Discussion: An Analysis of the Experiences of 62 Patients with Moderate Complications after Full-Face Fat Injection for Augmentation

Complications Associated with Facial Autologous Fat Grafting for Aesthetic Purposes: A Systematic Review of the Literature

Background

With the increasing demand for aesthetic procedures, autologous fat grafting (AFG) seems to be an attractive option for facial volumization and rejuvenation. The aim of this study was to assess the type and severity of associated complications after facial AFG for aesthetic purposes.

Methods

The entire PubMed/Medline and Cochrane databases were screened to identify studies describing complications that occurred after the injection of autologous fat into the face. These complications have been reviewed and analyzed according to their occurrence and severity in the different anatomical regions of the face.

Results

Twenty-two articles including 38 patients reported on a total of 58 complications. Thirty-two complications have been classified as severe or permanent, including hemiplegia (n = 11), loss of vision (n = 7), or skin necrosis (n = 3). The other 26 complications were classified as mild or transient, such as lipogranuloma (n = 12) or mycobacterial abscess (n = 2). The majority of complications were reported after injection to the forehead (n = 26) and the temporal region (n = 21). Interestingly, this location seems to be the area at risk because 53% of all severe complications occurred in this anatomical region.

Conclusions

AFG to the face is associated with a low incidence of complications, but if they occur, they can be dramatic, particularly in the forehead and temporal region. Nevertheless, AFG can be used to correct age-related changes of the face and volume loss and may represent an alternative to synthetic fillers. Therefore, AFG to the face should be performed by qualified doctors under careful consideration of risks and facial anatomy.

Autologous Adipose-Derived Tissue Matrix Part II: Implantation Biology

BACKGROUND

In part 1 of this study it was shown that liposuctioned fat could be a sufficient source of autologous collagen for use as a filler or in reconstruction. The collagen composition in liposuctioned fat was shown to form a cross-linked helical matrix composed of types II, III, and IV. Additionally, viable adipocytes and fibroblasts among other cells were found.

OBJECTIVES

The purpose of this research was to study the biology of this matrix after subsequent implantation compared to Juvederm (Allergan, Parsippany, NJ) common soft tissue filler.

METHODS

Fat was obtained from individuals undergoing routine liposuction and was processed by a two-step process to obtain a connective tissue matrix. The matrix was then cryo-frozen for a minimum of 4 weeks after which it was thawed and implanted in 46 nude mice. Juvederm Ultra was used as the control article and the animals followed for one year.

RESULTS

Liposuctioned fat was obtained from 10 individuals and processed as previously described. Mice were harvested at 3, 6, 9, and 12 months and histology obtained. There were no adverse effects from either article and the bio-reactivity rating was 0. The implanted collagen compared favorably to Juvederm at all stages and was found to be replaced by new collagen and fat.

CONCLUSIONS

A collagen matrix with viable cells for autologous use can be obtained from liposuctioned fat which has been processed and cryo-frozen. The material lasts at least one year and is slowly replaced by new collagenand fat.

LEVEL OF EVIDENCE

5.