Re-injection

After purifying the mixture (fat and PRF), it is transferred into 1 ml syringes without coming into contact with air. In accordance with Dr Coleman’s technique, the grafted tissue is placed in small amounts with each passage of the nozzle. Cannulae of different forms and lengths are used, all with a smooth stump to limit the risk of haematoma, and with lateral injecting apertures to avoid intravascular injection. It is important to perform much tunnelling. All layers are grafted, starting at the deepest point. The closing of the incisions is carried out using 6-0 sutures.

In isolated lipostructure, there are three main sites of re-injection: the cheekbones, cheeks and chin. Each zone receives, on average, 8 cc per cheekbone, 7 cc per cheek, and 5 cc for the chin.

With multiple lipostructures, on average, an additional 10 cc of the solution is used per temple, 4 cc for the
upper lip, 2 cc for the lower lip, and 3 cc per nasolobial fold. When the fat graft is associated with a cervicofacial lift procedure or blepharoplasty, the graft is always performed last to allow for adjustment and redistribution of volume. Furthermore, this avoids traumatising the transplanted fat tissue during surgery.

Figure 3 PRF is produced using a centrifuge of PC-02 (Process, Nice, France). The result is a fibrin clot rich in platelets. This is cut into small pieces before use

Figure 3 PRF is produced using a centrifuge of PC-02 (Process, Nice, France). The result is a fibrin clot rich in platelets. This is cut into small pieces before use

For the two patients treated via bilateral simple lipostructure, pre-treatment of the graft implantation site with PRF was performed unilaterally only, even if volumes of injected fat on each side were thereafter identical.

The postoperative evolution of patients was followed-up for at least 1 year, with clinical examination associated with photographic analysis. Results of patients having undergone an associated surgery (i.e. face lift, blepharoplasty) are most delicate to analyse. Evaluation of the results is carried out in each area by examining, in particular, the three facial zones that give the best results (i.e. the cheekbone, the cheek and chin).

Preliminary results

The results of procedures such as Dr Coleman’s lipostructure are difficult to evaluate in the absolute, because perception remains subjective. However, in this series of 232patients, all were satisfied with the result and no additional grafting was necessary. If it is difficult to evaluate the amount of fat resorption without performing pre- and postoperative magnetic resonance imaging (MRI). However, it was noted that the reabsorption was insignificant; it was not great enough to require a secondary lipostructure.

In the two patients treated with unilateral PRF, a light aesthetic asymmetry was noticed. Four months postoperatively, one-half of a face treated with PRF appeared more inflated than the other side treated without.

The results of Dr Coleman’s procedure are subjective and operator-dependent. Results are rather unforeseeable and the graft’s stability rate after 3 months varies in the literature. Using PRF with the grafted tissue enabled the author to stabilise the results. It is difficult to demonstrate the results objectively, unless systematically performing MRI on a much larger study of patients with or without PRF.

However, in the author’s research, the contribution of PRF did not necessitate remedial work as the patients were satisfied with the results. Furthermore, the procedure did not result in significant oedema or bruising.

In general, a significant percentage (approximately 10%) of patients present with oedema after the procedure, and approximately 6% will have bruising at 4 weeks post-treatment. In the author’s study, there was no case of an oedema or prolonged bruising. It is possible that the grafting treatment using PRF is the way forward. Indeed, the deposit of a fibrin matrix in the grafted areas makes it possible to induce a better angiogenesis and thus, better vascular and lymphatic drainage. The risks of bruising and oedema may also be reduced. Under-correction is the most frequent complication, which may be owing to an under-evaluation by the surgeon at the time of intervention, or an excess of resorption of the adipocytes.