Dr. Tzikas, a board-certified facial plastic surgeon in private practice in Delray Beach, Fla., has performed lipografting for nearly 12 years. He says the fat transfer technique does more than just revive external facial aesthetics; it addresses the loss of fullness and volume in facial areas that typically accompanies the aging process.
"It is really three-dimensional volume depletion that is the main aspect of sagging skin and loss of elasticity," says Dr. Tzikas, who presented his experience and results with lipografting at the World Congress of Liposuction here.He uses the technique alone or in combination with nearly all facial rejuvenation procedures he performs.
Lipografting alone is suitable for a younger patient or someone not interested in a facelift. It's also useful for revising unsatisfactory facelifts where indentations need to be filled in or in overly tight areas that need to be softened.
Before any procedure, Dr. Tzikas explains to patients the three-dimensional aspect of lipografting, and addresses their expectations. He tells them that lipografting results, which can last five to eight years, can be more subtle and longer lasting than results of a facelift.
In several key areas, his lipografting approach differs from how other cosmetic surgeons might execute deep tissue fat transfer. For instance, he typically injects a higher volume of fat and does so in all key areas of the entire face, not just in one trouble spot where wrinkling or skin laxity is more evident.
"The face has proportions. As we age, we lose fullness and volume in the face from all over," he notes. "When replenishing volume or adding fat, it must be added proportionally all over the face rather than injecting only the mouth, cheeks or one zone of the face." He typically injects in the glabella, malar, perioral, mandibular and temple areas, and feathers the fat between these zones.
Fat volume tailored The volume of fat injected is tailored to each patient's needs, age and volume loss, but generally it is still more than what is used for deep tissue fat transfer; usually 70 cc to 100 cc.
Injection locale is also different with lipografting. Instead of just injecting fat superficially beneath the skin's surface, Dr. Tzikas works the injections into many layers, concentrating on deep tissue layers and working out to the more superficial layers. He injects on top of the bone, into the muscle and around the periosteum for a multilevel volume enhancement approach.
"Rather than filling in lines, the correct way of using fat is for improving structure and support of the face," he says, adding that tissue fillers or other injectable products are suitable for filling fine lines, and such products complement lipografting quite nicely. Fillers may hold up better and be a better option than fat when treating fine lines in mobile areas, such as nasolabial folds, according to Dr. Tzikas.
Special cannula The tool he uses for lipografting is different, as well. To achieve multilevel injections but at the same time minimize trauma, Dr. Tzikas uses a bullet-tip cannula, now made by Byron Medical, that he designed. Its tip does not tear tissue when injections are administered.