Learning

The innovative procedures in which this method is used are illustrated in the section Adipofilling of the CRPUB.ORG Medical Video Journal, ISSN 1971-8152.
You can observe the operations as if you were beside the operating table.
The FAQ and the answers help you to extend your knowledge of the various techniques.

Training Programme

In this session, you can take part in the live surgery meetings that are organized and attend the theory courses.

Survival of the adipocytes in Adipofilling®

Alberto Cavalchini
Two theories have been put forward with regard to the outcome of traditional autologous fat transplants. The first holds that the adipocytes gradually die and are replaced by histiocytes, which phagocytize the cellular residues, sometimes leading to the formation of cystic micro-cavities and fibrotic septa. The second acknowledges that the grafted fat has the ability to survive in the long term.
Damage to the implanted lobules results in the lysis of adipocytes, with the release of fatty acids and glycerol; these can alter the local osmotic equilibrium and facilitate the onset of edema; this in turn worsens septal capillary perfusion, which has already been altered by the mechanical trauma of transplantation.
Damage to the microcirculation may constitute the prime cause of fibrosis, which has been histologically documented in recent publications concerning biopsy samples taken in the months following localized autologous fat implantation. This fibrosis is the most important aspect, together with the progressive shrinkage of the implanted fat and reduction in the mechanical quality of grafts of autologous adipose lobules implanted by means of traditional procedures. This outcome is in line with the experimental evidence published by José Guerrerosantos, Gonzalez Mendoza et al. back in 1996. These authors showed that the increase in the volume of single autologous fat grafts, even if implanted below the deep subcutaneous fascia, caused both damage to the adipocytes in the central portions of the grafts, on account of the distance from the capillary bed, and ischemia of the capillary bed itself, owing to the compression exerted by the fat.
By contrast, Adipofilling® seems to avoid these drawbacks both macroscopically and microscopically. Indeed, histological images of soft tissue samples previously implanted by means of the new Adipofilling® technique clearly reveal the vitality of the adipocytes, whether single or grouped into units.

References
Latoni J. D., Deirdre M. M. and Wolfe S. A. Overgrowth of fat autotransplanted for correction of localized steroid induced atrophy. Plast. Reconstr. Surg. 106: 1566-1569, 1999.
Guerrerosantos J., Gonzalez Mendoza A., Masmela Y. Long-term survival of free fat grafts in muscle: an experimental study in rats. Aesth. Plast. Surg. 20:403-408, 1996.

Adipofilling® and cellular trophism

Pietro Morini
From the histological and histochemical standpoint, aging of the subcutaneous tissues involves a regressive biotrophic process. This is manifested by: the diminished contiguity of the adipocyte membranes, the aggregation of poorly perfused cells, greater fibrohistopoiesis in response to stress factors, a network of rarefied capillaries, frequent stasis of fluids in the extracellular matrix, but especially by the expansion of the interstitial spaces between one cell and the next. Hypofunctioning is an expression of an empty structure, or rather, one that is bereft of the cellular elements that regulate its primitive function: the adipocytes. In Adipofilling, the adipose tissue obtained through liposuction, or surgically, is transformed into cellular tissue: vital adipocytes, stromal cells and connective material. When the material obtained from the procedure is injected, it appears initially to be palpable to the touch in the same way as a non-absorbable material. After a few minutes of delicate massaging, however, the cellular and connective elements are incorporated into the connective network, and help to increase the volume of the area. Once that happens, the sensation of hard edema caused by the injection disappears. As the Adipofilling penetrates and is integrated into the stroma, the subcutaneous tissue regains its normal consistency within a short time, despite the increased volume. The difference between Adipofilling’s cellular graft and the lobular graft of lipofilling seems to concern the relationship of the injected material with the connective stroma; in the former, the adipocytes are integrated into the stroma, while in the latter, they displace it. The vascular and trophic implications are obvious.