You are looking for information on lipofilling and specialists for treatment? Here you will find only experienced specialists and clinics in Germany, Switzerland or Austria. Find out about indications, procedure and risks or contact our experts.
List of doctors Lipofilling
Dr. med. Bjorn Kruger
Plastic & Surgery Aesthetic Surgery
Univ.-Prof. Dr. med. Christine Radtke, MBA, FEBOPRAS
Plastic& Aesthetic surgery
Dr. med. Uwe von Fritschen
Plastic& Aesthetic surgery
Information about lipofilling
What is lipofilling?
Lipofilling or "autologous fat grafting", as the medical term is known, means "injection of the patient’s own fat" and is a method of aesthetic and reconstructive surgery. The body’s own fat is used to fill the volume of the breasts or buttocks, to improve the shape of the tissue or to compensate for facial wrinkles, dents and scars. The fat is removed from the abdomen, thighs or buttocks. After the cells are harvested, they are prepared and inserted into the desired area with a large cannula.
Lipofilling has been used for years and is constantly being developed and improved. The use of lipofilling is now widespread for breast reconstruction after breast cancer surgery. But lipofilling is also becoming increasingly popular in cosmetic surgery. It is particularly suitable for the treatment of facial wrinkles and scars. The fact that no foreign substances such as implants, hyaloronic acid or Botox are used makes lipofilling particularly attractive for many patients.
On which parts of the body is lipofilling applied??
Lipofilling of the breast
Lipofilling is often used for breast reconstruction after cancer. Deformations and dents are easy to compensate for. Also for Breast augmentation with autologous fat lipofilling can be used. However, several procedures are usually necessary to achieve the desired result. In the case of implants, a single operation is sufficient. The method is suitable for patients who prefer a more natural result or who want to fill up the breast volume after an implant removal.
Lipofilling of the face
Wrinkles around the mouth, frown lines between the eyes, small wrinkles around the eyes and nasolabial folds (wrinkles to the left and right of the nose) can be easily filled with autologous fat. Lips and cheeks can also be plumped up.
The buttocks can be tightened, enlarged and plumped up with autologous fat.
How does an autologous lipofilling treatment work?
The doctor first explains the patient in detail and pays particular attention to whether the patient’s wish is comprehensible and can realistically be fulfilled. Before the operation, the surgeon carefully examines the patient and determines general condition and laboratory parameters. Treatment should not be performed if there is active cancer or acute infection in the tissue in question, during pregnancy and lactation, and if there is a serious coagulation disorder. In patients with an increased risk of breast cancer (occurrence in the family, mutation of the BRCA1/2 gene), immunosuppression or heavy nicotine consumption, the doctor must carefully consider whether surgery can be performed.
Depending on the indication, the procedure is performed on an outpatient or inpatient basis. The correct harvesting technique is important for the success of the treatment. The doctor must remove the fat cells as gently as possible, so that the cells are not damaged during the removal process. There are various techniques for this. In the "tumescent technique", the physician first injects fluid (saline solution with the addition of an anesthetic) into the fatty tissue. This is how fat cells are detached. The "water jet assisted" suction is particularly gentle. Here, the tumescent solution is injected into the tissue under slight pressure and the loosened fat cells are suctioned out with the fluid. Up to 90 percent of fat cells survive with this method. In addition to the water jet assisted technique according to BEAULI, other techniques are recommended in the "Guidelines for Autologous Fat Grafting": Coleman technique, "Lipivage", Shippert method and Khouri technique. The fat cells are then separated from blood, serum and damaged cells, for example by centrifugation or filtration. Preparation also plays an important role in the quality of the graft. After the preparation the fat cells are returned as soon as possible. Deep-frozen fat tissue should not be used. The physician uses a blunt cannula to distribute the fat cells at several locations in the target tissue. It injects a maximum of 0.5 ml at one point to avoid great pressure on the tissue. For the breast, the fat cells should not be injected into the glandular tissue, but under the skin, between and under the muscles.
One day after the operation, the doctor examines the wound and looks for complications such as wound infections and bruises. The patient is also examined regularly in the following weeks. If the procedure was performed on the breast and buttocks, the physician applies an elastic bandage. The patient should take it easy for four weeks, not do any sports and not go to the sauna. After lipofilling in the face, swellings are cooled down. Even slight shaping of the graft is still possible after the operation. If necessary, the doctor prescribes painkillers and anti-inflammatory drugs.
