Want a natural face lift? Amazing facial rejuvenation technique using your own body fat!

What is Nanofat Microneedling?

Nanofat microneedling provides a non-surgical facelift by way of rejuvenating the face using your own existing body fat. 

As we age our face loses volume through a combination of fat, bone, tissue reduction as well as the slowing down of collagen and elastin production. 

This causes the facial skin to loosen, sag, wrinkle and appear aged. 

Our lifestyle also affects our skin tone and texture - skin damage from the sun, smoking, air pollution, dehydration, etc. as well as natural lines and blemishes, or scarring are all common examples. 

The nanofat microneedling procedure is a natural way to reverse these ageing effects and leave the skin looking younger and healthier. 

What is nanofat? 

Nanofat is a processed form of our natural body fat which is loaded with healing and regenerative properties. 

Regular fat is removed from the body and undergoes a treatment process to reduce the size of the fat cells without losing any of its incredible natural attributes. 

Nanofat, an almost liquified version of our body fat, contains stem cells and growth factors as well as elastin and collagen to help restore skin health and appear more youthful. 

How does nanofat microneedling work?

The first step in the procedure is to remove fat from a specified area of the body. This will require a site, that has sufficient unwanted fat, undergoing extraction by way of liposuction. 

The fat that is removed from this region will then be processed at the clinic (it is liquified and filtered on site) and converted into nanofat. The nanofat is then injected in small amounts directly into the facial skin, this process is also known as fat grafting, fat transfer, or lipotransfer, and encourages the stem cells and growth factors within the fat to stimulate new growth within the dermis. 

Once injected by way of microneedling, the nanofat continues to rejuvenate the skin as collagen production is also induced using this procedure - over the next few months the face becomes fuller, less lined and withdrawn, and takes on an overall more youthful, smooth appearance. 

Pigmentation spots, scars, dark circles, blemishes, sun spots and wrinkles are all reduced using the nanofat technique as the skin tone and texture takes on an improved, rejuvenated look. 

What is microneedling?

A microneedling pen is a device which contains hundreds of tiny needles equipped with tiny microchannels that provide ways for nanofat to be pumped directly into the dermis (layers of the skin). 

Is nanofat microneedling safe? 

Facial lipotransfer procedures have a very low complication rate and a very high satisfaction rate with our patients in Marbella and Madrid. Facial fat transfer can be performed either as an isolated procedure or in combination with other facial procedures such as eyelid lift, browlift frontal lift, chin augmentation with implants or rhinoplasty.

How do Ocean Clinic assess their nanofat microneedling patients? 

Pre-operative considerations include a thorough evaluation of your facial anatomy and bone structure including the possible recommendation of complementary or alternative procedures, e.g. facelift. Our surgeons advice (regarding the combination of techniques), your understanding of the 3 dimensional ageing process and our enthusiasm for the best possible results are paramount in obtaining long-lasting, natural results.

Watch this explanatory video for a summary of the nanofat microneedling procedure. 

Interested in nanofat microneedling? Speak to one of our surgeons at Ocean Clinic Marbella and discover your rejuvenation options! 

Anti-aging is a three-dimensional process, Dr. Kai Kaye and Dr. Gabriela Casabona discuss

To achieve optimal results from fat grafting for facial rejuvenation, three-dimensional ageing must be considered…

When the face begins to lose both bony and soft tissue this leaves the skin with less ‘bulk’ and leads towards a more concave facial contour with reduced projection and sagging skin. The folds either side of the nose (nasolabial folds) deepen, grooves form in the mid-cheek area and the face begins to take on an older, more tired appearance. 

Facial rejuvenation by way of fat grafting is widely used, either alone or in combination with other techniques. Many techniques have developed for optimisation of fat grafting facial rejuvenation working on the multiple layers of fat compartments; both superficial and deep fat. The way in which individual face is contoured depends on these fat compartments which alter over the course of the ageing process. Everyone ages differently, though there are patterns, but analysis of the unique facial changes should be carried out to prevent a generic outcome from the rejuvenation procedure. 

