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

Background: 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. Methods: 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. Results: 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. Conclusions: 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.