Operations involving manipulation of the body's own adipose tissue are becoming the most common in plastic, reconstructive and aesthetic surgery today.
Against the fact that lipofilling is a multi-session procedure, statistics confirm its significant popularity and high patient satisfaction.
The range of lipomodeling technologies is becoming wider due to scientific and technological progress. So, today they include liposuction, lipofilling, various types of lipolysis, the use of multipotent adipose tissue stromal cells, growth factor preparations, as well as ultrasound techniques and combinations of technologies.
This review was prepared by: Andrei Petakh PhD, plastic surgeon
Perlyna Plastic Surgery Clinic, Kyiv
plastic surgeonPerlyna Plastic Surgery Clinic, Kyiv
Lipofilling - the connection of the past and the present
Since the second half of the 19th century, autolipotransplantation has been used by well-known European surgeons such as Gustav Neuber, Victor Cherny, Erich Lexer to eliminate tissue defects, compensate for the asymmetry of certain parts of the head and body of various origins, treat scar contractures, including palmar fibromatosis.
In its modern form, lipotransplantation technologies gained popularity again in the 80-90s of the last century – after the development of syringe liposuction, standardization of the method of processing and injection of adipose tissue Pierre Fournier, Yves-Gerard Illouz, Abel Chajchir, Sydney Coleman.
The latest technology improvements have been related to minimizing injury to adipose tissue during aspiration, maintaining its viability during processing, and improving the conditions for the survival of the injected tissue volume.
Why standardization of lipofilling techniques is necessary
The generally accepted standards of lipofilling as a technology were established in the 80s of the last century by the work of Sydney Coleman. Researchers have proven that gentle aspiration should be done with a syringe.
The treatment of cells during washing should be as minimally traumatic as possible, and the introduction of adipose tissue should be carried out by the tunnel method, without the formation of cavities. The use of platelet-rich plasma improves the engraftment of fat autografts.
At the turn of the 20th century, a number of observations recorded an improvement in the quality of integumentary dystrophic post-burn changes in tissues as a result of the therapeutic manifestation of lipofilling.
However, all these theses are being tested today, they require modern scientific justification, they need to be optimized and improved. Nowadays, fat grafting is increasingly a natural alternative to commercial fillers when compensating for soft tissue deficits or when volume is needed.
The statistics confirm the popularity of lipomodelling: according to ISAPS in 2009, lipofilling was used in 5.9% of cases of aesthetic procedures performed.
Liposuction procedure for a perfect figure? From a banal plastic surgery, the use of one's own adipose tissue has turned into a full-fledged transplantation technology, where recipient conditions for tissues, the technique of "collecting" and "preparing" the graft, the possibility of storing and optimizing grafts, postoperative care, etc. are studied.
The study of new possibilities of lipotransplantation becomes relevant, when the advantages of lipofilling are enhanced by the action of adipose tissue stem cells, when the use of body growth factors becomes possible.
Techniques for protecting grafts are of particular importance. The influence of individual local anesthetics on the survival of adipose tissue cells is being studied.
The data on engraftment of fat grafts published today – from 40% to 80% of the transplanted volume - indicate the lack of standardization of autolipotransplantation technology.
At the same time, the alternative results of lipofilling operations, in 70-90% of the survival of tissue transplantation, do not allow one to give preference to one or another technique for collecting adipose tissue, preparing it for transplantation, and other factors accompanying engraftment.
The technique of introducing adipose tissue and caring for recipient areas, optimizing donor sites also differ in different reports. Nevertheless, despite the possible problems with engraftment of fat grafts and the need for repeated lipofilling procedures to achieve the desired result of soft tissue deficiency compensation, a number of authors note a high percentage of patient satisfaction after lipomodelling.
Laser liposuction is a popular "novelty" in aesthetic medicine. Lipofilling and standardization: why is it so important
Analysis of literature reports, articles, presentations indicates the absence of autolipotransplantation standards that could unite surgeons or clinics into groups according to similar technology options.
Strategic differences in the parameters of operations speak to the relevance of research aimed at developing standards.
In their communique, the American Association of Plastic Surgeons, the American Association of Aesthetic Plastic Surgery noted: stem cells have the ability to secrete growth factors that promote healing and tissue regeneration.
Stem cells can differentiate when injected into damaged tissue cells.
The works of Bill Futrell, Gino Rigotti, Ricardo Mazzola proved the effectiveness of the regenerative potential of autolipografts. This is due to the discovery in their composition of multipotent stromal cells of adipose tissue, the so-called stem cells. Moreover, the ability of these cells to migrate to the foci of damage to body tissues, the ability of their differentiation into various types of tissues has been discovered and proved.
Lipofilling of the hands: recommendations for the procedure
This opened up new possibilities for compensating for the deficiency of not only soft tissues, but also supporting structures. That is why the list of nosologies that are included today in studies on the prospects for the use of autolipofilling is replenished not only with soft tissue defects, but also with cicatricial transformations and contractures, flap prefabrication technologies.
In the treatment of chronic trophic ulcers, lymphatic and ischemic tissue insufficiency, the introduction of own adipose tissue in combination with platelet-rich autoplasma is increasingly being used.
Despite the accumulated experience of lipofilling and lipomodelling, the issues of standardization and optimization of the method of collecting and processing adipose tissue, visualization of its engraftment, development of indications and contraindications for operations, systematization and evaluation of treatment results, etc. are topical today
Source estet-portal.com
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