Oo. Erol, Facial autologous soft-tissue contouring by adjunction of tissue cocktail injection (micrograft and minigraft mixture of dermis, fascia, and fat), PLAS R SURG, 106(6), 2000, pp. 1375-1387
Facial aging is both a physiologic and anatomic process characterized by ch
anges in the skin and supporting tissues. The aging process produces an out
er envelope that gradually expands while its contents gradually involute an
d the underlying structure weakens. This process results in an excess of sk
in that tends to create folds, grooves, and deepening furrows.
Contour augmentation and filling depressions with autologous tissue or hete
rogeneous materials are widely used in face rejuvenation as an adjunctive p
rocedure. There is unanimous agreement on the advantages of autogenous tiss
ue grafts over alloplastic materials and heterogeneous transplants. It is a
lso well known that the revascularization of a small graft (fat, dermis, an
d/or composite graft) is better than a large graft. For this reason, fat in
jections consisting of small particles have recently become popular. Accord
ing to different authors, a graft take may vary from 30 to 50 percent. Neve
rtheless, it has been thoroughly documented that a graft consisting of derm
is or fascia is superior to a fat graft in both the graft take rate and qua
lity of the tissue. Strips of dermal graft have been used successfully for
several years to fill lip contour and nasolabial folds. However, the main d
isadvantage of this technique is that utilization is restricted only to cer
tain areas where there is a need for a small incision. To overcome this obs
tacle, the author developed a simple technique to obtain an injectable mass
from a mixture of dermis, muscle strips, fat tissue, and fascia to use in
body contouring (especially in the facial region) in large areas.
The author describes the use of the technique in 450 patients. Follow-up in
these patients from 6 months to 10 years showed that the application of th
e "tissue cocktail" procedure in select patients improved the author's resu
lts and created a marked increase in the number of satisfied patients with
no complaints. The take and durability of this kind of graft were superior
to the author's results using fat grafts. The tissue cocktail graft remaine
d stable for several years, as effectively seen in the chin region. The sol
e complication from the procedure was some bruising, which was resolved in
several days. No single infection or inclusion cyst was observed in this se
ries.