See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/11883679

Fat transfer to the face: technique and new concepts

Article  in  Facial Plastic Surgery Clinics of North America · June 2001

Source: PubMed

CITATIONS READS
11 1,411

2 authors:

Melvin Shiffman Mitchell V Kaminski

Newport Specialty Hopsital Rosalind Franklin University of Medicine and Science-retired
300 PUBLICATIONS   660 CITATIONS    85 PUBLICATIONS   1,034 CITATIONS   

SEE PROFILE SEE PROFILE

Some of the authors of this publication are also working on these related projects:

All patients refereed for pressure wound treatment in 4 nursing homes had View project

New Bio-Scaffold in Bone Regenerative Procedure View project

All content following this page was uploaded by Mitchell V Kaminski on 07 March 2017.

The user has requested enhancement of the downloaded file.

 Facial Plast Surg Clin N Am 10 (2002) 191 – 198

Fat transfer to the face$

Technique and new concepts
Melvin A. Shiffman, MD a,*, Mitchell V. Kaminski, MD b
a
Private Practice, 1101 Bryan Avenue, Suite G, Tustin, CA 92780, USA
b
Finch University of the Health Sciences Medical School, 3333 Green Bay Road, Chicago, IL 60064, USA

The minimally invasive technique of using autol-
ogous fat transplantation has become a standard
procedure in facial rejuvenation. It is simple, inex-
pensive, permanent, and effective.
Injectable fillers, such as collagen and hyaluronic
acid, are only temporary and therefore have few
indications. GoreTex, which is a permanent material,
can extrude or be palpable. Since 1994, when Adatasil
(silicone) was approved by the Federal Drug Admin-
istration (FDA) for use in ophthalmic problems, the
use of silicone injected into other areas of the body is
termed an ‘‘off-label use’’ and is considered legal if it is
used for a specific patient with a specific product, and
there is no advertising. Autologous fat can be used to
augment facial structures or rejuvenate rhytides, or to
fill depressed scars or defects of the face. Since the
introduction of liposuction for body contouring in
1975, [1] there has been an easy way to obtain fat for
transplantation through very small incisions. The use
of the tumescent technique for retrieving large
amounts of fat for transfer has reduced the amount of
blood loss and made the technique safer [2].
Although some reports have shown that fat trans-
fer had disappointing results in some cases, the
success of fat transfer is operator dependent and can
be quite successful if attention is paid to the details of
the techniques of the procedure. The transfer of fat to
the face, where vascularity is excellent, has an
excellent chance for fat survival.
$
This article was originally published in Facial Plastic
Surgery Clinics of North America 9:2, May 2001.
* Corresponding author.
The only relative drawback has been the lack of
100% take of the fat graft. With proper technique,
approximately 30% to 70% of the fat is retained.
Low-speed, short-time centrifugation of the fat
decreases the fluid in the transplant and reduces the
apparent loss of graft by compacting the fat and
separating out the excess liquid. Because some of
the apparent graft loss is the resorption of fluid from
the transplanted fat, there is less fluid in centrifuged
fat and therefore more mass is retained.
A newer concept to facilitate graft retention is the
use of albumin during the harvesting and transfer
phases. Albumin reduces the colloid osmotic pressure
disparity between the low colloid osmotic pressure of
the fat graft, with saline, epinephrine, lidocaine, and
sodium bicarbonate, and the interior of the fat cells.
The higher the difference in colloid osmotic pressure
between the cells and the surrounding fluids, the more
fluid will enter the cells and the more probable the
destruction of cells. If the colloid osmotic pressure
between the fat cells and the surrounding fluid with
albumin is almost equal, the more likely that there will
be improved fat survival and retention.
History of fat transfer
Since Neuber [3] in 1893 reported that trans-
planted fat can be used to fill in a depressed area of
the face, there have been many reports [4 – 13] that
have shown that fat, in pieces, can be transplanted
and survive in various areas of the body. Since
liposuction was conceived by Fischer and Fischer in
1974 [14] and put into practice in 1975 [1] the fat
aspirate has been used to fill defects and for contour-

