to 6 months after the procedure, resorption being the main problem in the long term.

Recent advances in biological knowledge of fat transfer help to explain, to some extent, why injecting fat under an old scar improves its appearance, since cells with regenerative capacity are naturally present in fatty tissue. These properties are increasingly exploited throughout reconstructive surgery, for breast reconstruction, in the treatment of the after-effects of trauma, to restore the quality of irradiated tissues, and therefore quite naturally find their place in cosmetic rejuvenation surgery.