 

Figure 1 (A) Temples Before, (B) after. Injected with microfat, intramuscular and prefascial , 12 cc per side

This article outlines Dr. Kai Kaye & Dr. Gabriela Casabona’s algorithmic, area-based approach which takes the type of fat, layers needing restoration, and overall desired effect or patient expectations into account. The approach encompasses six main areas of treatment:

Area 1: Temples

Deflation of the temples (one of the first areas to age), due to a loss of volume in the fat compartments, leads the brow and the lateral region of the face to lower as well as develop a hollow appearance to the temples themselves. 

Our goal is to restore volume, to re-contour the affected area, as well as restore projection and provide support to the outer brow and cheek. 

To achieve rejuvenation of the skin we apply the following;

• Type of fat: microfat and nanofat
• Layer injected: micro fat to the deep layer of the posterior temple (behind hairline), the deep compartments and intramuscular in the anterior temple. Nanofat to the superficial compartments.
• Aesthetic effect: lifting and revolumising of the lateral brow, lifting of the lower lateral temple/lateral orbital region.

Area 2: Midface/malar (cheek - side of the head)

Deflation of the midface/malar areas occurs quite early in the ageing process. Volume loss, in combination with the progressive loss of bony support by the inferior orbital rim, leads quickly to a lack of support of the lower eyelid. Often even young patients complain about having a ‘tired’ look. Revolumizing the periocular fat pad and restoring support for the lower eyelid is one of the main goals, as well as recontouring of the zygomatic bone to augment projection and achieve lifting to the lateral face.

• Type of fat: microfat
• Layer injected: deep compartments of the anterior & lateral cheek, and periocular fat pad. 
• Aesthetic effect: better contour of the cheek/malar and smooth transition into the lower face, less sunken and deflated lower eyelid with revolumization to give a more ‘rested’ look.

Area 3: Mandible/gonial angle

The mandibles not only define the framework of a masculine look in men but also provide strut-like tension support for the overlying facial skin in both sexes. An under-projecting mandible reduces this support and leads to the early formation of jowls. This loss of projection can begin in either sex as early as age 25, therefore it is considered as a preventative anti-aging procedure from this time. 

 

Figure 2 (A) Perioral before, and (B) after. SNIF intradermal nanofat injection perioral 5 cc total, microfat upper/lower lips 2 ml each, 2 cc marionette fold, 3 cc nasolabial groove per side

• Type of fat: microfat
• Layer injected: deep to on top of the bone.
• Aesthetic effect: improved jaw definition and contour. Better posterior projection of the gonial angle and anterior projection of chin to augment projection of the mandible, thus enhancing the cervicomental angle of the neck, and providing a lifting effect to the anterior neck.

Area 4: Brow/Periorbital

The brow and periorbital area form an aesthetic unit that should be addressed simultaneously, as their visual connection defines the frame of any beautiful eye.

Progressive descent of the brow caused by forehead skin laxity, in combination with deflation of the ROOF, during the ageing process leads to a heavy upper-eyelid and patients often complain about looking ‘sad’. Atrophy of the superficial portion of the area underlying the lid crease leads to an augmentation of visible upper eyelid height (doll eye effect). Age-related atrophy of the periocular fat pad augments the visible lower lid length and deepens the lid-cheek junction, and subsequent exposure of the underlying structures like fat compartments and canthal ligaments results in the skeletonization of the infraorbital area.

Revoluminisation of lateral eyebrow fullness and reprojection of the eyebrow shape are key goals when treating this area; as well as the reduction of upper-lid height, correction of lower lid skeletonization, and treatment of dark circles.

• Type of fat: microfat and nanofat
• Layer injected: brow and deep forehead layers; microfat on the periosteum, upper eyelid, microfat in lid crease area and nanofat in the superficial upper eyelid crease. Lower eyelid; microfat under the orbicularis oculi muscle and nanofat over the orbicularis oculi to achieve dermal rejuvenation via an SVF effect.
• Aesthetic effect: better contour of the brow, restoration of lateral fullness with brow elevation, correction of the skeletonisation effect, eyelid height, lid/cheek junction and dark circles.

Area 5: Perioral/lips

In much the same way as the periorbital area should not be addressed separately from the brow; the perioral area forms an equally strong aesthetic unit with the lips. Structures like the philtrum, the white roll and the vermillion support the lip and define its youthful shape.

