Written by: Dr Nerina Wilkinson – MBChB (Stell), FCS Plast (SA)

A youthful face is a face with beautiful soft curves created by perfectly placed volume and a radiant skin. To therefore achieve a totally rejuvenating effect it is of utmost importance to correct both volume and skin quality. I see so many patients who have undergone a technically beautiful facelift, however if the volume and skin quality has not been addressed, I believe we have failed these patients in in delivering a refreshed, youthful result.

 

The Adipolaser technique is therefore one of my top procedures in delivering a scar-less facelift that rejuvenates and regenerates the facial tissues, achieving the most natural results.  This procedure utilizes 4 techniques that work in synergy in one surgical session i.e. Fat grafts, ADSC (adipose derived stem cells) in the form of Nano fat, PRP (platelet rich plasma) and CO2RE Fractional Co2 laser resurfacing.

 

Who would be the ideal candidate?

This procedure is ideal for patients who have started to notice the signs of aging i.e. deflation, hollowness and sagging of the face as well as the typical skin quality changes resulting in fine lines, irregular pigmentation and loss of elasticity. The rich regenerative capacity of the stem cells makes this procedure ideal for any patient who wants to “slow down” the aging process.

In my practice therefore I would advise this procedure to my patients who are requesting facial fillers, however who require more extensive volume replacement and skin tightening to achieve a more youthful appearance.

 

How is the procedure performed?

Unlike a normal facelift, in which the flaccid skin is excised to create an artificial firmness, a Adipolaser lift  is performed solely by injection and laser.  The procedure is performed under local anesthetic in the day clinic. The procedure involves  firstly harvesting fat from a part of the body with abundant fat deposits using a Tulip Tonnard  2,4mm cannula The fat is then centrifuged at 1000 rpm for 2 minutes ,  purified and divided into fat grafts and nanofat. The fat grafts are precisely injected  into the deeper layers of the face to improve the contours and create an uplifting effect.  The nanofat Also known as micro-fat grafting is a refined process of fat grafting where the fat cells are specifically emulsified using Tulip Nano Transfer Membrane . The nanofat is therefore used in very delicate areas ie periorbital, perioral  and fine lines. The nanofat is layered very superficially under the skin harnessing the potential of the rich stemcells to improve quality of the skin.

As stem cells are natures way to regenerate  new cells in targeted areas, the results are noticeable in a firmer and more youthful appearance of the face. The skin becomes more taut and plumper which improves over months to years.

The final step in the procedure is the Co2Re factional laser .

Essentially, the upper layers of the skin are vaporized, removing the superficial skin layers. This direct photo-thermal and photo-biostimulation effect therefore removes the dull  upper layers of the skin , stimulates new collagen and enhances the survival of the fat injections. This leaves the targeted area of skin feeling tighter and looking rejuvenated.

 

What is the recovery?

Patients are therefore more swollen and bruised than they would be if they underwent the simpler liquid facelift. It is a fairly invasive procedure with 7 days downtime required afterwards. The advantage is that the results are more permanent and the stem cells in the fat have regenerative potential. CO2RE is therefore indicated for patients looking for a once off treatment to improve their skin rather than multiple less invasive skin rejuvenating treatment

 

How is the fat survival improved by the CO2 laser resurfacing?

There has been a growing interest in regenerative medicine over the past few years.

The advantages of ADSC in the plastic surgery field has been demonstrated in many studies with scar remodeling, healing chronic wounds and skin regeneration

However following the Adipolaser technique the regenerative tissue improvements are increased resulting in greater tissue remodeling and fat cell survival.

 

What is the mechanism of laser activation on cultured cells?

This is explained in a recent study published in 2017 (Lasers Med Sci: 32:117-127) In vitro fractional CO2 laser applied to human ADSC (Adipocyte derived stem cells) The results were significant increases in  the cell viability /proliferation compared to controls. The study explained that through bio-photo-stimlation the CO2 laser stimulates the mitochondria which by activation of Redox pathways increases cell proliferation and enhances a significant cell secretion of VEGF, MMP2 and MMP9, The increased VEGF are functional in  inducing angiogenesis and therefore improved blood supply to the transferred fat. Whereas the MMp2 and MMP9 assists in tissue remodeling.

Additionally Fractional lasers create numerous microscopic thermal injury zones that induce the growth of cells following the release of FGF (fibroblast growth factor) and  EGF (epidermal growth factor)

Similar results are shown in a study of Fractional laser assisted hair growth. Visibly enhanced hair growth i.e. Hair follicle neogenisis / hair follicle regeneration secondary to CO2 Laser wounding and Growth factors has been demonstrated.

 

Regenerative medicine is an exciting field with the potential to change our conventional surgical approaches in facial rejuvenation. Beautification naturally is the future, and therefore the significant results of Adipolaser non-surgical facelift is becoming my gold standard procedure in my practice.