Validation of a New Standarized Anatomic and Regenerative FAT Grafting: Dynamic Photometric Evaluation from 1-19 Months
Facial fat grafting has become increasingly popular. In 1998, Coleman standardized the technique. In 2001, stem and regenerative cells were identified in fat. In 2007, Rohrich and Pessa pointed out the different anatomical fat compartments above and below the muscles and Lambros has helped us understand facial aging as both a gradual loss of facial volume from fat atrophy, bone resorption and gravitational shifts. With the new understanding of the regenerative effects of fat along with our improved understanding of the anatomical changes that occur with aging, a new standardized facial fat grafting protocol was developed that incorporated anatomical replacement of fat with skin and tissue regeneration (ITR2).
Methods/Technique
:We previously published our results in patients ITR2 in combination with deep plane facelift and showed for the first time, progressive improvement in facial volume 18-24 months after the procedure. The technique consists of injecting 3 types of fat grafts- a more structural fat graft is placed in the deep fat compartments and in areas of bone loss; a microscopic fat is grafted into superficial compartments and a cell optimized nanofat is grafted by cannula, injected intradermally, microneedled intradermally and compounded with a liposomal transport agent and used as a biocream 2 times a day for 3 days after the procedure. To objectively evaluate the dynamic changes that occur in facial volume after ITR2 fat grafting without a facelift, the same midfacial zones in 29 patients age 38 to 70 years, (average=52.9 years) were prospectively evaluated using 3D Photometric Imaging (Canfield Scientific Inc., Parsippany, NJ).
Results/Complications
:In the 29 patients, 3D analysis of facial volume improvement over pre-operative measurements averaged 56.6% at the 1–3-month range. By 4–7 months, improvement in midfacial volume dropped to an average of 32.1%, and thereafter steadily increased to 46.6% by the 8 – 13-month period, leveling off at about 52.3% by 14-19 months. When separating patients based on age (above and below 55 years), two different trends were observed. Patients under 55 years of age exhibited the same dynamic changes that the collective analysis demonstrated, but to a greater extent. The facial volume initially declined, reaching a nadir at 6 months, but later increased to an average of 75.3% of original fat injected), peaking at around 14 months (range, 7-19 months). Patients above 55 years of age exhibited a linear decay beginning with an initial average volume improvement of 60.6% and steadily declining to 29.5% by the 14-19 month range. The curves remained statistically valid regardless of the amount of fat grafted. Patients’ weight change over the time of the study was negligible, with an average of 0.31 pounds gained postoperatively.
Conclusion
:Isolated fat grafting using a standardized approach of anatomic fat replacement and regeneration based on topographic evaluation in patients under 55 showed dynamic improvement in facial volume over the 19 months of study. Patients over 55 who underwent fat grafting alone using the ITR2 technique showed similar improvement in facial volume in the initial phases, but gradually declined to around 30% improvement at 19 months. To our knowledge, this is the first study to evaluate dynamic changes of fat grafting at different post-treatment intervals and the first to show progressive improvement in facial volume 19 months after treatment in patients 55 years or younger using a new standardized approach.