1064-7406/02/$ – see front matter D 2002, Elsevier Science (USA). All rights reserved.
PII: S 1 0 6 4 - 7 4 0 6 ( 0 2 ) 0 0 0 0 9 - 3
192 M.A. Shiffman, M.V. Kaminski / Facial Plast Surg Clin N Am 10 (2002) 191–198
ing [15 – 21]. Aspirated fat should be washed atrau-
matically in physiologic solution to remove blood,
which allows better fat survival [22].
Certain principles of fat transfer have evolved
[15 – 21] over the years, which include aspiration at
lower vacuum (rather than at atmospheric) pressure,
fat that is present for over 60 days after transfer
(survives and grows better), avoiding dessication of
the fat during transfer, and fat grafts surviving when
there is vascular ingrowth. The survival of free fat
used as an autograft is operator dependent and
requires delicate handling of the graft tissue, careful
washing of the fat to minimize extraneous blood
cells, and installation into a site with adequate vas-
cularity. There is evidence that fat cells can survive
and that filling of defects is not from the residual
collagen following cell destruction. There is some
loss of fat after transplant, and most surgeons overfill
the recipient site.
For a more complete discussion of these princi-
ples, the reader is referred to the references cited at
the end of this article.
Insulin
Some physicians have added insulin to the fat in
preparation for transplantation [23 – 25]. The theory is
that insulin inhibits lipolysis.
In 1956, Sidman found that insulin decreases
lipolysis. In 1980, Hiragun et al [26] stated that
theoretically insulin could induce fibroblasts to pick
up the lost lipid and become adipocytes [27]. In 1993
Chajchir et al found that the use of insulin did not
show any positive effect on adipocyte survival during
transplantation compared with fat not prepared with
insulin [28].
Centrifugation
Some physicians centrifuge the adipose tissue to
remove blood products and free lipids to improve the
quality of the fat to be injected [24,27].
In 1987, Asken stated that his ‘‘method of reducing
the material to be injected to practically pure fat is to
place the fat-filled syringe with a rubber cap (the
plunger having been previously removed and kept in
a sterile environment) into a centrifuge [29]. The
syringe is then spun for a few seconds at the desired
rpm and the serum, blood, and liquefied fat collects in
the dependent part of the syringe. . .’’
In 1991, Toledo reported that ‘‘for facial injection
we spin the full syringes for 1 minute . . . in a manual
centrifuge (about 2000 rpm), eject the unwanted
solution, and transfer the fat . . .’’ [4].
In 1993, Chajchir et al centrifuge 1 mL of bladder
fat pad from mice (both at 1000 rpm for 5 minutes
and at 5000 rpm for 5 minutes) and injected this into
the subdermis of the malar area [26]. Microscopically,
after 1 to 2 months there were macrophages filled
with lipid droplets, giant cells, focal necrosis of
adipocytes, and cystlike cavities of irregular size
and shapes. After 12 months following injection, no
recognized adipocytes could be found. Total cellular
damage was present in both groups.
In 1996, Brandow and Newman found that cen-
trifugation of harvested fat did not alter the micro-
scopic structured integrity of cells. Spun and unspun
samples were examined and were found to be
similar [28].
In 1998, Fulton et al noted that centrifuged fat
(3 minutes at 3400 rpm) works well for small volume
transfers but not for large-volume transfers into
breasts, biceps, or buttocks [30].
Albumin in improving fat cell survival
Oncotic pressure
