The Evolution of Knifeless Microcolumn Fat Injection in 1362 Patients: Emphasizing Longevity of Results and Optimal Contour.

The field of regenerative surgery has been revolutionized by minimally invasive fat injection methods. Over the past decades, techniques have evolved significantly. However, concerns regarding long-term volume retention and creating the desired result remain a challenge for many surgeons. Our experience with 1362 patients has led to the development of a refined microfat injection technique that achieves durable facial contouring with a single treatment. Our method eliminates the need for overinjection, reducing the risks of contour irregularities and unpredictable fat resorption. The technique is knife-free, minimizing scarring and improving patient satisfaction. Meticulous preoperative planning is paramount. Targeted areas are drawn on the face and delineated in subunits. These recipient sites undergo preinjection with a vasoconstrictive agent, mirroring the planned fat volume. This allows intraoperative assessment and precise volume refinement. Fat is harvested, processed, and injected in microcolumns using blunt side-port cannulas ranging from 17 to 20 G cannulas, with each pass depositing 0.025 to 0.05 mL in a new vascularized plane. This systematic microcolumnar deposition of small threads of fat ensures uniform augmentation, optimal vascularization, and long-term volume preservation. This technique is particularly advantageous to delicate facial areas requiring high precision, including the upper eyelid sulcus, lower eyelid/lid-cheek junction, and creating refined chin definition with augmentation. By emphasizing a precise fat placement technique, we achieve natural, long-lasting results. This article presented the rationale, evolution, and technical details of our microfat injection approach, highlighting its special applications with safe, enhanced, and predictable outcomes in facial contouring.