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Dr. Prof. SUPRIYA KOKANE PATIL Cosmetic Surgeon Fellow (Facial Plastic Surgery) Professor(ORL MGM medical college) VASHI I PANVEL I BORIVALI I PUNE.

abstract. Neck Rejuvenation : Submental Liposuction.

This neck looks better on turkey ,isn’t it.

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Various methods of neck rejuvenation. Non surgical countouring : Polyamide threads Fillers Lipodissolve injections Surgical intervention: Tumescence face and neck liposuction Rhytidectomy Submentoplasty with playtsymoplasty Necklifts Combination techniques.

[image] Classification of cosmetic deformity of the neck Grade I normal cervicomental angle grade II mild grade III moderate grade IV severely oblique cervicomental angle 8.

Liposuction. Tumescent liposuction uses large volumes of dilute hypotonic solutions of vasoconstrictor agent that is gently injected into the subcutaneous fat and virtually eliminates surgical blood loss.

Submental region liposuction. SURGICAL TECHNIQUE Preoperative markings Tumescent infiltration (14 Gauge cannula) in subdermal plane 3 Stab incision- Submental and below the ear lobule Aspiration with 2-3 mm suction cannula Dressing and compression garment of face and neck.

Submental region liposuction. SURGICAL TECHNIQUE AND INSTRUMENTATION.

Complications Management. Immediate - noted up to 48 hours Conservative/ Symptomatic Pain Oozing Early - noted up to the first week Conservative/ Symptomatic Bruising, Ecchymosis, Swelling Late - noted up to six months Seroma Drained (1 to 3 sittings) Necrosis Debridement and secondary closure Persistent indurations with local rigidity Local ultrasonic massage Contour Irregularities.

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Case:. abstract. Before After.

AUTOLOGOUS FAT HARVESTING.

Why fat as fillers ? Readily available Natural Easy to harvest Inexpensive No immunological response so no rejection No donor site morbidity Not only to replace volume but also as tissue quality improver. No migration.

INDICATION. Facial Augmentation Rejuvenation Facial Contouring Facial Reshaping Facial atrophy and ageing Filling & smoothing wrinkles Restoration of the “fullness” of ageing face In complement to certain Neck & Face Lifts Effacement of the nasolabial folds Augmentation of the lips, malar region & cheeks Rhinoplasty, mentum rejuvenation.

INDICATION. Correction of depressions or fatty deficits due to Lipodystrophy syndromes and atrophic areas Post-liposuction depressions’ correction. Breast,Buttock Augmentation & Hand Rejuvenation. Augmentation of the paralyzed vocal cord Treatment of scars , ulcers, and burns.

process. Should be Thoroughly Planned. Amount of fat needed.

Harvesting sites: Ideal site Should be convenient for access & Enhance patient’s contour volume required at recipient site ,healing implications Most common: Abdomen – more viable fat cells with stem cell properties Gluteal region Medial thighs Others: Suprapubic area, anterior or lateral thighs, knees, lower back, hips, sacrum Buccal fat pad: if present good for face fat transplant.

General Cannulas Harvesting Cannulas. 2.00 mm Cannula.

Processing methods. Centrifugation. Sedimentation.

Processing & Refinement (cont’d). Separation techniques: Sedimentation (Force:1g) Centrifugation High speed 3000rpm for 3 minutes (Force:3-5g) Manual (Force:1-2g).

C_JSL_. Sedimentation. Least traumatic. Gravitation , decantation, any closed collection container..

Filtration. )111). Eliminate most contaminants and inflammatory components.

Centrifugation. Most widely used. Separates components by density to create layers that can be easily divided and transferred.

RECIPIENT SITE & ENGRAFTMENT. Small skin incision that corresponds to the diameter of the cannula being used.

Procedure: Stab incisions: 1-2 mm (No.11 blade) Cannula inserted & advanced: Into appropriate plane Injection of the fat: During withdrawal through the tissues Fat deposited as fractions of a milliliter, like peas in a pod Every next injection into a new plane / layer  Sequentially from deep to superficial layer multiple passes in a 3-D manner Injection volume per withdrawal Face: 0.1 ml Eyelids: 0.02 – 0.03 ml Breast: 1-2 ml.

Closed system aspirator and injection systems. Closed system aspirators allow for a consistent deposition of fat in 1–2 mm aliquots to avoid overcrowding and necrosis of infiltrated fat.

Graft survival. Nutritive plasmatic imbibition- 48 to 72 hrs Neovascularization of the graft occurs- 1 mm per day. The primary problem in autologous fat transfer is that of graft survival and volume retention postoperatively Preadipocytes and mature cells..

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Final results. Assessment at 3-6 months Many patients may need more than one treatment - usually 3-6 months after the first one The benefits of fat grafting can last anywhere from 3 months to 3 years, and probably more.

Complications. AESTHETIC Under correction Not enough material Resorption Over correction More difficult to solve Irregularities Asymmetry.

Fellowship in Rhinoplasty Fellowship in Hair Transplant Fellowship in Facial Cosmetic Surgery Contact :- Dr. Supriya Kokane Patil (Cosmetic Surgeon) 9653641750 / 9004350766 Professor [ORL] Mahatma Gandhi Medical College.

THANK YOU. Basic principles to be taken care…… • Be conservative • Should know where to stop • Never promise miraculous results after surgery • Beware of psychotic patients • Consent.