Facial autologous soft-tissue contouring by adjunction of tissue cocktail injection (micrograft and minigraft mixture of dermis, fascia, and fat)

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.