What does the procedure consist of?
The procedure is performed under local anesthesia and/or sedation, so it is not painful or uncomfortable for the patient. A sufficient amount of adipose tissue is extracted (from the abdomen, love handles, or any localized adipose accumulation desired by the patient), processed by centrifugation according to Dr. Coleman’s protocol, and then infiltrated into the desired area. The entire process takes approximately 45-50 minutes to complete.
Subsequently, the patient has to rest for 5-6 days to achieve an adequate attachment of the adipose tissue, and finally in 1 month and a half the final result (the attachment of the grafts) is evaluated.
It is usual to perform a touch-up to achieve the optimal result, although as we have already mentioned, once the adipose tissue has taken hold, it is not necessary to repeat the infiltration.
FILLING OF DARK CIRCLES UNDER THE EYES AND MALAR AREA
The filling of dark circles under the eyes and malar area is one of the most requested by our patients.
That look of tiredness, dark circles under the eyes, darkening of the lower eyelid… is very characteristic of the active woman who today manages to meet her thousand commitments to work, study, family and social commitments.
The procedure of filling dark circles under the eyes and/or the malar area with the patient’s own adipose tissue is a procedure that is becoming more and more fashionable every day and it is no wonder, since it is an excellent treatment to improve the aging of the periorbital area. It must be remembered that it is necessary to make an anatomical study of each patient and a diagnosis prior to the procedure, since it is essential to make a good selection of the patient.
Within the specialty of plastic surgery, one of the basic objectives is the correction of deformities, and one of the most commonly used tools for this purpose are fillers.
There are an infinite number of filler materials (synthetic, biological, autologous…), and although there is still no universal consensus on the ideal filler material, there are certain points on the properties of the ideal filler on which the different authors agree.
- The filler material must be biocompatible, with total integration in the recipient, without degeneration of the filler material or alterations in the recipient organism.
- They must not be toxic or produce cancer or other alterations in the receptor.
- They must be immunologically neutral, so as not to trigger allergies or exacerbation of autoimmune diseases such as lupus, rheumatoid arthritis, scleroderma, etc.
- They must be similar to the fabric we want to replace or simulate.
- They must be permanent.
- They must be easy to remove after injection, if the patient needs it or it is necessary for any other reason.
- The filling material should not distort the diagnosis of other pathologic processes, both by physical examination and imaging tests.
- Preferably from the same patient.
For which patients is the facial filler intended?
Patients of any sex and age who present with tear through deformity, either in the form of sagging or dark coloration of the dark circles under the eyes. The bluish discoloration of dark circles under the eyes is significantly improved with this procedure.
However, patients with large preseptal fat herniation (commonly referred to as “lower eyelid fat pads”), excessive laxity or severe lower eyelid elastosis are not good candidates for this procedure. On the other hand, in cases of skin hyperpigmentation, there may be no improvement in coloration after the procedure.
What does the lipofilling procedure look for?
Restore the natural and aesthetically considered “attractive” shape to the lower eyelid: with a smooth and continuous transition between the preseptal and orbicular portions of the eyelid, with no definite transition point or groove between these areas, and restore the appearance of fullness to the malar prominences.
What types of filling materials are available, and which is the most recommended?
One of the best-known and most widely used fillers today is hyaluronic acid, a resorbable and biocompatible material (meaning it will not cause foreign-body reactions or rejection) that is used in many areas of the body. It has a resorption rate ranging from 6 months to a year (though it can sometimes last up to 2 years if appropriate touch-ups are performed). One of its drawbacks is the high cost of the vials of this product, which means it is primarily used in areas that require small-volume injections.
Another filler material is the patient’s own adipose tissue, which through a standardized technique is extracted and processed, isolating the adipose cells to later infiltrate them for repair and/or remodeling of certain body areas. The advantages of this type of filler are the following: it is an autologous material (the patient’s own), it is totally biocompatible, safe, and once the graft is stabilized, stable over time. This technique allows us to prepare adipose tissue grafts of large size or volume, so it is generally more economical.
One of the strengths of adipose tissue filling is that once the treatment is complete, the deposited adipose tissue “takes hold” in the recipient site (in this case, the under-eye area) and is not reabsorbed; therefore, it is not necessary to repeat the procedure periodically, as is the case with absorbable fillers.
Our preferred treatment for dark circles under the eyes is the injection of adipose tissue grafts, since, for optimal results, two areas typically need to be treated: the “tear trough” depression itself, and the malar region, which will provide long-term support to the lower eyelid, preventing the deformity from recurring. This means that a considerable volume of filler material is used to perform the complete treatment.
However, it is necessary to analyze each case and patient individually.
What is the tear through deformity?
One of the most common concerns patients bring up during cosmetic surgery consultations is thepresence of dark circles under the eyes, a “tear trough” or “tear groove” with a sunken appearance, with dark discoloration of the lower eyelid, resulting in a tired or fatigued appearance (even if the patient has had adequate rest).
This deformity is caused by the anatomical nature of the orbital system; it results from the presence of lower eyelid ligaments attached to the periorbital margin, which remain more or less taut over the years, unlike the rest of the tissues of the eyelid and the malar region, which become lax and increasingly weaker as we age. As a result, the smooth transition between the structures of the lower eyelid and the malar region is lost.
Which type of facial filler meets virtually all of these premises?
The patient’s own adipose tissue, properly treated and processed, It is the filler that most closely matches the definition of “ideal filler material.”
Its use has been documented since the end of the 19th century to repair traumatic or oncological sequelae of the whole body, however, in recent years, already in the 21st century, is when the use of adipose tissue grafts has reached its splendor, with the refinement of extraction, processing and infiltration techniques.
Facial infiltrations with adipose tissue
Particularly in facial aesthetic surgery and medicine, this type of infiltration is used for allows us to correct a wide variety of defects: dark circles under the eyes, tear through deformity or tear trough, fill the malar area, jaw area, chin, treat barcode wrinkles, fill lips, nasolabial fold, wrinkles in general?
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