Managing the Soft Tissue Envelope in Facial Feminization Surgery: Filling and Tightening Surgical Approaches

Abstract

It could also be combined with harvested fat, passed 10 times with a 1.2-mm Micronizer, and injected with a 1-mm blunt cannula with good clinical results. We continue to assess the need for further procedures based on resorption rates.The PRP preparation protocol requires the use of an anticoagulant, which has an important effect because acid-citrate-dextrose has a low pH, which may be detrimental to platelet concentrates and some patients have an allergic reaction to the citrate. Furthermore, acidcitrate-dextrose may add antiangiogenic, antiregenerative, and proinflammatory properties to PRP. 4 PRF continuously releases large amounts of growth factors, such as platelet-derived growth factor and vascular endothelial growth factor, for up to 28 days. The growth factors are related to revascularization and anti-inflammation that promote survival of the fat graft and subsequent incorporation into the recipient site. 5 These aspects make it a promising choice to promote fat graft survival in cosmetic and reconstructive procedures. We found that, by using the Micronizer to liquefy PRF, we were able to easily inject it alone into the tissue with optimal postoperative aesthetics.PRF has been shown to have better long-term release of growth factors compared with PRP but is more difficult to inject because of its denser state on preparation. However, PRF can be injected by liquefying it with a Micronizer or can be injected with fat grafts to improve survival. This procedure offers promising aesthetic and healing results because of the prolonged growth factor release that can stimulate cell proliferation. Additional research regarding the PRF injection technique and outcomes are warranted.