The Facial Autologous Muscular Injection (FAMI) Procedure: An Anatomically Targeted Deep Multiplane Autologous Fat-Grafting Technique Using Principles of Facial Fat Injection

Abstract

As widely described in the medical literature, facial fat grafting has been limited to the subcutaneous plane, with only vague reference to the muscular plane and deeper tissues. Local infiltration, with or without general anesthesia, is commonly used. The challenges of maintaining volumetric correction, symmetry, and predictability have limited practitioners' confidence in obtaining a desirable result when fat grafting the face. The authors describe a technique for facial fat grafting that targets specific anatomic structures and tissue beds, in effect making the patient's underlying anatomy the template for rejuvenation. Engrafting the muscles of facial expression improves graft retention and therefore predictability and symmetry. The ability to target anatomic structures other than muscle lends itself to the prospect of greater therapeutic advances using adipose-derived stem cells (ADSCs). A set of principles guiding the technique intended to promote successful cellular engraftment is presented. Three illustrative cases are presented, each the result of a single session: two from a 10-year experience of 700 patients by the lead author and one by the corresponding author. The majority of cases (80-90%) needed only a single session for creation of permanent improvement in facial volumes and contours. The facial autologous muscular injection (FAMI) technique offers an anatomically based approach to facial fat grafting with greater predictability and efficiency than current techniques. The principles of the technique put forth apply equally to volumetric enhancements obtained through successful fat grafting and to the promise of ADSCs.