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a soft centrifugation (400 g/L min [1,000 rpm/L min]) as an width × 15 cm length cannula (Shippert medical, Denver,
alternative following washing of the graft. CO) connected to a biplane luerlok handle attached to a
250 mL Filtron Unit (Shippert Medical, Denver, CO) linked
Both traditional fat grafting and micro fat grafting have
pros and cons. Differential fat harvesting is performed to an surgical aspirator.
in an attempt to obtain the correct fat parcel size for Fat processing was performed through washing in a closed
each target area, expanding the potential uses of fat, and manner with the aid of Filtron device for the thick fat and
allowing for superior homogeneity and aesthetics. manually in an open system for the thin fat extracted.
Facial regional blocks were performed with mepivacaine
METHODS prior to infiltration phase.

Sixty consecutively recruited patients underwent facial Thin fat parcel infiltration was carried out through
fat grafting, between March 2012 and October 2013 in 0.9 mm × 5 cm Tulip injector cannula (Tulip medical,
private practice setting. The procedure was explained in San Diego, CA) in critical areas (temples, periorbital,
detail and informed consents and ethical statements were lips, and nasal) or with needles; 23 G × 30 mm in SNIF
signed for each case. or 27 G × 4 mm in Mesofat technique. Needle was
placed in superficial wrinkles and lines, to enhance
A Torres facial fat grafting record was used to predict corrections at an intradermal plane for deep folds, and
the quantity and quality of the fat to be used in each in cases of strong photo and chrono aging (Mesofat).
case [Figure 1].
When available ASCs filter Mystem (Bimedica SRL, BG, Italy)
Facial fat consumption was estimated taking into was used in combination with fine parcel fat to obtain ASC
consideration: enhanced serum to be mixed with fat prior to infiltration.
1. Fat to be placed in critical areas (periorbital, temples, lips,
nasal) Thick fat parcels were infiltrated using a 1.2 mm × 7 cm
2. Fat for needle placement prediction (sharp needle Tulip cannula in all the other parts of the face. This
intradermic fat [SNIF] grafting or mesofat technique) [7,8] placement was favoured whenever the primary goal was
3. Fat for adipose stem cell (ASC) enhancement estimation volumetric enhancement and when soft tissue envelope
4. Fat for volume enhancement in the rest of the face. was thick.

Super wet infiltration of the donor site was performed with The amount and type of fat injected in each area is
a low dose of lidocaine solution (maximum 20 mL lidocaine summarized in Table 1.
2% in 500 mL saline), trying to infiltrate an equal volume of Parameters analysed were downtime and discomfort, skin
liquid compared to the volume of fat to be removed. [9] benefits, volumetric enhancement, reabsorption rate, and
Following the record, the differential harvesting concept was overall improvement, all of which were recorded using a
applied, where fat was extracted in two different manners. patient satisfaction questionnaire [Table 2], applied at 7 days,
1 month, 3 months and 6 months. Satisfaction scores were
Thin fat parcels (i–iii) were extracted manually with a considered as excellent (15–20 points), good (10–14 points),
six port (0.8 mm each) Tulip Tonnard harvesting 2 mm minor (5–9 points) and poor (< 5 points). Statistical analysis
width × 15 cm length cannula (Tulip medical, San Diego, was performed in Excel 2013.
CA) coupled to a 20 mL syringe.

Thick fat parcels (iv) are automatically extracted with a
Shippert four port (5 mm × 2 mm each) harvesting 3 mm Table 1: Amount and type of fat injected per area
Area Type of Amount of fat
fat injected (mL)
Eyebrow Thin fat 1*
Temples 2*
Lower palpebral medial 1*
Lower palpebral lateral 1*
Lateral canthus 0.3*
Lips 3
SNIF (glabella, lips and NLF) 2
Zygoma Thick fat 2–3*
Malar 2*
Buccal 3*
NLF 1*
Canine fossa 1*
Labiomental fold 1.5*
Mental crease 1*
Total per side 21.8
Figure 1: Torres fat grafting module. It helps to estimate pre operatory Total for full face approach 43.6
fat volumes and type of fat needed for each case, that will command the
differential harvesting and posterior grafting *Per side. SNIF: Sharp needle intradermic fat, NLF: Nasolabial fold
104 Plast Aesthet Res || Vol 1 || Issue 3 || Dec 2014