When a molecule is greater than 10,000 D (a dalton
[D] is an arbitrary unit of mass equal to the mass of the
nuclide of C12 or 1.657 x 10
24 g), it is called a colloid
and is capable of generating an oncotic pressure if it is
restricted to one side of a semipermeable membrane.
Colloid restricted to one side of a semipermeable
membrane creates an osmotic gradient measured in
millimeters of mercury. Very small molecules and ions
such as sodium, potassium, glucose, and urea easily
cross a capillary membrane and can increase osmolar-
ity toward isotonicity to prevent red blood cells from
absorbing water and bursting. Osmolarity is measured
by freezing point depression, and the greater the
number of particles in solution, the colder the solution
must be before it can freeze.
Colloid osmotic pressure
In determining the colloid osmotic pressure (COP),
the Landis Papenheimer equation [31] takes into
account that soluble proteins, whether albumin, globu-
lin, or fibrinogen, are highly negatively charged:
COP ¼ 2:1ðTPÞ þ ð0:16TP2 Þ þ 0:009TP3
where COP = colloid osmotic pressure and TP =
total protein.
 M.A. Shiffman, M.V. Kaminski / Facial Plast Surg Clin N Am 10 (2002) 191–198
Positively charged sodium ions surrounding the
core protein attract and hold water thus accumulating
more fluid on one side of the semipermeable mem-
brane. The combination of the oncotic pressure of the
sodium ions, resulting in an increased pressure gra-
dient, is called the colloid osmotic pressure.
Albumin is 69,000 D; globulin is 150,000 D,
and fibrinogen, 400,000 D. Because it is the num-
ber of molecules that are held on one side of the
semipermeable membrane that creates COP, albu-
min creates the most pressure because 1 g of albu-
min has twice as many molecules as globulin and
five times the number of molecules as fibrinogen.
Starch molecules, found in hetastarch and dextran,
should not be used for fat transfer because such
molecules are too large to be evacuated through the
lymphatics and can cause localized edema in the
interstitial space.
Starling’s equation
In equation form, Starling’s equation [32,33] rep-
resents the hydrostatic pressure pushing fluid through
the capillary pore (Pc through d) versus COP forces
holding fluid in circulation, and the rate of fluid flow
across the gel-sol matrix (Kf is inversely proportional
to if and back into circulation by lymphatic channels
Fig. 1. A 55-year-old woman with flattened malar eminences. (A) Preoperative. (B) One year postoperatively, following fat
transfer to the malar eminences.
193
(Qlymph). When all of these factors are combined, the
entire equation is written thus:
Jv ¼ Kf½ðPc
Pif Þ
ðc
if Þ
Qlymph
where
Jv = Interstitial fluid flow
Kf = Filtration coefficient
Pc = Hydrostatic pressure in the capillary
Pif = Hydrostatic pressure in the interstitial space
d = Pore membrane size on the reflection
coefficient
c = Colloid pressure created by total protein [TP]
in circulation
if = Colloid pressure created by TP in the
interstitial protein
Qlymph = Lymph flow
The pressure in the capillary minus the opposing
pressure in the interstitial space is known as the
hydrostatic pressure. Central venous pressure (Pc) is
the pressure pushing fluid across the endothelial mem-
brane through the body. The total protein in circulation
creates colloid osmotic pressure (c). At any given time
at any given pore in the vascular endothelium, there is
more protein concentrated in circulation than there is at
194 M.A. Shiffman, M.V. Kaminski / Facial Plast Surg Clin N Am 10 (2002) 191–198

