A Combined Approach for Fast Nanofat Microneedling

Abstract

Background: Lipofilling is currently a fundamental component of rhytidoplasty and fat harvesting has become a common procedure. Tonnard introduced the concept of nanofat grafting, a revolutionary milestone, in which adipocytes are mechanically separated from the stromal vascular fraction and the latter is injected, adding the possibility of cellular therapies to the surgical field. Later, Verpaele et al. published a report using a new device to apply this nanofat in a uniform manner, which they termed nanofat needling. The device has 24 microneedles of 1.5 mm length and is applied as a stamp, in a tapping motion. The same manufacturer offers a similar model with 64 microneedles, 1.0 mm length, and available as a roller.

Objectives: We sought to evaluate the combination of the above-mentioned microneedling devices to achieve faster nanofat delivery.

Materials and methods: A prospective evaluation of patients undergoing a combined nanofat microneedling approach for skin rejuvenation and scar revision, using both a stamp device as well as a roller, was performed in a private practice setting, from January 2019 to January 2020. Patient satisfaction, complications, and surgical time were evaluated.

Results: We applied this combination treatment to over 100 treatment areas in 86 patients over a 12-month period, with a short operative time, no increase in complications, consistent results, and good patient satisfaction.

Conclusions: We recommend the use of this new device in association with the original one, in order to decrease the procedure time. We designate this strategy "fast nanofat microneedling."

Keywords: Collagen induction; facial rejuvenation; fat grafting; microneedling; nanofat.

Figure 1

Flow chart—nanofat preparation

Figure 2

Preoperative (A,C) and 1 year postoperative views of a 58-year-old female who underwent fast nanofat microneedling in association with face- and necklift. Improvement in skin pigmentation and texture, as well as improvement of fine rhytides, are noted

Figure 3

(A) Preoperative and (B) postoperative images of a 44-year-old female who underwent fast nanofat microneedling as a standalone procedure. Improvement in fine rhytides and pigmentation, especially in the infraorbital area, can be noted

Figure 4

(A,C) Preoperative and (B,D) 1 year postoperative images of a 73-year-old female who underwent face and necklift as well as fast nanofat microneedling. Close-up views show improvement of the perioral and chin regions, with decreased fine rhytides and pigmentation (this area medially to the nasolabial folds is not undermined or otherwise treated by facelift)

Figure 5

(A) Preoperative and (B) 14-month postoperative views of fast nanofat microneedling performed to the dorsal hands of a 68-year-old female demonstrating improvement in skin quality and turgor. No structural (volumetric) fat grafting was performed

Figure 6

Décolletage area of a 54-year-old Caucasian woman who underwent facelift, necklift with medial platysmaplasty and fast nanofat needling. (A) Preoperative; (B) 12-month postoperative, showing improvement in skin texture and fine rhytides

Figure 7

Décolletage area of a 47-year-old Caucasian woman who underwent fast nanofat needling. She did not undergo additional facial or neck procedures. (A) Preoperative view demonstrating loss of elasticity when pinching the skin; (B) view at end of procedure, with the goal of diffuse pinpoint bleeding; (C) postoperative view at 14 months showing improvement of elasticity, with decreased fine rhytides on skin pinch