Lipostructure

As soon as the first liposuction was performed, Plastic Surgeons had the idea of reusing the extracted fat to inject it into another part of the body, with the aim of filling it up.
This technique of transferring autologous fat (the patient's own fat), called lipofilling, has long proved disappointing: the reinjected fat tended to disappear in a significant proportion, making the results random and ephemeral.
However, Plastic Surgeons did not stop at these first disappointments and tried to understand the reasons for these failures. Step by step, the results have improved, the reinjection of autologous fat, also called Lipostructure, has become a really reliable method.
Aesthetic indications:
• The filling and attenuation of certain wrinkles or furrows, particularly on the face during the early stages of facial ageing.
• Restoration of facial volumes and shapes: this may include the Restoration of a face emaciated by aging.
• A complement associated with certain cervico-facial lifts to improve facial harmony.
• Secondarily, after a first facelift, to improve the shape of the middle third of the face without having to resort to a new facelift.
• Correction of irregularities secondary to liposuction.
• The reshaping of the silhouette, also called Lipomodelling: it consists in taking the fat from an area where it is excessive (saddlebags for example) and reintroducing it into an area where the volume is missing (top of the buttock for example).
The treatment of these aesthetic problems does not justify coverage by health insurance.
Indications in restorative and reconstructive surgery
• The filling of a tissue depression following a trauma
• Correction of massive fat losses after tritherapy in HIV+ patients.
• Aesthetic improvement of breast reconstruction results after removal of the mammary gland or after placement of breast implants.
In these indications for reconstructive surgery, lipostructure can be covered by health insurance under certain conditions.

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A preoperative check-up is carried out in accordance with the prescriptions.
The anaesthetist will be seen in consultation at the latest 48 hours before the operation.
No medication containing aspirin should be taken within 10 days of the procedure.
Depending on the type of anesthesia, you may be asked to fast (do not eat or drink anything) 6 to 7 hours before the procedure.
Type of anaesthesia:
Lipostructure is usually performed under extensive local anesthesia with tranquilizers administered intravenously ("vigilant" anesthesia). A simple local anaesthetic or even a general anaesthetic can also be used.
Hospitalization conditions:
This surgery is most often performed on an outpatient basis, with entry and discharge taking place on the same day. It may be advisable to stay in hospital overnight after the procedure.

Each surgeon adopts procedures that are specific to him/her and that he/she adapts to each case to selectively correct the defects present and obtain the best results. However, common basic principles can be retained:
The first step is to accurately identify the fat sampling areas and reinjection sites.
The fat tissue is collected atraumatically by a microincision hidden in the natural folds using a very thin suction cannula.
A discreet region where there was a reserve, or even an excess of fatty tissue, will have been chosen.
Then centrifugation is carried out in order to separate the intact fat cells that will be grafted from the elements that cannot be grafted.
The reinjection of the fat tissue is done by means of 1 mm incisions using micro-canulas.
Fat micro-particles are injected in different levels and in multiple and divergent directions to increase the contact surface between implanted cells and recipient tissues, thus improving the survival of the grafted fat cells.
Insofar as it is a question of a real grafting of living cells and provided that the technique is good and the grafting is effective, the cells thus grafted will remain alive within the body, which makes the lipostructure technique a definitive technique since the fat cells thus grafted will live as long as the tissues that are around them.
The duration of the operation depends on the quantity of fat to be reinjected and the number of locations to be treated. It can vary from 30 minutes to 2 hours in case of isolated lipostructure.

They directly concern the injected area(s), but may also be of interest to the area(s) sampled.
In the post-operative period, pain is generally not very severe.
Tissue swelling (edema) appears during the first 48 hours after the procedure and generally takes 5 to 15 days to be fully absorbed.
Bruises appear in the first few hours in the fat reinjection areas: they disappear within 10 to 20 days after the operation.
Thus, if physical recovery is usually quick because of the light and superficial nature of the intervention, it will be necessary to take into account the importance of the social discomfort caused by oedema and bruises in order to adapt one's family, professional and social life.
The operated areas should not be exposed to the sun or UV rays for at least 4 weeks, which would run the risk of permanent pigmentation.
After resorption of the phenomena of oedema and bruising, the result begins to appear within 2 to 3 weeks after the operation.

About Lipostructure

THE RESULT:
It is assessed within 3 to 6 months after the operation.
It is most often satisfactory whenever the indication and technique have been correct: depressions are generally filled and volumes restored.
There is a variable difference of 20 to 40% between the amount of fat re-injected and the amount of grafting taken, due to the fact that even with an irreproachable technique, part of the re-injected fat will be absorbed. The practitioner will have taken this into account in the evaluation of the fat re-injection.
Potential risks Scars, infection, embolism, perforation of an internal organ, seroma, nerve modification, swelling, necrosis, burns (with ultrasound), hydro-electrolytic imbalance, risks related to anesthesia.
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