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Correction of severe facial contour abnormalities still is a challenge to plastic surgeons. The aim of plastic surgical treatments is to restore a harmonious and symmetrical appearance. Some of the entities that cause this abnormalities include: Parry Romberg syndrome, lupus, Melkerson Rosenthal syndrome, Morphea, trauma’s sequel, embolization sequel, trauma, hemifacial microsomy, etc. (Gutierrez “ et al”. 2007,2009). The free fat graft has been used since 1889, with the open ceiling technique, in 1893 Neuber recommended the use of fat grafts size lesser than an almond (Neuber 1893).In 1910 Lexer start the use of fat graft in aesthetic surgery and in 1925 reports the first case of facial contour reconstruction in a patient with Parry Romberg syndrome.(Lexer 1910) Peer reports lost of fat tissue as much as 50% (Peer 1950,1956) later it was used the fat obtained by liposuction ; absorption of the graft was the main problem and several different procedures have been described to minimize this phenomenon .Illouz in 1990 demonstrated that 80% of the injected fat graft was resorbed (Illouz 1990) .In 1994 it started the “ atraumatic purified” technique preconized by Coleman. Being the last one the one with better results in preserving volume because of a more viability of the adipose tissue and long lasting results. He recommends to avoid chopping, washing, manipulation, freezing, high negative pressure during extraction with a vacuum or high positive pressure during placement. Exposure to dry air will cause fat to desiccate rapidly.(Coleman 1995,1997,2002). Fat grafts collected by liposuction can be subcutaneously reinjected for correction of depressed or irregular areas. The live fat tissue is revascularized at the transplantation site within 48 hours,during which time it is fed by diffused materials from plasma. Explantation of adipose tissue as performed during the procedure of autologous fat transfer confers stress to preadipocytes and adipocytes. Disruption of blood supply during fat harvesting may result in hipoxia and apoptosis of the heterogeneous population of cells present in adipose tissue. Preadipocytes play an important role in soft tissue augmentation, because these adipocyte precursor cells have a higher survival rate under ischemic conditions than mature adipocytes and even have the ability to proliferate and differentiate into mature adipocytes. (Asken 1990;Guerrerosantos “et al”. 1996; Latoni “et al”.2000;Rieck & Schlaak 2003; Sadick &

Liposuction and Fat Graft to Enhance Facial Contour in Reconstructive Surgery - Nine Years Experience with the use of Peridural Cannula