| ?Objective?To summarize the clinical experience of combined application and layered injection of multiform autologous fat(granular fat,Nanofat,SVF-gel)in facial rejuvenation,and explore the proper fat transplantation method.?Methods?40 cases of beauty seekers who received combined application and layered injection of multiform autologous fat from December 2017 to December 2018 in the plastic and cosmetic department were selected as the research objects.Small incisions was made and low negative pressure suction was used to suck fat from on both thighs of the beauty seekers,and the fat was treated by a unified preparation method to prepare multiform fat grafts: granular fat,Nanofat,SVF-gel.The combined layered injection technique was used to carry out fat transplantation on the face of the beauty seekers.The details was that: granular fat was injected into the superficial and deep of the facial superficial musculoaponeurotic system(SMAS),and the superficial layer of the periosteum.Such as the superficial layer of frontal periosteum,temporal deep fascia and fascia parotidea masseterica in cheek,and the deep fat ventricle layer of middle face and the surrounding around piriform aperture.SVF-gel was injected into subcutaneous fat layer or superficial fat chamber layer,such as frontal subcutaneous fat layer,temporal and cheek subcutaneous fat layer,nasolabial groove superficial fat cushion,etc.Nanofat was injected into the dermis and subdermis,mainly around the eyes,mouth and facial wrinkles area.Fat injections in different subunits of face are slightly different.The thickness of subcutaneous soft tissue in the predetermined position of the forehead was measured by B-mode ultrasonography before operation,one week after operation and three months after operation,and the fat retention rate was calculated.VISIA skin testerwas used to detect the facial skin texture,including spots,wrinkles,pores,textures,ultraviolet spots,red distribution,brown spots,purple matter and so on,and the related values of facial skin characteristics of beauty seekers were collected before and after 3months,and statistics and analysis were made.According to Pitman's criteria for cosmetic surgery and Likert Scale 5-grade scoring method,the post-satisfaction of the beauty seekers was followed up.By combining preoperative and postoperative photographs,other cosmetic doctors,that didn't take part in the operation,evaluated the postoperative results of the beauty seekers.SPSS 23.0 software was used for statistical analysis.?Results?All the beauty seekers received a surgery that combined application and layered injection of multiform autologous fat was performed in facial,in which the amount of granular fat injection was about 30~60ml,the dosage of Nanofat was about 8~12ml,and the injection volume of SVF-gel was about 10 ~ 15 ml.The total amount of multiform autologous fat that injected was about 50 ~ 70 ml.Higher postoperative satisfaction was received and no significant long-term complications were observed.1.Measurement of frontal fat transplant retention: The mean and standard deviation of the frontal subcutaneous soft tissue thickness(mm),before operation,one week after operation and three months after operation,and the preservation rate of frontal fat transplant was calculated.The mean and standard deviation of the preoperative frontal subcutaneous soft tissue thickness are: 3.91±0.77;One week after operation: 9.14±1.53;three months after operation: 7.37±1.44;the difference between one week after operation and before operation: 5.23±1.10;the retention rate:0.670±0.153.That is,the average retention rate of frontal fat transplant in this clinical application is about 67.0%.We used paired t-test for statistical analysis.The value of T was-30.07 before and one week after operation,and-20.9 before and three months after operation,respectively.The results were all P < 0.001.There were significant differences in the value of T before and one week after operation and three months after operation.2.VISIA skin tester: Facial skin texture was detected by VISIA skin tester before and 3 months after operation.3 months after operation,wrinkles,textures and brown spots in the face of the beauty seekers were significantly improved,and the absolute score was significantly lower than that before operation.And the difference was statistically significant(P < 0.05).The absolute score of the pores decreased compared with preoperative,but the effect was not obvious.There was no significant difference between the preoperative and postoperative(P>0.05).There was no significant improvement in spots,ultraviolet spots,red areas and purple matter before and after operation(P > 0.05).3.Postoperative satisfaction survey: Among the 40 beauty seekers in this clinical application,the satisfaction with the improvement of facial contour was higher.34(85%)were satisfied and very satisfied,while one of the unsatisfied beauty seekers indicated excessive fullness,which affected the appearance.And others indicated failure to meet expectations.The satisfaction of the skin texture improvement satisfaction survey was acceptable.28(70%)were satisfied and very satisfied,the main reasons for the dissatisfaction are poor skin texture improvement,color sink and yellowing after operation.35(87.5%)were satisfied with the satisfaction survey of surgical complications.Surgical complications are less,mainly for postoperative pain,small incision scar and local color formation.4.Evaluation of plastic effect by doctors: Postoperative results were satisfactory,including 72.5% improvement of contour,22.5% effective,5% ineffective,and 95%total effective rate.Skin texture improvement is 55% effective,32.5% effective,12.5%ineffective,and the total effective rate is 87.5%.No long-term complications were observed.?Conclusion?The combined application and layered injection of multiform autologous fat in face has the functions of increasing the volume of facial soft tissue,adjusting the contour of the face,improving the texture of the skin,and preventing of complications such as unevenness in the injection area effectively.Beauty seekers has high postoperativesatisfaction.And it has a good effect of facial rejuvenation.Good clinical results,few complications and high safety make it easy to popularize and apply. |
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