String Fat/Dermis Graft for Correction of Wrinkles and Scars

Established creases and wrinkles do not predictably respond to the fat injection technique. The authors describe a minimally invasive yet simple technique to address recalcitrant facial rhytides and minor depressed scars. This technique optimally requires a concomitant procedure whereby suitable fat or dermis graft could be available for grafting without having to make another incision. However, if needed, the graft can be harvested from an easily concealed area such as postauricular sulcus. Preferably, dermis or a combination of fat and dermis is harvested in the form of strings using a pair of straight iris scissors. The sharp end of an 18-gauge needle is then used to create a tunnel in the subcutaneous plane beneath each line while releasing any fibrous bands. The string of dermis/fat is then engaged at the end of the 18-gauge needle and delivered into the subcutaneous tunnel with rotation and advancement of the needle. The authors have used this graft on 49 sites on 39 patients. The mean age of the patients was 57.6 years, with eight male and 31 female patients. The sites included rhytides in upper and lower lips, oral commissure, labial mental groove, and frown lines, and scars in the forehead, nasal dorsum, nasal tip, and eyebrows. String fat grafting is a simple and reliable method to address limited rhytides or depressed scars. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, V.