Alexis Verpaele

Nanofat grafting: basic research and clinical applications.

Background: The indications for fat grafting are increasing steadily. In microfat grafting, thin injection cannulas are used. The authors describe their experience of fat injection with even thinner injection needles up to 27 gauge. The fat used for this purpose is processed into “nanofat.” Clinical applications are described. Preliminary results of a study, set up to determine the cellular contents of nanofat, are presented. Methods: Nanofat grafting was performed in 67 cases to correct superficial rhytides, scars, and dark lower eyelids. Three clinical cases are described. In the research study, three fat samples were analyzed. The first sample was a classic lipoaspirate (macrofat). The second sample was microfat, harvested with a multiport small-hole cannula. The third was microfat processed into nanofat. Processing consisted of emulsification and filtering of the lipoaspirate. Fat samples were analyzed for adipocyte viability. Cells from the stromal vascular fraction and the CD34+ subfraction were quantified. The stem cell quality was investigated by culturing the cells in standard and adipogenic media. Results: No viable adipocytes were observed in the nanofat sample. Adipose-derived stem cells were still richly present in the nanofat sample. Cell cultures showed an equal proliferation and differentiation capacity of the stem cells from the three samples. Clinical applications showed remarkable improvements in skin quality 6 months postoperatively. No infections, fat cysts, granulomas, or other unwanted side effects were observed. Conclusions: Nanofat injections might become a new concept in the lipofilling area. In clinical situations, nanofat seems to be suitable for skin rejuvenation purposes.

The versatility of the pudendal thigh fasciocutaneous flap used as an island flap.

The pudendal thigh flap is a sensate fasciocutaneous flap based on the terminal branches of the superficial perineal artery, which is a continuation of the internal pudendal artery. Several authors have reported using this axial patterned flap in a bilateral fashion to reconstruct the vagina, mostly in patients with vaginal atresia. The technique is simple, safe, and reliable, and no stents or dilators are required. The reconstructed vagina has a natural angle and is sensate. The donor site in the groin can be closed primarily with an inconspicuous scar. The distinct advantages of this flap widen its indications to several other pathologies. In this article, the authors report on the bilateral use of the flap to reconstruct a vagina in patients with congenital atresia (n = 8) and after oncological resection (n = 5). Furthermore, the versatility of this island flap is also demonstrated by its use in a unilateral fashion in patients with recurrent or complex rectovaginal fistulas (n = 4) and in two patients with a defect of the posterior urethra in a heavily scarred perineum. All 31 pudendal thigh flaps survived completely. Some wound dehiscence was observed in two patients. Two other patients required a minor correction at the introitus of the vagina. The functional outcome was excellent in all patients, despite the presence of some hair growth in the flaps. This article discusses the expanding indications of this versatile flap and the refinements in operative technique. (Plast. Reconstr. Surg. 107: 719, 2001.)

The MACS-lift short scar rhytidectomy.

The minimal access cranial suspension (MACS) lift, a short scar face lift for the lower and middle third of the face, uses a pure vertical vector, involves no lateral tension, and may be performed with the patient under local anesthesia in 2 to 2.5 hours. According to the authors, the procedure reduces recovery time and morbidity, and results are as stable as more classic, extended face lift techniques.

Optimising Results from Minimal Access Cranial Suspension Lifting (MACS-Lift)

Between November 1999 and February 2005, 450 minimal access cranial suspension (MACS) lifts were performed. Starting with the idea of suspension for sagging soft tissues using permanent purse-string sutures, a new comprehensive approach to facial rejuvenation was developed in which the vertical vector appeared to be essential. The neck is corrected by extended submental liposuction and strong vertical traction on the lateral part of the platysma by means of a first vertical purse-string suture. The volume of the jowls and the cheeks is repositioned in a cranial direction with a second, slightly oblique purse-string suture. The descent of the midface is corrected by suspending the malar fat pad in a nearly vertical direction. In 23 cases (5.1%), the result in the neck was unsatisfactory, and additional work had to be done secondarily, or in later cases, primarily. The problem that appeared was unsatisfactory correction of platysmal bands (resolved with an additional anterior cervicoplasty) or vertical skin folds that appeared in the infralobular region (corrected with an additional posterior cervicoplasty). This article describes two ancillary procedures that, although not frequently necessary, can optimise the result of MACS lifting.

300 MACS-lift short scar rhytidectomies: analysis of results and complications

Between November 1999 and April 2004, 300 MACS-lifts (Minimal Access Cranial Suspension–lifts) were performed. Starting from the idea of suspension of sagged soft tissues with permanent purse-string sutures, a new comprehensive approach to facial rejuvenation was developed, in which the vertical vector appeared to be essential.The neck is corrected by extended submental liposuction and strong vertical traction on the lateral part of the platysma by means of a first vertical purse-string suture. The volume of the jowls and the cheeks is repositioned in a cranial direction with a second, slightly-oblique purse-string suture. The descent of the midface is corrected by suspending the malar fat pad in a nearly vertical direction.The skin excess generated by these actions is redraped in a pure vertical direction and excised at the temporal hairline and the paracanthal region. As no horizontal pull on the skin is exerted, a retro-auricular incision becomes obsolete. The result is a pure antigravitational lifting procedure, which produces a natural facial rejuvenation through a short scar.