String Fat/Dermis Graft for Correction of Wrinkles and Scars.

Established creases and wrinkles do not predictably respond to the fat injection technique. We describe a minimally invasive, yet simple technique to address recalcitrant facial rhytids and minor depressed scars. This technique optimally requires a concomitant procedure whereby suitable fat or dermis graft could be available for grafting without having to make another incision. However, if needed, the graft can be harvested from an area such as post-auricular sulcus where the incisional scar is successfully concealed. Preferably dermis or a combination of fat and dermis is harvested in the form of strings using a pair of straight Iris scissors. The sharp end of an 18-gauge needle is then used to create a tunnel is in the subcutaneous plane beneath each line while releasing any fibrous bands. The string of dermis/fat is then engaged at the end of the 18-gauge needle and delivered into the subcutaneous tunnel with rotation and advancement of the needle. We have used this graft on 49 sites on 39 patients. Mean age was 57.6, with 8 male and 31 female patients. The sites included rhytids in upper and lower lips, oral commissure, labial mental groove, frown lines, and scars in the forehead, nasal dorsum, nasal tip, and eyebrows. String fat graft is a simple and reliable method to address limited rhytids or depressed scars.