Lipografting: autologous fat grafting for total facial rejuvenation

Surgeons who perform facial rejuvenation procedures have long recognized the importance of volume enhancement. The primary manifestation of aging is loss of subcutaneous tissue, especially the atrophy of fat, which directly contributes to laxity of skin. Autologous fat transplantation has been attempted for over a century with varying degrees of success but more recent techniques have provided more predictable, reproducible, and even permanent results. Fat is an ideal tissue filler substance because it is living tissue and because it is from the patient's own body it is nonallergenic. My technique has evolved over an 11-year period in more than 1800 patients. The procedure can be performed alone as a total facial rejuvenation or in combination with facelift or other facial surgery. The technique requires minimally traumatic fat harvesting, fat preparation, and multilevel facial infiltration. Excess fat not used in the initial procedure is frozen and stored at -16 degrees C and can be used successfully for minor touch-up procedures. Preoperative evaluation of the patient and their understanding of the benefits and limitations of volume restoration surgery is imperative. Structural improvement to the main support areas of the face in the appropriate aesthetic proportions is of prime importance.