Injection with one's own fat tissue remains controversial due to a lack of objective data pertaining to postoperative volume control. Facial defects in a total of 53 patients were repaired using autogenous fat tissue. The fatty tissue was obtained from the lower abdomen, buttocks, or inner portion of the upper thigh and then suspended before injection in a solution of 250 ml Ringer's solution, 50 ml distilled water, and 0.7 ml hyaluronidase. The fatty tissue was collected by a filter integrated within the suction system and subsequently prepared, as follows: (1) Cell detritus, blood constituents, and local anesthetic were flushed away by using a physiological Ringer's solution. (2) The defects were filled by using a finely calibrated, locked injection, whereby the desired amount of fatty tissue could be accurately instilled. (3) Injection was carefully performed directly under the cutis through a large lumen cannula and under close observation to avoid the injection of any fatty tissue intracutaneously. Before the procedure, the augmented areas had been evaluated by using magnetic resonance imaging (in T1-weighted images). Postoperatively, the sites were once again documented for volume at control intervals of 6 days, and 3, 6, 9, and 12 months. The volumes were computer-calculated integrally from the sum of the area of all the layers according to the following formula:v = (d + g).E(ai). Despite the use of hyaluronidase as well as an atraumatic liposuction technique, microscopic examination revealed 40% of the aspirated cells to have defective cell membranes. Without hyaluronidase, this figure rose to 50%. One-year follow-up in 10 patients showed that through the break-down of these damaged cells, a particularly high volume loss of 49% was documentable at 3 months after the procedure. Further follow-up at 6 months showed that average volume decline had risen to a total of 55%, whereas, at 9 months as well as 12 months, no further loss could be detected. Autogenous fat transplantation after liposuction is a procedure only suitable for the repair of small, soft-tissue defects, especially of the face. The individual deposits should not be any larger than 1 ml, whereby intact fat cells are guaranteed sufficient diffusion up to the point of neovascularization. It is essential that the fatty tissue injection be exactly administered subcutaneously. Together with basic clinical observation, magnetic resonance imaging provides an objective evaluation of volume loss with an average error of only 5%.