that site in the interstitial space. The COP creates a Disease (acne)
constant negative force holding the fluid in circulation Iatrogenic
and keeping interstitial fluid flow to a minimum, Cosmetic
packing cells together and preventing edema. Furrows (e.g., rhytides, wrinkles)
Refill of lost supportive tissue (aging)
Avoiding hypo-oncotic trauma in fat transfer Enhancement

When Klein’s solution or any modification is used Preoperative consultation

in harvesting fat, the infranatant of the harvested fat
contains 1.1 to 1.2 g% protein. The normal level is The patient should be examined carefully in
2.0 to 4.0 g%. When one ampule of concentrated relation to the specific complaint for which he or
human albumin (12.5 g in 50 mL) is added to 1 L of she has come in for consultation. A description of the
tumescent solution of 8.3 mL added to 60-mL har- physical problem must be recorded, with appropriate
vesting syringe, the harvested fat contains 2.6 g% pro- measurements. Pictures should be taken before any
tein. Three washes of harvested fat also increases the procedure is undertaken and postoperative photo-
difference in colloid osmotic pressure and, therefore, it graphs taken at an appropriate interval of time, when
is necessary to add 18.75 g of albumin to each liter of healing is completed.
washing solution. Adequate time must be allowed be- If there are problems detected by the physician
tween each wash to allow the fat cells to pack above the other than that of which the patient complains, this
infranatant layer. The process can be accelerated by must be recorded and possible treatment explained to
centrifugation. The supranatant oil must be removed the patient, so that steps can be taken to correct other
before insertion of the fat into the recipient site. deficits not previously identified by the patient or so
that the patient understands that adequate correction
could require other procedures. At the same time,
Ratchet gun for injection however, the patient must not be pressured into
procedures that are not really desired. The patient
In 1987, Newman and Levin designed a lipoinjec-
tor with a gear-driven plunger to inject fat tissue evenly
into desired sites [22]. Fat injected with excessive
pressure in the barrel of syringe can cause sudden
injections of undesired quantities of fat that can pour
into recipient sites. In 1987, Agris stated that a rachet-
type gun allows controlled accurate deposition of
autologous fat [34]. Each time the trigger is pulled,
0.1 mL is deposited. Asaadi and Haramis described the
use of a gun with a disposable 10-mL syringe for fat
injection [35]. In 1994, Niechajev and Sevcuk used a
special pistol and blunt cannula, with 2.3-mm internal
diameter, to inject the fat [36]. Berdeguer used to a
lipotransplant gun to inject fat into areas to be en-
hanced [37]. In 1998, Fulton et al stated that it is
beneficial for a surgeon just beginning this type of
procedure to use a ratcheted pistol for injection, be-
cause this gives a more uniform injection volume [30].

Indications for fat transfer

There are several indications for fat transfer, which

can be distilled down to the following two categories:

Fill Defects
Congenital Fig. 2. (A) A 39-year-old with thin lips. (B) Four months
Traumatic postoperatively, following fat augmentation of the lips.
 M.A. Shiffman, M.V. Kaminski / Facial Plast Surg Clin N Am 10 (2002) 191–198 195

may need time to think about which procedures are
necessary and to seek other consultations.
The patient must understand the need for using
autologous fat as a filler substance, compared with
other fillers presently available. To conform with the
standard of care for informed consent, the patient
must have sufficient information to be knowledge-
able about the procedure, the possible material risks
and complications, and the alternatives and their
possible material risks. Someone from the surgeon’s
office must take time to explain this information, and
the physician must make sure that the patient under-
stands the procedure, risks, and alternatives and also
answer any questions about the procedure. It is
suggested that the physician include in the record
the statement that ‘‘the surgical procedure was dis-
cussed, as well as viable alternatives and all material
risks and complications.’’
Technique
Fat survival depends on the careful handling of fat
during harvesting, cleansing, and injecting. Harvest-
ing is performed by liposuction in areas of fat with
alpha-2 receptors, where the fat responds poorly to
diet (e.g., abdominal or trochanteric areas [genetic
fat]) [29]. The fat can be retrieved with liposuction,
using a cannula (2.5 mm to 3.5 mm) and suction
machine ( – 500 mm vacuum or less) or needle 14-to
16-gauge) with syringe (3 mL to 50 mL). Small
amounts of fat ( < 50 mL), which is usually all that
is necessary for transfer to the face, are easier to
remove with syringe and needle.
The fat must be cleansed with physiologic solu-
tion of normal saline or lactated Ringer’s solution by
gently mixing and decanting the infranatant liquid,
which consists of tumescent fluid, serum, and blood.
Fat can be concentrated with the use of centrifugation
at 3600 rpm for 1 minute. This allows less need for as
much overfilling (30% to 50%) as is usually used.
Kaminski [38] has proposed the addition of 12.5 g of
concentrated human albumin for each 1000 mL of
Klein’s solution used for harvesting and 18.5 g for
each 1000 mL washing fluid, to maintain the normal
extracellular oncotic pressure necessary to prevent the
influx of solution into the cells with possible rupture.

