Combined Approach Can Surpass Face Lift Results

Skin and Allergy News

By Anna Nidecker - Staff Writer

New Orleans - Transtiny amounts of fat plus doing a little bit of laser resurfacing and liposuction can produce consistant long-lasting changes in facial contour, said Dr. Robert A. Yoho, a cosmetic surgeon in Pasadena, California.

This combined technique can produce more natural results than facelifts in some cases, he said at the annual meeting of the American Academy of Cosmetic Surgery.

First, the face should be sculpted with fat transfer and liposuction. Then the skin can be resurfaced with a Coherent UltraPulse CO2 laser.

Getting a consistent result with facial fat transfer depends on how the fat is handled. Harvest the fat gently, spin it in a centrifuge, and transplant it with extremely small 1-cm3 syringes in a stereo-type fashion, Dr. Yoho told the audience.

Dr. Yoho uses tumescent liposuction with 10-cm3 syringes to harvest 150 cm3 of fat from the outer thigh. He uses fat from the thigh because this area has less blood and more fat than other potential harvesting areas. Leaving some air in the syringe also adds the quality of the fat by reducing negative pressure, which can damage the fat.

Retention of fat is better when it has been spun; the harvested fat should be spun in a centrifuge for 3 minutes before transfer. The oil on top and fluid on the botttom can be decanted out of the 10-cm3 syringe before the fat is transferred to smaller syringes for injection.

The final key to consistency is using exceedingly small amounts, Dr. Yoho said. He transfers the spun fat into 1-cm3 syringes, and injects one-third to one-fouth of a cubic centimeter with each pass over a filling area.

He acknowledged that this technique id extremely tedious. "I've used a 3-cm3 syringe, and it goes faster... but then you get little spots of fat that are hard and nodular, and irregular contours."

Dr. Yoho cautioned that facial fat transfer is harder than it looks and requires extensive experience in many cosmetic surgery techniques. Physicians should be well versed in aspects of blepharoplasty and other facial rejuvenation procedures as well before trying fat transfer, he recommended.

As with liposuction, the fat injection passed need to criss-cross and be placed into the face in an organized fashion.

"There's a degree of fussiness and litigiousness [when you are working on faces]... that just isn't there with body work," said Dr. Yoho. "I've personally backed off on the aggressiveness of my facial fat injection."

Some areas of the face are more difficult to treat than others. The forehead andpterygoid fossa are particular problem areas, and including them in the transfer increases transplant time alone to 4 hours.

Dr. Yoho simultaneously selectively liposuctions the jowls, the chin, and other small areas of the face with some excess fat.

Following the liposuction and fat transfer, he resurfaces the patient's filled-out face with the Coherent UltraPulse laser.

"If you do a deeper resurfacing... patients have less discomfort and heal better with a dressing," Dr. Yoho commented. Recovery time can be up to 6 weeks.