A major problem of autologous fat treatment is that many transplanted fat cells do not survive. Therefore, a procedure called "cell-assisted autologous fat grafting" has been developed with the aim of improving the regenerative capacity of fat cells. Mesenchymal stem cells are present in the fat tissue. If fat cells die, new fat cells are created from these stem cells. This allows the fatty tissue to renew itself again and again.
In cell-assisted autologous fat grafting, the graft is enriched with mesenchymal stem cells. This is to improve the regenerative capacity of the transplanted fat tissue. This is to counteract the high loss of fat cells during the treatment. After the removal of fat tissue, the mesenchymal stem cells are isolated from a part of the fat tissue using a special purification process. These isolated stem cells are added to the actual adipose tissue graft. The transplant thus has a higher concentration of stem cells than normal fatty tissue. So far, however, little research has been done on the method. There is no evidence of an advantage over conventional lipofilling and studies are still lacking that clearly prove the harmlessness of the method. The cell-assisted method should therefore only be used in strictly controlled clinical studies for the time being.
How long does lipofilling last?
Many of the transplanted fat cells do not grow and are resorbed or die off. Depending on the method, there is a high volume loss of between 25 and 90 percent within the first three months after the operation! Even with small amounts of transplanted fat cells, for example when injecting wrinkles, long-term losses of up to 70 percent are reported.
The actual success of the treatment is therefore only visible after three months. It largely depends on the method used and proper performance of the surgery! The result after three months is permanent, unless the patient generally loses a lot of weight. Then the body regions treated with lipofilling are also affected. If repeated treatment is necessary, it should only be performed after three months.
What are the risks?
The following complications are possible after the treatment:
- Contour irregularities
- Over or under correction of deformities
- minor bleeding
- High volume loss
- Isolated cases of fat embolism (occlusion of blood vessels by fat droplets), stroke and meningitis caused by fat cells
Breast surgery can also lead to the formation of calcium deposits in the tissue and oil cysts – cavities filled with fat. However, these complications occur just as often with other breast surgeries. Rarely, a pneumothorax occurs due to an injury during the operation, i.e. air gets between the lungs and the ribs.
Edema, bruising, scarring, hypersensitivity, pigmentary abnormalities, itching, and infection-related skin necrosis may occur at the site where the fat was removed.
In breast cancer patients, diagnosis with imaging techniques is more difficult after autologous fat treatment. A meaningful mammogram can be performed 6 months after fat grafting at the earliest. There is a risk that a recurrence of the tumor will not be detected in time. In isolated cases, an increased tumor recurrence rate was found when lipofilling was performed shortly after breast cancer surgery. Therefore, lipofilling in breast cancer patients should not be performed until 24 to 36 months after complete recovery!
Experts also discuss increased cancer risk from autologous fat grafting: mesenchymal stem cells are present in fat tissue. They are there to allow the fat tissue to regenerate by forming new fat cells. However, because stem cells generally have the potential to divide and differentiate into other cells, there is also a risk that they may also turn into cancer cells. Bishert, however, there is no evidence of increased tumor risk from the mesenchymal stem cells contained in the fat graft.
What are the costs?
Depending on the clinic, the prices for breast augmentation range between 4.500 and 6.500 euros. For wrinkle treatment with lipofilling, one needs about 2.pay 500 euro.
Which doctors and clinics are specialists in lipofilling??
As a rule, a specialist in plastic and cosmetic surgery performs lipofilling. In Germany, there are numerous clinics and practices that specialize in plastic and aesthetic surgery, many of which offer lipofilling. Specialized dermatologists can also perform autologous fat injection of wrinkles on the face. The success of the treatment depends largely on the method used and the experience of the clinic! Therefore, the patient should inform himself well before the operation and choose the doctor or clinic carefully.
Guideline "Autologous fat grafting", prepared in 2015 as a guideline of the German Society of Plastic, Reconstructive and Aesthetic Surgery
"Status of autologous fat grafting in breast medicine"; D.Rezek; Aesthetic Surgery, 2015
"Cell-assisted autologous fat grafting"; Grabin S., Antes G., Strong GB., Motschall E.,Buroh S., Lampert FM.; German Medical Journal 2015
"Autologous fat grafting into the female breast-clinical application and safety issues," Rene D. Largo, Jurg Hacki, Sinan Guven, Arnaud Scherberich, Alexandre Kampfen, Daniel F. Kalbermatten, Martin D. Haug, Dirk J. Schaefer; Swiss Medical Forum 2011
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