10. Eliminating lip wrinkles with intradermal cellular Adipofilling
KEYWORDS: lip wrinkles, eliminate lip wrinkles, intradermal Adipofilling, mixed timedsurgical peeling, adipose and stromal cells, regenerative medicine
Lip wrinkles are a common esthetic problem. The techniques that we use in order to eliminate or reduce them are timedsurgical mixed peeling and intradermal Adipofilling.
In Adipofilling, liposuction is carried out through a cannula of 3 or 4 mm in diameter. As always, we use mepivacaine to anesthetize the area from which the fat is taken. Once aspiration is complete, the small entry incision is sutured and the area of liposuction is massaged with iodovinylpyrrolidone.
The upper lip is anesthetized with 2% mepivacaine with epinephrine. The loco-regional anesthesia is carried out through the vestibular mucosa.
The lobular fat is washed with Ringer lactate solution or physiological solution in a beaker equipped with a tap, until the washing liquid becomes clear. The washed lipoaspirate is fragmented by means of the Adipopimer. The aspiration vortex created by this disposable device separates the lobules; small lobular fragments are first produced, then, after 20 seconds, single living adipocytes and stromal cells. The operator checks the granulometry of the suspension by examining the wall of the beaker, where a thin uniform layer of cells can be seen.
The cellular suspension is placed in 20 mL Luer Lock syringes equipped with caps. The syringes are centrifuged at 400 rpm for 4 minutes. After centrifugation, the operator eliminates the fragmentation liquid. The adipose and stromal cells are placed in a beaker in order to be remixed. During centrifugation, most of the stromal cells, which are heavier than the adipocytes and lighter than the fragmentation liquid, form a thin white layer immediately above the saline solution. The operator gently shakes the beaker in order to redistribute the stromal cells. The cellular suspension is poured into a 20 mL syringe. A connecting tube is attached and a 1 mL Luer Lock syringe is filled.
The living adipose and stromal cells are injected into the dermis of the vertical wrinkles, preferably with a 21 G needle. This needle is sufficiently rigid to be inserted with precision inside the wrinkle. . Once the cellular suspension has been injected into the vertical wrinkles, it is injected into the dermis of the entire lip and into the vermilion border. The needle is inserted laterally. The injection must whiten the dermis. The cellular suspension is injected into the dermis of the entire surface of the lip and along both sides of the nasal filter.
The result is visible after a few weeks. The fact that the Adipofilling suspension can be conserved in a 1 ml syringe at temperatures from -20°C to -30°C means that further small adjustments can subsequently be made, if necessary.
Capurro S. (2019): Eliminating lip wrinkles with intradermal cellular Adipofilling. Adipofilling section. www.crpub.org
What is the difference between using timedsurgical mixed peeling and intradermal Adipofilling to eliminate lip wrinkles?
Timedsurgical mixed peeling is a standardized physico-chemical technique that involves timedsurgical de-epithelialization and the application of a saturated solution of resorcin for about 2 minutes. The resorcin acts on all the geometric points of the de-epithelialized surface, and is extremely efficacious. Subsequently, a crust forms, which remains in place for 1 to 2 weeks. When the crust drops off, the treated area remains slightly reddened for a few months.
By contrast, intradermal Adipofilling is a very simple biological technique. The living adipose and stromal cells that are injected into the dermis exert a potent regenerative action without increasing the volume. If injected beneath the skin of the lip, the suspension elicits a controlled increase in the thickness of the lip, thereby correcting the atrophic appearance typical of the elderly person's lip. The results of intradermal cellular Adipofilling are already visible after three weeks.
When conserved in 1 mL syringes, the Adipofilling suspension can later be used to correct any areas where the result is incomplete. In conclusion, Adipofilling yields much more rapid results. Timedsurgical mixed peeling is more efficacious but more invasive, nor does it have the volume-enhancing effect that the Adipofilling suspension elicits when injected beneath the dermis.
How is it that the Adipofilling suspension can be conserved at the low temperatures of a normal freezer? The whole world is looking for a cryo-preserver of fat...
The Adipopimer, the economical disposable device (Korpo srl), causes resonance of the biological material, which acquires the property of not freezing; for this reason, it can be conserved at low temperatures for long periods.
How long can the Adipofilling suspension be conserved at -31°C?
We have never exceeded one year, but we think it is possible to do so.
Why do your massage the area where liposuction has been carried out?
To redistribute the small fragments of fat that remain the subcutaneous tissue and to render the surface of the area uniform.