Lip and perioral enhancement by direct intramuscular fat autografting.

Extensive fat resorption when injected subcutaneously was proven a long time ago, as well as central fat necrosis when injected in bulk. On the other hand, direct intramuscular fat injections in the form of 1- to 2-mm threads allow good revascularization and thus proper taking of the graft with minimal resorption. Following that principle, a 2-year follow-up showed less than 20% resorption in our cases. Adipose tissue was obtained by superficial syringe liposuction from the lower abdomen or subgluteal region, or from facial subdermal collections, and then gently cleansed from the blood and local anesthetics with large quantities of a warm physiological solution. Using a strong injector with 1.5- to 2-mm blunt cannulas, the fat was injected during withdrawal in the form of very thin threads directly into the orbicular muscle to correct thin lips. To correct a bony appearance of the face, larger quantities of fat, up to 15 ml, were injected into the buccinator and zygomaticus muscles, while 5-7 ml was injected into the conjunction of the orbicularis oris, depressor anguli oris, and risorius muscles in order to elevate the corners of the mouth.