 

Figure 3 (A) Panfacial before, and (B) after. Microfat chin 7 cc total, mandibular 8 cc, gonial angle 6 cc, upper/lower lips 2 cc each, philtrum/supraoral 6 cc, malar 6 cc ,infraorbital 2 cc, lat brow 2 cc, temples 6 cc per side

From the mid-twenties onwards the maxillary bone begins to lose projection. With further advance of the ageing process, the deep sub-muscular fat compartments also lose volume resulting in a loss of support for the anatomic structures mentioned above.

The lip becomes straighter, losing the cupid bow shape, and becomes inverted. In cases with severe deflation and loss of volume in the subcutaneous layer, the patient often complains about the ‘bar code’ lines on the upper lip. The restoration of support and recreation of a youthful shape is the principal goal in this area, as well as conservative volume restoration and correction of dermal wrinkles.

• Type of fat: microfat and nanofat
• Layer injected: micro fat to the perioral/philtrum deep compartments and intramuscular lips. Nanofat to the white roll, upper lip superficial sub-dermal layers.
• Aesthetic effect: better contour of the lip and proportions, lip eversion, smoother skin and reduced wrinkles around the mouth.

Area 6: Piriformis fossa/nasolabial/deep cheeks

The nasolabial fold (the creases running from either side of the nose to the lips) was one of the first regions for volume restoration with injectable fillers.

 

Figure 4 (A) Panfacial transgender before, and (B) after. Microfat forehead 7 cc, chin 4 cc total, mandibular 10 cc, upper/lower lips 2 cc each, philtrum/supraoral 4 cc, malar 8 cc ,infraorbital 3 cc, lat brow 4 cc, temples 8 cc per side

At the time, the anatomy of the deep and superficial fat compartments of the face was not yet fully explored, and so treatments with injectables concentrated on linear filling along this fold. The formation of this fold and its subsequent deepening during the ageing process is the result of a loss of soft tissue volume and bone projection not only along the line itself, but in all adjacent areas. It should, therefore, all be treated as a unit. 

The widening of the piriform fossa (part of the pharynx area) due to bone resorption of the maxillae (bone either side of, above and below the nose) leads to an inwards rotation and depression of the soft tissues on both sides of the nose, as well as a loss of support of the upper lip and nasal base. Subsequently, the support to the lateral deep cheek compartments is diminished, leading to the deflation of the deep cheek fat compartments and a downwards/inwards sagging cheek, thus further enhancing the development of the fold.

Patients often complain of a ‘sad’ or ‘aged’ look, and the goal in this area is the restoration of a smooth transition between the cheek and the perioral area.

• Type of fat: microfat
• Layer injected: piriform fossa, deep cheek fat compartments periosteal - deep, spina nasalis/philtrum periosteal/ submuscular under orbicularis oris
• Aesthetic effect: Smooth transition between perioral area and cheek with volumization. Re-projection and eversion of the lip with correction of gummy smile, plus enhanced support of the nasal base.

 

Figure 5 (A) Cheek/malar before, and (B) after. Microfat forehead 10 cc, mandibular 5cc, chin 4 cc, upper/lower lips 2 cc each, philtrum/supraoral 4 cc, malar 6 cc, infraorbital 3 cc, lateral brow 2 cc, temples 8 cc per side

Application / Safety 

As the success of any fat grafting procedure depends on a variety of factors, especially on the careful handling and even distribution of the fat aliquots, the surgeon should gather enough experience with single zone, small volume approaches before performing large volume, pan-facial single treatments to avoid the multiplicator effect for complications.

 

Figure 6 (A) Periorbital before, and (B) after. Microfat, 4 cc infraorbital, 3 cc lateral brow

To avoid intravascular injections, the injection should be performed with a retrograde movement of the cannula, and the injector should avoid placing a degree of pressure on the plunger. Vascular anatomy should be visualised prior to injections, and injection pathways should be perpendicular to large vessels, not parallel, to minimise the possibility of vascular canulization. In areas with large diameter vessels at the surface, digital compression of the main vessel minimises flow and vessel diameter.

