Platelet-rich fibrin during facial lipostructure

The filling of tissue for facial rejuvenation can be challenging. The aim is to restore harmonious volumetric facial ratios by regaining the contours of cheekbones, drooping jaw lines and nasolobial folds. Adipocyte grafts can return the skin to a state of brightness and to a volume that deteriorates gradually during ageing. To ensure that a tissue graft remains stable, it must be integrated into the receiver site. This integration has to—as for all living tissue—take place in the form of a matrix and a tissue fusion. Fat grafts have always had difficulties in inducing the necessary neoangiogenesis, which subsequently had significant resorption. Non-reabsorbable, exogenic material such as silicone was introduced as early as the 1950s but was suspended years later owing to harmful effects (migration, granulomas). Hyaluronic acid fillers and other formulations are popular but absorb quickly and large volumes present cost issues. The adipocyte graft technique, described by the American plastic surgeon Sydney Coleman, deals with the problem of resorption. The fat tissue that is grafted is centrifuged before re-injection, meaning it can be sufficiently broken apart without damaging the adipocytes to stimulate the neosynthesis of an extracellular matrix and to facilitate the colonisation of the graft by endothelial cells. This centrifugation stimulates the preadipocytes, cells allowing the reconstruction of the grafted tissue. Like the Latin expression: destruam et aedificabo—“I destroy and I build up”—Dr Coleman’s technique requires decomposition of preexistent tissue to allow its in situ reconstruction. Growth-inducing agents to improve the sustainability of adipocyte grafts have never really been developed. The graft-