Fig. 3. A 45-year-old woman with depressions of the left malar eminence A, and left cheek B, and depressed scar of the left
chin C. (A) Preoperative. (B) Six months postoperatively, following subcision and fat transfer.
196 M.A. Shiffman, M.V. Kaminski / Facial Plast Surg Clin N Am 10 (2002) 191–198
Alternatively, 8.3 mL of human serum albumin can
be added to a 60-mL harvesting syringe.
Injection of the fat is with a needle (18-gauge) or
cannula (1.5 mm – 2.0 mm) uniformly distributed into
tunnels in multiple layers to fill the defect. With
depressed scars, the attachments to the skin should
be subcised before fat injection. The use of the ratchet
gun for injection does not damage fat cells [39].
The areas of the face that can be enhanced include
the cheeks (malar, submalar), lips, and chin (mentum,
Figs. 1 and 2). The brows can be lifted with fat transfer
to the forehead, and indentations can be improved in
almost any area of the face. Rhytides in the glabella,
the nasolabial folds, and ‘‘marionette’’ lines can be
improved. If the glabella is to be injected, the patient
should be informed of the rare possibility of blindness.
Any area of the face can have a depressed scar
elevated by subcision and fat transfer (Fig. 3).
Complications
There are very few serious complications of
autologous fat transfer. Because it is the patient’s
own tissue, there is no rejection phenomenon or
allergic reaction. Harvesting of large amounts of fat
by liposuction can trigger the complications of lip-
osuction in the donor area, but facial fat transfer is
usually with small amounts of fat. If small amounts of
fat ( < 50 mL) are retrieved, the one can expect the
possibility of bruising or infection in the donor site.
Autologous fat injection can be associated with
the following risks:
1. Loss of fat volume (the most common
problem)
2. Possible need for repeat injection(s) of fat
3. Bruising and hematoma
4. Swelling (especially with overinjection)
5. Asymmetry
6. Prolonged erythema (usually temporary, over
a short period)
7. Scar that is depressed or thickened (rare
except in the area of liposuction)
8. Tenderness and pain
9. Fibrous capsule around fat accumulation
(from too much fat injected into one area)
10. Fat cyst (mass)
11. Infection (rare)
12. Microcalcifications (has not been reported in
the face)
13. Central nervous system damage or loss of
sight from retinal artery occlusion (can occur
with injection in the glabellar area)
14. Any of the problems that can accompany lipo-
suction (if a large amount of fat is removed)
References
[1] Fischer G. Surgical treatment of cellulitis. Third Con-
gress of the International Academy of Cosmetic Sur-
gery. Rome, May 31, 1975.
[2] Klein JA. The tumescent technique for liposuction sur-
gery. American Journal of Cosmetic Surgery 1987;4:
263 – 7.
[3] Neuber F. Fettransplantation. Chir Kongr Verhandl
Deutsche Gasellsch Chir 1893;22:66.
[4] Bruning P. Contribution e l’ètude des greffes adipue-
ses. Bull Acad R Med Belg 1914;28:440.
[5] Cotton FJ. Contribution to technique of fat grafts.
N Engl J Med 1934;211:1051 – 3.
[6] Czerny M. Plastischer Ersatz der brusterlruse durch ein
lipom. Verhandl d Deutscher Ges Chirurg 1895;2:216.
[7] Lexer E. Freie Fettransplantation. Deutsch Med Wo-
chenschr 1910;36:640.
[8] Peer LA. Loss of weight and volume in human fat
grafts. Plast Reconstr Surg 1950;5:217.
