Joris van Dongen

11 General introduction and outline of the thesis GENERAL INTRODUCTION History of lipofilling Transplantation of adipose tissue was first described by Gustav Neuber in 1893. 1 Neuber successfully used resected fat grafts to fill depressed scars in the face and noted that only small fat grafts were suitable. 1 In those days, fat grafts were only used to restore loss of volume of soft tissue defects as a result of trauma or congenital defects. In 1910, Lexer was the first to use fat grafts aesthetically to correct wrinkles and fill the infraorbital area. 2 Two years later, Holländer and Veriag von Velt treated two cases of facial lipoatrophy with fat grafts to improve the natural appearance of the face. 3 In 1919, Brunning introduced syringes to transplant fragmented adipose tissue and thus no incision was needed on the recipient site. 4 It took several years before syringes were used to harvest adipose tissue by means of liposuction. In 1926, Miller published about infiltration of fat grafts through cannulas to corrects scars in the head and neck region. 5 Yet, the early ancestor of the modern liposuction technique with a blunt hollow cannula were Arpad and Giorgio Fischer in 1975. 6 Their liposuction technique was, however, rather invasive and traumatic for patients. 6 Two years later, Ilyouz modified the liposuction technique introduced by Arpad and Giorgio Fischer and created the foundation of modern liposuction technique. 7 He used tumescent infiltration fluid prior to liposuction to create a less invasive and traumatic procedure. Liposuction was then performed through a 0.5 to 1 cm incision with a blunt rounded tip cannula in 1,326 patients. Several other plastic surgeons followed Ilyouz’s example of tumescent liposuction; some with small modifications. 8-11 In contrast, Fournier and Otteni proposed a dry liposuction technique i.e. without tumescent infiltration. Adipose tissue obtained by dry liposuction showed histological comparable results with tumescent liposuction but was less time-consuming. 10 On the other hand, tumescent liposuction showed less anaemia, but more seroma in comparison with dry liposuction. 12 Further instrumental improvement was made by Toledo in 1988 by presenting disposable syringes with different sizes for harvesting adipose tissue. 13 A great advantage of disposable syringes for aspiration of adipose tissue is the reduced risk of contamination or biofilms to grow. 14 A year later a new technique of injection of adipose tissue, called lipofilling, was shown by Fournier. 15 However, liposuction and subsequently lipofilling did not develop very fast in the early and mid-twentieth century mainly due to large variability in results. The inconsistent results were caused by a high variety in volume retention due to donor variations and direct use of unprocessed lipoaspirate mixed with infiltration fluid as well as over-injection of target sites limiting graft survival. At that time, fat grafting was also hampered by legislation issues from the food and drug administration (FDA) because it was considered unclear whether lipofilling would e.g.