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Fat injection or fat transplant as it is called by the plastic surgeon is becoming very popular these days and is the hottest topic in aesthetic meeting. Not only it is useful in the face but also it is used in the breast and the buttocks. It is a filler that can correct the depression anywhere in the body following lost of tissue caused by trauma. I would like to discuss the use of fat injection in the face. With aging there is a loss of facial volume in certain areas caused by loss of fatty tissue. It is therefore quite logical that the right material to restore this loss is fat itself from other areas of the body. The loss of volume exists on deep compartments which are close the bony structure as well as superficial compartments which are close to the skin. It is therefore imperative to augment the deep compartment as well as the superficial ones. In aging there is loss of volume as well as tissue laxity caused by gravity effects. Improving the tissue laxity is done by surgical approach of face lifting. By doing so, we still did not correct the loss of volume, therefore we do not achieve optimal results in rejuvenation. Not to mention that restoring volume by fat injection is most of the time more effective than correcting the tissue laxity by surgery. Furthermore, by restoring the volume loss with fat injection we also improve the skin laxity, eliminating the need for facelift if skin laxity is moderate. I prefer to restore volume in the deep compartments at the same session with the superficial one. The most important thing in fat injection is the location in the volume of fat to be injected. We all know that there are many fillers on the market that are available and ready to use in a sterile syringe. But in contrast to fat injections they are all temporary and require repeated injections everyone one to two years. Which is a great financial burden on the consumer. Fat injection is done properly lasts for years. Another advantage for the fat injection is rare appearance of echymoses (black and blue) at the injection site due to the use of cannulla which has a blunt tip. Before we get to the artistic placement of the fat in the face I'd like to describe the procedure which is one under local anesthesia and is well tolerated by the patient. Having done close to 4,000 proceedures with high satisfaction rate help me to continue being conservative because it is easier to add more fat if needed than take excess of fat out. The fat injection not only can restore youthful look but also can enhance the patient look. After restoring the volume comes the next step to decide where to inject in order to enhance the look of the patient. Here come the artistic eye of the surgeon into action. There is significant differences between men and women. In men, the surgeon needs to be conservative, avoiding augmenting the cheeks and concentrating on the nasojugular, nasolabial grooves and improve the jawline and the chin if necessary. In women, cheek augmentation is very useful for restoring a youthful look at the same time enhancing it. A surgeon must be conservative in cheek augmentation if the chin is deficient unless the chin is augmented at the same time. Also, a decision must be made if there is need to augment the submalar, malar area or both. Extending the augmentation laterally in the side should be minimized in wide face individuals since it may create a even wider face that is not desired. On the other hand, on narrow faced individuals, it will be desired to augment the cheeks laterally together with the submalar area to create more balance and harmony in the face. With aging, the areas that need to be augmented 1. temple area,, 2, nasal jugular, 3. malar, 4. sub malar, 5. nasal labia, 6. marionette lines, 7. medial cheeks (lateral to the nose), 8. pre jowl area, 9. lips. The treatment is individual and is tailored to each patient differently. A different patient requires a different and different volume. The decision needs to be done by plastic surgeons only who are familiar with the anatomy, have artistic eye and able to treat unfavorable results. Most patients do not want to look different but to refresh their look. Therefore conservative approach is the key to success. If there is a need for a touch up, it performed not before three months until the injected fat is settled. Occasionally I see new patients in my office that have fillers or fat injections on their face claiming that they looked better before the injection. The reason for that is poor decision on the location and the amount injected. Therefore, there is a need for careful analysis of the patient's face and demonstrating the improvement to the patient in front of the mirror. When analysing the need for cheek augmentation, a surgeon must look at the oblique few of both sides of the face and take into consideration the length the height and the width of the face, and the degree of the nasal and chin prominence. Uppe lip augmentation should be conservative, if upper jaw (maxilla) is prominent, or the lips are wide. At the same time the "M" shape of the upper lip should be preserved. Augmentation of the lower lips is advisable if the chin is prominent. In the prejowl area a common concern to women age 40 and up, a decision should be made whether to fill the pre jowl area or to proceed with the mini lift procedure. If the jowl are prominent enough to create a square face look then the preferred approach is facelifting in order to restore the triangular youthful look. It is not surprising that many patients opt for non surgical rejuvination. Many times, volume restoration by fat is so impressive that can make the surgical approach unnecessary. Fat injection is no role in improving neck skin laxity. I normally combine my facelift procedure with fat injection therefore correcting the laxity of the skin and the loss of volume at the same time. In summary, fat injection possess a major role in facial rejuvenation and enhancement performed on young individuals. It is an enhancement for young individuals and rejuvenation tools for older ones. Restoring their youth. The procedure performed under local anesthesia and patient may return to work the next day!! There is minimal discomfort and swelling and is affordable. Also every adult person may benefit from fat injection and is a preferred form of filler than the artificial ones. For wrinkles only the artificial fillers are still the treatment of choice. It is imperative that fat injection is performed by experienced surgeon in the procedure and must be done in sterile fashion like any other surgical procedure. About the Author Dr. Yoel Shahar Natural Look Institute 903 Park Avenue (corner of 79th Street) New York, NY 10021 Tel:(212) 717-4066 Email: info@naturallookinstitute.com http://www.naturallookinstitute.com http://www.facebook.com/naturallookinstitute https://twitter.com/nlinstitute
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