[9] Peer LA. The neglected free fat graft. Plast Reconstr
Surg 1956;18:233.
[10] Peer LA. Transplantation of tissues, transplantation of
fat. Baltimore: Williams & Wilkins; 1959.
[11] Straatsma CR, Peer LA. Repair of postauricular fistula
by means of a free fat graft. Arch Otolaryngol 1932;
15:620 – 1.
[12] Tuffier T. Abces gangreneux du pouman ouvert dans
les bronches: hemoptysies repètee operation par de-
collement pleuro-parietal; guerison. Bull Mem Soc
Chir Paris 1911;37:134.
[13] Willi CH. The face and its improvement by aesthetic
plastic surgery. London: MacDonald & Evans; 1926.
p. 15 – 41.
[14] Fischer G. The evolution of liposculpture. American
Journal of Cosmetic Surgery 1997;14:231 – 9.
[15] Bircoll M. Autologous fat transplantation. The Asian
Congress of Plastic Surgery. February, 1982.
[16] Bircoll MJ. New frontiers in suction lipectomy. Second
Asian Congress of Plastic Surgery. Pattiyua, Thailand,
February, 1984.
[17] Fischer G. First surgical treatment for modeling body’s
cellulite with three 5 mm incisions. Bulletin Interna-
tional Academy of Cosmetic Surgery 1976;2:35 – 7.
[18] Fischer A, Fischer G. Revised technique for cellulitis
fat reduction in riding breeches deformity. Bull Int
Acad Cosm Surg 1977;2:40 – 3.
[19] Illouz YG. The fat cell ‘‘graft’’: a new technique to fill
depressions. Plast Reconstr Surg 1986;78:122 – 3.
[20] Johnson GW. Body contouring by macroinjection of
autologous fat. American Journal of Cosmetic Surgery
1987;4:103 – 9.
[21] Krulig E. Lipoinjection. American Journal of Cosmetic
Surgery 1987;4:123 – 9.
[22] Newman J, Levin J. Facial lipo-transplant surgery.
 M.A. Shiffman, M.V. Kaminski / Facial Plast Surg Clin N Am 10 (2002) 191–198
American Journal of Cosmetic Surgery 1987;4:
131 – 40.
[23] ASPRS Ad-Hoc Committee on New Procedures. Report
on autologous fat transplantation, September 30, 1987.
[24] Ellenbogen R. Free autogenous pearl fat grafts in the
face—a preliminary report of a rediscovered technique.
Ann Plast Surg 1986;16:179 – 94.
[25] Newman J. Preliminary report on ‘‘fat recycling’’—
liposuction fat transfer for facial defects. American
Journal of Cosmetic Surgery 1986;3:67 – 9.
[26] Hiragun A, Sato M, Mitsui H. Establishment of a clo-
nal line that differentiated into adipose cells in vitro. In
Vitro 1980;16:685.
[27] Sidman RL. The direct effect of insulin on organ cul-
tures of brown fat. Anat Rec 1956;124:723.
[28] Chajchir A, Benzaquen I, Moretti E. Comparative ex-
perimental study of autologous adipose tissue proc-
essed by different techniques. Aesthetic Plast Surg
1993;17:113 – 5.
[29] Asken S. Autologous fat transplantation: micro and
macro techniques. Am J Cosm Surg 1987;4:111 – 21.
[30] Fulton JE, Suarez M, Silverton K, et al. Small volume
fat transfer. Dermatol Surg 1998;24:857 – 65.
[31] Guyton AC. Capillary dynamics and exchange of fluid
between the blood and interstitial fluid. In: Guyton AC,
editor. Textbook of medical physiology. 7th edition.
Philadelphia: W.B. Saunders; 1986. p. 348.
[32] Civetta J. A new look at the Starling equation. Crit
Care Med 1979;7:84 – 91.
[33] Kaminski M, Haase T. Use of albumin in total paren-
teral nutrition solutions: understanding Starling’s law
and the resolution of hypo-oncotic edema. In: Van Way
C, editor. Handbook of surgical nutrition. Philadephia:
J.B. Lippincott; 1992. p. 272 – 82.