Conclusion

The overall goal of pan-facial rejuvenation using a combination of micro and nanofat in a holistic, anatomy-based approach is not only to restore a youthfully shaped face but also to create beauty through enhanced proportions and recreate the natural glow we find in younger skin, resulting in a true three-dimensional regeneration concept.

Figures 1–6 © Dr Kaye, Ocean Clinic, Marbella. 

References:

1. Hopping SB, Joshi AS, Tanna N, Janjanin S. Volumetric facelift: Evaluation of rhytidectomy with alloplastic augmentation. Ann Otol Rhinol Laryngol. 2010;119:174–180
2. Coleman SR. Facial augmentation with structural fat grafting. Clin Plast Surg. 2006;33:567–577
3. Xie Y, Zheng DN, Li QF, et al. An integrated fat grafting technique for cosmetic facial contouring. J Plast Reconstr Aesthet Surg. 2010;63:270–276.
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What are the Top Trends for men in plastic surgery for 2023?

Trends for men in plastic surgery for 2023

With advances in technology and technique as well as the continuous surge in male grooming making the mainstream, men’s plastic surgery is still on the rise as we head for the final stretch of this quarter century. 

Men are far from being strangers to nipping and tucking and so when we looked at the predictions for 2023 it wasn’t surprising to discover that the most popular surgeries and procedures are still topping the list, as well as some less obvious treatments that are to be new trends for men this coming year. 

MALE LIPOSUCTION

Already one of the most popular male procedures, liposuction will most likely stay at the top spot as body contouring is high on the list for the majority of men seeking cosmetic surgery. The most popular regions for liposuction in men tends to be the ‘love handles’, lower abdomen and sides, as well as back, chest and shoulders. 

ABDOMINAL FAT GRAFTING

Following suit with the body sculpting prevalence, abdominal contouring is a popular short cut to getting a toned stomach. For men seeking the ‘six pack’ look, small pockets of fat are sculpted in the area where the abdominal muscles would project giving the appearance of muscle definition but actually using the existing fat from the body. The fat is removed via liposuction, treated and reintroduced in the designated areas.

MALE BREAST CORRECTION / GYNECOMASTEA

A common complaint in the male physique is that the chest area can have enlarged nipples or ‘breasts’ which give a feminine appearance. This can be due to the enlargement of glands under the skin in the nipple region, a very common occurrence in teenage boys going through puberty. Occasionally the glands do not correct themselves and this can prompt surgery in later years to remove the unwanted, swollen look. Similarly an excess of fat in the chest area can give a male chest a fuller appearance and the desire for a more masculine, smooth, toned pectoral area can be achieved with the removal of fat via surgery or liposuction, then sculpted (if required) using fat grafting techniques. 

FOREHEAD REDUCTION

Reducing the signs of a receding hairline in men can also reduce the signs of ageing. The height of the forehead being reduced gives the impression of a fuller head of hair and a more youthful look. The incisions are made along the hairline itself and excess skin removed. The scarring is minimal as it is disguised by the existing hairline. 

CHIN / JAW IMPLANTS

A prominent chin and well-defined jawline are traits which are associated with being handsome and masculine and so augmentation of the male jaw and chin are hugely popular treatments. Definition can be achieved non surgically using dermal fillers, however surgery is also a popular choice for a more dramatic and long lasting effect, usually a combination of both is preferred to achieve an overall desired look. Cosmetic chin enhancement for men may involve repositioning the chin, placing an implant over the bone of the chin, contouring the lower jaw, removing excess fat from the cheeks and neck, injecting dermal fillers to alter the proportions of the face, or any combination of the above. Chin and jaw enhancement is quite a tricky procedure and a qualified, experienced surgeon is absolutely necessary. The implant surgery and chin advancement procedures are complex due to the angular, bony situation they present. Fat grafting and fillers need to be placed accurately which takes knowledge, experience and an element of artistry. 

BROW LIFT

A heavy brow can cause the eyelids to sag and even hang over the upper eye, wrinkles and frown lines can create an unhappy, tired expression. A brow lift can correct this by removing excess skin the brow line is lifted and tightened, the forehead wrinkles are smoothed out, the upper eyelids are lifted and the overall facial look is more youthful. 

