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One more big evolution in the field of BC has been also   safe  procedure  and trying  to  reduce at  least  the  use
            given by the structural fat graft.                of prothesis: “less is more” and “don’t throw anything
                                                              away”  seems  to be  paradigmatics.  An  appropriate
            Fat grafting  is  characterized by  a simple  concept, fat   preoperative plan is mandatory to get the best! However,
            removal where it is in excess and re-injection of it in areas   surgeons have also to encourage patients, after BC, to
            that  need  to be  augmented:  also with  this  technique   have an healthy life style, get sport and follow a right
            “don’t throw anything away”!                      dietary; only with a good surgeon and a good patient,
                                                              unbelievable result can be achieved!
            However, fat grafting isn’t a “novel technique”; in 1912,
            Joseph,  a German surgeon, for the first time published   Financial support and sponsorship
                  [13]
            photographic documentation of natural appearing   Nil.
            changes after infiltration of fat into 2 patients with facial
            lipoatrophy; in 1926, Miller  described his experience   Conflict of interest
                                   [14]
            with infiltration of fatty tissue through cannulas on 36   There are no conflicts of interest.
            cases correcting cicatricial contraction on the face and
            neck; however, this technique never became widely used.  REFERENCES

            In  the  1980s, Illouz [15,16]  described great  results   1.   The American Society for Aesthetic Plastic Surgery. Cosmetic Surgery
            for iatrogenic liposuction deformities and facial     National  Data  Bank  Statistics. Available from:  http://www.surgery.org/
            lipodystrophies,  although his  later  reports were   sites/default/files/Stats2015.pdf. [Last Accessed on June 20, 2016].
            discouraging and claimed that grafted fat had a survival   2.   Callia WEP. Dermolipectomia abdominal. Sao Paulo, Brazil: Carlo Erb;
            similar  to that  of injectable  collagen. Later  on similar   3.   1963.
                                                                  Cardoso  de  Castro  C,  Salema  R,  Atias  P,  Aboudib  JH  Jr.  T
            results  were  reported by  Ersek  et al. [17,18]   for first  and   abdominoplasty to remove multiple scars from the abdomen. Ann Plast
            then by Ellenborg,  both had disappointing results that   Surg 1984;12:369-73.
                           [19]
            discouraged  plastic surgeon on this technique, even   4.   Dillerud E. Abdominoplasty combined with suction lipoplasty: a study
            when a few years later, both of them,  changing their   of complication, revisions, and risk factors in 487 cases. Ann Plast Surg
                                                                  1990;25:333-8; discussion 339-43.
            fat processing  technique  reported long term  results  if   5.   Pitanguy I. Abdominoplasty: classification and surgical techniques. Rev
            fat grafting. Only in the 1990s, thanks to the American   Bras Cir 1995;85:23-44.
            plastic surgeon Coleman,  who firstly described and   6.   Huger WE Jr. The anatomic rationale for abdominal lipectomy. Am Surg
                                  [20]
            codified the technique called  “structural fat graft”, fat   7.   1979;45:612-7.
                                                                  Matarasso A.  Liposuction  as  an  adjunct  to  full  abdominoplasty.  Plast
            grafting gained popularity; although not all the surgeons   Reconstr Surg 1995;95:829-36.
            use the technique described by Coleman,  fat grafting is   8.   Saldanha OR, Pinto EB, Matos WN Jr, Lucon RL, Magalhães F, Bello EM.
                                              [20]
            performed routinely in plastic surgery, often and often as   Lipoabdominoplasty without undermining. Aesthet Surg J 2001;21:518-26.
            ancillary procedure in body contouring.           9.   Saldanha  OR,  De  Souza  Pinto  EB,  Mattos WN  Jr,  Pazetti  CE,  Lopes
                                                                  Bello  EM,  Rojas  Y,  dos  Santos  MR,  de  Carvalho  AC,  Filho  OR.
                                                                  Lipoabdominoplasty with selective and safe undermining. Aesthetic Plast
            Although some question the long-term survival potential   Surg 2003;22:322-7.
            of fat transfer, nowadays there are hundreds of papers   10.  Saldanha  OR.  Lipoabdominoplastia.  1st  ed.  Rio  de  Janeiro,  Brazil:  Di-
            outlining  how  great  is  this  surgical  procedure,  with  a   Livros; 2004.
            resorption that tends to be uniform in the first 3 to 6   11.  Saldanha  OR.  Lipoabdominoplasty.  1st  ed.  Rio  de  Janeiro,  Brazil:  Di-
                                                                  Livros; 2006.
            post operative months; in fact patient are told that the   12.  Aly AS.  Body  Contouring  after  Massive Weight  Loss.  St.  Louis,  MO:
            final results are not fully evident until that time and, if   Quality Medical Publish-ing, Inc; 2005.
            at that time they desire further augmentation, this can   13.  Joseph M. Handbuch der kosmetik. Leipzig: Veit & Co.; 1912.
            be repeated, since patients looking for BC procedures   14.  Miller C. Cannula Implants and Review of Implantation Techniques in
                                                                  Esthetic Surgery. Chicago: The Oak Press; 1926.
            frequently have multiple areas of lipodystrophy that may   15.  Illouz YG. The fat cel “graft”: a new technique to fill depression. Plast
            necessitate additional procedures. [11]               Reconstr Surg 1986;78:122-3.
                                                              16.  Illouz YG. Present results of fat injection. Aesthetic Plast Surg 1988;12:175-81.
            However, even fat grafting is only one of the thousands   17.  Ersek RA. Transplantation of purified autologous fat: a 3-year follow-up
                                                                  is disappointing. Plast Reconstr Surg 1991;87:219-27; discussion 228.
            refinements  that  have been  described in  BC in  last   18.  Ersek  RA,  Chang  P,  Salisbury  MA.  Lipo  layering  of  autologous  fat:
            century…                                              an  improved  technique  with  promising  results.  Plast Reconstr  Surg
                                                                  1998;101:820-6.
            This surgery is changed a lot in last years, is changing   19.  Ellenborg R. Free autogenous pearl fat grafts in the face: a preliminary
                                                                  report of a rediscovered technique. Ann Plast Surg 1986;16:179-94.
            now, year after year, and will also changes a lot in the   20.  Coleman RS. Structural fat grafting: more than a permanent filler. Plast
            future, fundamental concepts are represented by doing   Reconstr Surg 2006;118:S108-20.







            272                                                              Plast Aesthet Res || Volume 3 || August 12, 2016
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