[34] Agris J. Autologous fat transplantation: a 3-year study.
American Journal of Cosmetic Surgery 1987;4:95 – 102.
[35] Asaadi M, Haramis HT. Successful autologous fat in-
jection at 5-year follow-up. Plast Reconstr Surg 1993;
91:755 – 6.
[36] Niechajev I, Sevchuk O. Long-term results of fat trans-
plantation: clinical and histologic studies. Plast Re-
constr Surg 1994;94:496 – 506.
[37] Berdeguer P. Five years of experience using fat for leg
contouring. Am J Cosm Surg 1995;12:221 – 9.
[38] Kaminski Jr MV, Fulton JE, Wolosewick JJ. New con-
sideration in fat transfer: a possible role for maintaining
interstitial protein to reduce shrinkage of transferred
volume. In: Shiffman MA, editor. Autologous fat
transplantation. New York: Marcel Dekker; 2000.
p. 299 – 309.
[39] Shiffman MA. Effect of various methods of fat harvest-
ing and reinjection. Journal of Aesthetic Dermatologic
and Cosmetic Surgery 2000;1:231 – 5.
Further Readings
Bames HO. Augmentation mammoplasty by lipotransplant.
Plast Reconstr Surg 1953;11:404.
197
Billings E Jr, May JW. Historical review and present status
of free fat graft autotransplantation in plastic and reconstruc-
tive surgery. Plast Reconstr Surg 1989;83:368 – 81.
Bircoll M. Autologous fat transplantation: an evaluation of
microcalcification and fat cell survivability following (AFT)
cosmetic breast augmentation. Am J Cosm Surg 1988;5:
283 – 8.
Brandow K, Newman J. Facial multilayered micro lipoaug-
mentation. International Journal of Aesthetic and Restorative
Surgery 1996;4:95 – 110.
Campbell GLM, Laudenslager N, Newman J. The effect of
mechanical stress on adipocyte morphology and metabo-
lism. American Journal of Cosmetic Surgery 1987;4:89 – 94.
Carpaneda CA, Ribeiro MT. Percentage of graft viability
versus injected volume in adipose autotransplants. Aesthetic
Plast Surg 1994;18:17 – 9.
Carpaneda CA, Ribeiro MT. Study of the histologic alter-
ations and viability of the adipose graft in humans. Aesthetic
Plast Surg 1993;17:43 – 7.
Coleman S. Long-term survival of fat transplants: controlled
demonstrations. Aesthetic Plast Surg 1995;19:421 – 5.
Courtiss EH. Surgical correction of postliposuction contour
irregularities. Plast Reconstr Surg 1994;94:137 – 8.
Courtiss EH, Choucair RJ, Donelan MB. Large-volume suc-
tion lipectomy: an analysis of 108 patients. Plast Reconstr
Surg 1992;89:1068 – 79.
Davis CB. Free transplantation of the omentum, subcutane-
ously and within the abdomen. JAMA 1917;68:705 – 6.
Eppley BL, Sidner RA, Plastis JM, et al. Bioactivation of
free-fat transfers: a potential new approach to improving
graft survival. Plast Reconstr Surg 1992;90:1022 – 30.
Ersek RA. Transplantation of purified autologous fat: a
3-year follow-up disappointing. Plast Reconstr Surg 1991;
87:219 – 27.
Fagrell D, Enerstrom S, Berggren A, et al. Fat cylinder
transplantation: an experimental comparative study of three
different kinds of fat transplants. Plast Reconstr Surg 1996;
98:90 – 6.
Fulton Jr. JE. Breast contouring by autologous fat transfer.
American Journal of Cosmetic Surgery 1992;9:273 – 9.
Green JR. Repairing bone defects in cranium and tibia.
South Med J 1947;40:289.
Guerney CE. Experimental study of the behavior of free fat
transplants. Surgery 1938;3:679 – 92.
198 M.A. Shiffman, M.V. Kaminski / Facial Plast Surg Clin N Am 10 (2002) 191–198
Hansberger FX. Quantitative studies on the development of