INJECTABLES

In the non-surgical department, men are becoming regular injectables patients, smoothing out wrinkles, and replacing lost volume with fillers. Also fillers in the penile department can also increase girth, and in some cases, even lengthen slightly. 

For more information on all our male procedures and treatments please contact us directly at Ocean Clinic Marbella for a consultation. 

What is the top cosmetic procedure to get during winter?

 The Top Cosmetic Procedure to get during Winter

The new year is a time of resolutions; getting healthy, fit and making positive changes to look and feel better are top of the to-do list for many people. This desire for a fresh start often includes cosmetic surgery or aesthetic procedures. We regularly

see a rise, or surge if you like, in people calling for consultations in the new year. It is a time for change and rejuvenation! One of the most popular treatments in the aesthetic department at this time of year is facial laser treatments. 

Laser Skin Resurfacing

Any aesthetic skin procedure involving lasers requires the patient to stay out of the sun as part of the post-treatment care, so the winter months are the best time of the year to undergo this type of approach to skin rejuvenation. Also, when the skin is not tanned this is a safer and more effective time to have laser treatment. Usually more than one session is required for optimum results and these appointments can be weeks apart so the longer the skin can remain out of the sun, the better. 

At Ocean Clinic we offer a range of laser-based treatments which, depending on the patient’s skin analysis may be used individually or as part of a combination, alongside treatments such as superficial peelings, or skinbooster / filler treatments.

• IPL (Limelight xeo® CUTERA) optimal to treat skin redness and pigment disorders.
• YAG long pulse (xeo® CUTERA) used to treat teleangectasias (spider veins) and small vessels.
• YAG micropulse (Genesis xeo® CUTERA) targets hyperpigmentation disorders and produces skin tightening by stimulation of collagen fibres.
• Non Ablative Fractionated Erbium Glass (Fraxel®) addresses pigment disorders, large pores, stretch marks and scars.
• Ablative RF (Venus Viva™) used for skin tightening, stimulation of collagen / elastin fibres and treatment of pigment disorders, stretch marks and scars.

When our skin begins to age there are tell-take signs such as sun spots, loss of collagen, loss of fat, enlarged pores, varying skin textures, hyper-pigmented areas, wrinkles, etc. The constant, rapid advances in new technologies means that the aesthetic market offers many options when it comes to IPL or laser treatments. With each individual case (skin type) being unique it is important to be able to offer the most effective treatments / combinations to suit that particular situation.  

At Ocean Clinic we believe that the treatment of each different layer of the skin is a vital pillar of a 3-dimensional skin rejuvenation process. We believe in a multi-level, multi-technology approach for our anti-ageing and skin rejuvenation treatments because there are multiple cellular structures at play in the ageing of the skin; melanocytes, vessels, immunologic cells and the famous elastic fibres of the skin - collagen and elastin; during any rejuvenation treatment we must be selective when treating such structures to ensure no damage is caused to other structures. 

Laser resurfacing has a significant impact on the skin and can leave you looking refreshed, rejuvenated and the skin tone smooth and more youthful, there are certain factors to consider in relation to recovery or post-treatment care. 

Before laser treatments the skin is treated with a topical anaesthetic numbing cream to avoid any discomfort and the procedure generally lasts between 30-40 minutes. Depending on the condition or severity of the case in question the number of sessions required to achieve the desired outcome is between 1-5. Patients are able to leave the same day, and depending on which treatment is administered recovery time is between 1-4 days. To return to work can vary between 1-7 days, again dependent on the individual situation. As mentioned sun exposure must be avoided as the skin will be far more sensitive and new layers exposed. A strict sun skin care routine must be implemented following laser treatment. Maintenance is between 3-6 months. 

The rate of complications with IPL / Laser treatments is very low with the right patient selection and when right conditions are addressed with the appropriate technology. In some patients skin preparation is needed before a treatment, especially in patients with darker skin or melasma. The aftercare is very important and each technology has specific recommendations that our team will explain to you.

For more information on the Laser / IPL treatments available at Ocean Clinic, please contact us directly.