Facelifts must reconstruct the facial contour, rejuvenate the eye region, smooth the lines and wrinkles caused by repeated facial expressions, and improve tissue quality.

To do this, we capitalize on the regenerative quality of adipose tissue. Fat cells include stem cells and the stromal vascular fraction.

We aspirate the fat at low pressure with the help of a syringe and a multi-perforated minicannula. Once the fat is obtained, we wash it with Ringer’s lactate solution. This washed fat, called microfat, can be injected through a microcannula. If injected with a needle the procedure is termed SNIF (which stands for single needle injection fat), which was first described in our book on liposculpture:  Liposucción en Cirugia Plástica y Estética. ED. Salvat). If we transfer this fat 30 times between two syringes it becomes liquefied and forms an emulsion. This technique, which we invented, is used to fill very superficial structures and to improve skin quality by mesoplasty. Other authors filter this fat and call it nanofat, but the collagen fibers, which are very useful to fill the microgrooves, are lost in this process.

The Negative Vector: dark circles and cheeks
When there is malar atrophy and the lower eyelid is very long, with noticeably dark circles and a marked flattening of the facial contour, this phenomenon is called the facial negative vector. It may be congenital or may be caused by aging.

After the completion of a thorough anamnesis we perform blepharoplasty if required and then treat the dark circles and the tear trough with fat emulsion injected via microcannula. We then perform malar lipofilling with microfat injected with crossed tunnels in the malar region with a volume of 7.12 cc on each side using a 1.6mm cannula.

Frown lines
Frown lines can give a bad-tempered appearance. This effect in the corrugator and procerus muscles may have many causes, many of them related to sight. The treatment (botulinum toxin injection, either via endoscopic resection or via the upper eyelid) inhibits the contraction of these muscles and fills the wrinkles. We use fat emulsion injected into the dermis with a micro-needle and subdermal SNIF.

Temporal region
Sometimes the temporal region may appear sunken, due to atrophy. We perform the filling with criss-cross injections of microfat.

Tail of the eyebrow
Sometimes we inject SNIF in the outer third of the eyebrows, to the side of the supraorbital vessels and nerves and above the orbital rim, in order to raise the eyebrow.

The upper lip grows longer with age; the vermilion border loses volume and the columns of philtrum become flat.

At the Institute we avoid excessive filling of the lips. To rejuvenate the upper lip we use SNIF subdermally to enhance Cupid's bow. We then inject SNIF intramuscularly to reconstruct the two pillars of the philtrum that have become flattened with age.

In the lower lip we also enhance the mucocutaneous line in the middle.

If the patient has vertical lines, we fill them with subdermal SNIF. If they are very marked we prefer to perform pre-treatment with laser or dermabrasion.

Nasolabial folds
The descent of the cheeks causes lateral depressions called nasolabial folds. We perform longitudinal SNIF to provide filling and subdermal/transversal SNIF to halt the formation of the fold.

Marionette lines
Marionette lines may appear to the side of the corners of the lower lip. We treat these lines in the same way as the nasolabial folds, using longitudinal SNIF for the filling and subdermal/transversal SNIF to prevent the appearance of new lines.

Sometimes we create ascending tension columns in the malar and temporal regions to rejuvenate the skin with dermal microinjections of fat emulsion, due to the action of the stem cells and the stromal vascular fraction present in adipose tissue. We can also add platelets stimulated with CLCA ++ or vitamins.

These facial rejuvenation techniques are very useful because they improve the quality of aged facial tissues. They can be used in association with surgery, but the surgical procedures must be conservative and must not involve extensive detachments that affect the viability of the grafts. We have described these techniques in more detail in the "Atlas of the Minimally Invasive Facelift: Facial Rejuvenation with Volumetric Lipofilling. Serra-Mestre, J.Mª., Serra-Renom, J.Mª. Ed. Springer-Verlag ".