autotransplants of immature adipose tissue of rats. Anat Rec
1995;122:507.
Hilse A. Histologische ergebuisse der experimentellen freien
fettgewebstronsplantation. Beitr 2 Path Anal U Z Allg Path
1928;79:592 – 624.
Hudson DA, Lambert EV, Block CE. Site selection for fat
autotransplantation: some observations. Aesthetic Plast Surg
1990;14:195 – 7.
Illouz Y-G. Fat injection: a four-year clinical trial. In: Hetter
GP, editor. Lipoplasty: the theory and practice of blunt suc-
tion lipectomy. 2nd edition. Boston: Little, Brown & Co;
1990. p. 239 – 46.
Illouz Y-G. New applications of liposuction. In: Illouz Y-G,
editor. Liposuction: the Franco-American experience. Bev-
erly Hills (CA): Medical Aesthetics; 1985. p. 365 – 414.
Jones JK, Lyles ME. The viability of human adipocytes after
closed-syringe liposuction harvest. American Journal of
Cosmetic Surgery 1997;14:275 – 9.
Kanavel AR. The transplantation of free flaps of fat. Surg
Gynecol Obstet 1916;23:163 – 76.
Kononas TC, Bucky LP, Hurley C, et al. The fate of suc-
tioned and surgically removed fat after reimplantation for
soft-tissue augmentation: a volume and histologic study in
the rabbit. Plast Reconstr Surg 1993;91:763 – 8.
Lexer E. Fatty tissue transplantation. In: Die transplantation,
part I. Stuttgart: Ferdinand Enke; 1919. p. 265 – 302.
Lexer E. Ueber freie fettransplantation. Klinische Therape
Wechenschrift 1911;18:53.
Mann FC. The transplantation of fat in the peritoneal cavity.
Surg Clin North Am 1921;1:1465 – 71.
Markman B. Anatomy and physiology of adipose tissue.
Clin Plast Surg 1989;16:235.
Neuhof H. The transplantation of tissues. New York: Apple-
ton & Co; 1923. p. 74.
View publication stats
Nguyen A, Pasyk KA, Bouvier TN, et al. Comparative study
of survival of autologous adipose tissue taken and trans-
planted by different techniques. Plast Reconstr Surg 1990;
85:378 – 86.
Samdal F, Skolleborg KC, Berthelsen N. The effect of pre-
operative needle abrasion of the recipient on survival of
autologous free fat grafts in rats. Scan J Reconstr Hand Surg
1992;26:33 – 6.
Sattler G, Sommer B. Liporecycling: immediate and de-
layed. American Journal of Cosmetic Surgery 1997;14:
311 – 6.
Saunders MC, Keller JT, Dunsker SB, et al. Survival of
autologous fat grafts in humans and mice. Connect Tissue
Res 1981;8:85.
Schorcher F. Fettgewebsver pflanzung bei zu kneiner. Brust
Munchen Medizin Wochenschrif 1957;99:489.
Toledo L. Syringe liposculpture: a two-year experience.
Aesthetic Plast Surg 1991;15:321 – 6.
Ullmann Y, Hyams M, Ramon Y, et al. Enhancing the sur-
vival of aspirated human fat injected into mice. Plast Re-
constr Surg 1998;101:1940 – 4.
Van RLR, Roncari DAK. Complete differentiation of adipo-
cyte precursors: a culture system for studying the cellular
nature of adipose tissue. Cell Tissue Res 1978;195:317.
Van RLR, Roncari DAK. Complete differentiation in vivo of
implanted cultured adipocyte precursors from adult rats. Cell
Tissue Res 1982;225:557.
Verderame P. Ueber fettransplantation bei adharenten kno-
chennarben am orbitalrand. Klinische Monatsblatter Fur Au-
genheil Kunde (Stuttgart) 1909;47:433 – 42.
Wertheimer E, Shapiro B. The physiology of adipose tissue.
Physiol Rev 1948;28:451.
Zocchi M. Produccion y utilizacion de Colegeno Autologo
para el remodelaje facial. II Congreso Chileno de Cirugia
Plastica, 1991.